UTVÄRDERING AV DEN KLINISKA FORSKNINGENS KVALITET VID DE LANDSTING SOM OMFATTAS AV ALF-AVTALET 41
INTRODUCTION
The
alf
agreement24 regulates the compensation from the Government to certain county councils for participating in medical education, clinical research and development of health services, i.e. “alf
fun-ding”. In 2015, the total amount of
alf
funding for clinical research was approximately 1 700 millionsek
. Regional agreements between the county councils and the universities providing medical edu-cation complement the nationalalf
agreement. In this report, the county council and the university are jointly referred to as an “alf
region” (Table 10).Table 10. The ALF regions, county councils and universities that are subject to the ALF agreement. Note that Region Örebro did not receive ALF funding before 2015.
ALF region County Council University Share of total ALF funding
for clinical research (2015)
Stockholm Stockholms county council Karolinska institutet 27 % Västra Götaland Region Västra Götaland University of Gothenburg 21 %
Skåne Region Skåne Lund University 20 %
Uppsala Region Uppsala Uppsala University 12 %
Västerbotten Västerbottens county council Umeå University 11 % Östergötland Region Östergötland Linköping University 8 %
Örebro Region Örebro county Örebro University 2 %
Evaluation of clinical research
The current
alf
agreement came into effect in 2015. One of the additions in the current agreement is a quality-based model for allocating a percentage of thealf
funding. This model entails that as from 2019, 20% of thealf
funding will be allocated based on the results of evaluation of the quality of the clinical research. The main purpose of the new allocation model and evaluation of the clinical resear-ch is to identify good examples ofalf
regions that may serve as role models for the otheralf
regions, in order to enhance the overall quality of clinical research in Sweden.The Government has therefore commissioned the Swedish Research Council to evaluate the quality of the clinical research conducted in the county councils that are subject to the
alf
agreement.25 The results of the evaluations will be used in the new model for allocatingalf
funding.According to the
alf
agreement, clinical research is defined as research that requires access to the structures and resources of the health services, and for which the aim is to solve a problem of ill health, or identify factors that lead to improved health.26 Clinical research in the county councils is conducted both by the county councils and the universities, and often in collaboration between the two. Thus, the evaluations include all clinical research conducted by both the county council and the university, jointly referred to as an “alf
region” (Table 10).The National
alf
Steering Committee has decided on the starting points for the evaluations.Accordingly, three international expert panels have been appointed to perform the evaluations of:
• the quality of the scientific output (
alf
panel 1)• the clinical significance and societal impact of the clinical research (
alf
panel 2)• the prerequisites for clinical research (
alf
panel 3).24 U2014/07551/F National ALF agreement
25 U2016/02935/F Uppdrag att utvärdera den kliniska forskningens vetenskapliga kvalitet. (Commission to evaluate the scientific quality of clinical research); U2016/04203/F Uppdrag att utvärdera den kliniska forskningens kvalitet avseende forskningens kliniska betydelse och samhällsnytta samt forskningens förutsättningar (Commission to evaluate the quality of clinical research in terms of clinical significance and social benefit, as well as prerequisites for research).
26 Section 7, National ALF agreement
According to the National
alf
Steering Committee, the results of the evaluations should be weighted, so that the results fromalf
panel 1 accounts for the distribution of 50% of the allocation pool, and the results fromalf
panels 2 and 3 account for the allocation of 25% of the allocation pool respec-tively. Each panel should provide an overall assessment and group eachalf
region into one of three categories.• Inferior quality
alf
regions are only expected to be placed in this category in exceptional cases. This category is used if the evaluation of the collected documentation indicates an inferior performance in relation to the share of allocatedalf
funding, and/or thealf
region in question has failed to fully contribu-te to the evaluation (for example by producing inferior/non-assessable self-evaluation or otherwise delivering incomplete data, etc.). Anyalf
region that ends up in this category will not be included in the panel’s allocation pool.• Good–high quality
A majority of the
alf
regions are expected to be placed in this category. This category is used if the evaluation of the collected documentation indicates a performance at a level that is to be expected based on the share of allocatedalf
funding. Thealf
regions in this category are guaranteed alloca-tion of funds from the panel’s allocaalloca-tion pool.• Very high quality
This category is used for the
alf
regions that have performed better than expected, based on the share of allocatedalf
funding. According to the Nationalalf
Steering Committee, this category should consist of the 1–3alf
regions that excel and set a national example within each panel’s area.These
alf
regions receive a premium of a larger share of the allocation pool than thealf
regionsplaced in category 2.
The three panel reports are summarised into a joint evaluation report by the Swedish Research Coun-cil, and delivered to the Government at the latest on 31 March 2018.
Each panel report begins with a description of the appointment of the panel and the evaluation process followed by the panel’s reflections and overall comments. The panel’s full assessments and justifications for each
alf
-region are found last in each panel report.UTVÄRDERING AV DEN KLINISKA FORSKNINGENS KVALITET VID DE LANDSTING SOM OMFATTAS AV ALF-AVTALET 43