Adoption Of New Medical Technologies Research Articles

Hospital Rurality and Gene Expression Profiling for Early-Stage Breast Cancer among Iowa Residents (2010-2018).

Objective Given the challenges rural cancer patients face in accessing cancer care as well as the slower diffusion and adoption of new medical technologies among rural providers, the aim of our study was to examine trends in gene expression profiling (GEP) testing and evaluate the association between hospital rurality and receipt of GEP testing. Methods Data from the Iowa Cancer Registry (ICR) were used to identify women with newly diagnosed, histologically confirmed breast cancer from 2010 through 2018 who met eligibility criteria for GEP testing. Patients were allocated to the hospitals where their most definitive surgical treatment was received, and Rural-Urban Commuting Area codes were used to categorize hospitals into urban (N = 43), large rural (N = 16), and small rural (N = 48). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to evaluate the association between hospital rurality and GEP test use, adjusting for demographic and clinical characteristics. The association between test result and treatment received was assessed among patients who received Oncotype DX (ODX) testing. Results Of 6,726 patients eligible for GEP test use, 46% (N = 3,069) underwent testing with 95% receiving ODX. While overall GEP testing rates increased over time from 42% between 2010 and 2012 to 51% between 2016 and 2018 (Ptrend < 0.0001), use continued to be the lowest among patients treated at hospitals in small rural areas. The odds of GEP testing remained significantly lower among patients treated at hospitals located in small rural areas (aOR 0.55; 95% CI 0.43–0.71), after adjusting for demographic and clinical characteristics. ODX recurrence scores were highly correlated with chemotherapy use across all strata of hospital rurality. Conclusions GEP testing continues to be underutilized, especially among those treated at small rural hospitals. Targeted interventions aimed at increasing rates of GEP testing to ensure the appropriate use of adjuvant chemotherapy may improve health outcomes and lower treatment-related costs.

“I'm not going to be a guinea pig:” Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA

BackgroundRacial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans’ adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans’ experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. Study DesignWorking with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. ResultsJust over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. ConclusionsBlack men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans’ history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency. ImplicationsWhile the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.

Adoption of new medical technologies: The effects of insurance coverage vs continuing medical education

Medical technologies innovate rapidly and responsively to patient needs, but the adoption of the latest technologies in practice can be delayed by lack of knowledge and ability to pay. Customized individually made (CIM) knee implants potentially provide an option for individuals to maintain moderate to high activity levels with fewer surgical revisions following a total knee replacement, however they are costlier upfront. Not only is the technology more expensive, but insurance typically covers around 50% (versus 90% for older off-the-shelf knee implants). We used a recent simulation model and analyzed the effects on overall adoption of CIM through 2026 and found that continuing medical education (CME)—a common intervention to increase the adoption of new medical technologies through increasing practitioner knowledge and comfort with the new technologies—can increase the adoption of CIM to 48% in the short term, but increasing insurance coverage to be equal to OTS knee replacement coverage increases the adoption to 87% in the sustained long term. Efforts to implement CME are well-placed and will increase the rate of adoption, however the combination of CME and increased insurance coverage provides the most benefit, with the technology reaching 80% of the population undergoing total knee replacement by 2021.

Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants

ObjectivesTo investigate the impact of insurance coverage on the adoption of customized individually made (CIM) knee implants and to compare patient outcomes and cost effectiveness of off-the-shelf and CIM implants. MethodsA system dynamics simulation model was developed to study adoption dynamics of CIM and meet the research objectives. The model reproduced the historical data on primary and revision knee replacement implants obtained from the literature and the Nationwide Inpatient Sample. Then the dynamics of adoption of CIM implants were simulated from 2018 to 2026. The rate of 90-day readmission, 3-year revision surgery, recovery period, time savings in operating rooms, and the associated cost within 3 years of primary knee replacement implants were used as performance metrics. ResultsThe simulation results indicate that by 2026, an adoption rate of 90% for CIM implants can reduce the number of readmissions and revision surgeries by 62% and 39%, respectively, and can save hospitals and surgeons 6% on procedure time and cut down cumulative healthcare costs by approximately $38 billion. ConclusionsCIM implants have the potential to deliver high-quality care while decreasing overall healthcare costs, but their adoption requires the expansion of current insurance coverage. This work presents the first systematic study to understand the dynamics of adoption of CIM knee implants and instrumentation. More broadly, the current modeling approach and systems thinking perspective could be used to consider the adoption of any emerging customized therapies for personalized medicine.

Physicians’ Decision Making on Adoption of New Technologies and Role of Coverage with Evidence Development: A Qualitative Study

ObjectivesTo foster value-based pricing and coverage with evidence development in Germany, certain new diagnostic and treatment methods have been subject to a benefit assessment since 2016 to determine their reimbursement. Although this is a paradigm shift, the German approach is limited to some few specific technologies for which reimbursement is requested. As physicians encounter this regulatory instrument, the aim of the study was to understand physicians’ decision making regarding the adoption of new medical technologies and to identify their perspectives on the evidence base and financing with additional reimbursement systems. MethodsFrom April to August 2017, semistructured interviews with chief and senior physicians of vascular surgery and cardiology in inpatient care in Germany were conducted (N = 23). The interviews were carried out by one researcher in one-to-one appointments or via telephone. Data were analyzed inductively to identify factors and generate thematic categories using qualitative content analysis. ResultsWe identified 52 factors in eight categories influencing physicians’ adoption of new technologies. The evidence base for new technologies was criticized (e.g., lack of available studies). Physicians’ knowledge of the regulation of market approval and innovation payments varied. They recommended the utilization of new technologies in certain specialist centers and the facilitation of observational studies. ConclusionsPhysicians saw the need for the new approach and supported its aim. However, its design and implementation appeared to be questionable from their medical perspective. The provision of summarized information on the benefit of technologies might be a possibility to assist physicians’ decision making.

Adopting new medical technologies in Russian hospitals: what causes inefficiency? (qualitative study).

The adoption of new medical technologies often generates losses in efficiency associated with the excess or insufficient acquisition of new equipment, an inappropriate choice (in terms of economic and clinical parameters) of medical equipment, and its poor use. Russia is a good example for exploring the problem of the ineffective adoption of new medical technologies due to the massive public investment in new equipment for medical institutions in 2006-2013. This study examines the procurement of new technologies in Russian hospitals to find the main causes of inefficiency. The research strategy was based on in-depth semistructured interviews with representatives of prominent actors (regional health care authorities, hospital executives, senior physicians). The main result is that inefficiencies arise from the contradiction between hospitals' and authorities' motivation for acquiring new technologies: hospitals tend to adopt technologies which bring benefits to their department heads and physicians and minimize maintenance and servicing costs, while the authorities' main concern is the initial cost of the technology.

The role of hospital payments in the adoption of new medical technologies: an international survey of current practice

This study examined the role of prospective payment systems in the adoption of new medical technologies across different countries. A literature review was conducted to provide background for the study and guide development of a survey instrument. The survey was disseminated to hospital payment systems experts in 15 jurisdictions. Fifty-one surveys were disseminated, with 34 returned. The surveys returned covered 14 of the 15 jurisdictions invited to participate. The majority (71%) of countries update the patient classification system and/or payment tariffs on an annual basis to try to account for new technologies. Use of short-term separate or supplementary payments for new technologies occurs in 79% of countries to ensure adequate funding and facilitate adoption. A minority (43%) of countries use evidence of therapeutic benefit and/or costs to determine or update payment tariffs, although it is somewhat more common in establishing short-term payments. The main barrier to using evidence is uncertain or unavailable clinical evidence. Almost three-fourths of respondents believed diagnosis-related group systems incentivize or deter technology adoption, depending on the particular circumstances. Improvements are needed, such as enhanced strategies for evidence generation and linking evidence of value to payments, national and international collaboration and training to improve existing practice, and flexible timelines for short-term payments. Importantly, additional research is needed to understand how different payment policies impact technology uptake as well as quality of care and costs.

Adopting New Medical Technologies in Russian Public Hospitals: What Causes Inefficiency?

The adoption of new medical technologies in Russian public hospitals is an important part of healthcare modernization and thus is a subject for public finance and regulation. Here we examine the decision-making process on adoption of new technologies in Russian hospitals, and the institutional environment in which they are made. We find that public hospitals operate within a strategic-institutional model of decision making and tend to adopt technologies that bring indirect benefits to their heads/physicians. Unlike Western clinics, the interests of Russian hospital heads and physicians are driven by the possibilities to obtain income from a part of hospital activities: the provision of chargeable medical services to the population, as well as receiving informal payments from patients. The specifically Russian feature of the decision-making process is that hospitals are strongly dependent on health authorities’ decisions about new equipment acquisition. The inefficiency problems arise from the contradiction between hospitals’ and authorities’ financial motivation for acquiring new technologies: hospitals tend to adopt technologies that bring benefits to their heads/physicians and minimize maintenance and servicing costs, while authorities’ main concern is initial cost of technology. The main reason for inefficiency of medical technology adoption arises from centralization of procurement of medical equipment for hospitals that creates the preconditions for rent-seeking behaviour of persons making such decisions.

Use of innovation payments to encourage the adoption of new medical technologies in the English NHS

ObjectivesThis study aimed to investigate the use of innovation payments in the English NHS. MethodsA structured on-line survey was developed to explore the use of innovation payments. The survey was disseminated to NHS hospital finance managers. A total of 20 surveys (n=20) were returned. ResultsThe majority (70%) of responding hospitals have applied for innovation payments. In one-third of cases, the payment was for medical devices, followed by drugs (31%), diagnostics (19%), and other technologies (15%). Innovation payments were generally requested because the existing HRG tariff did not reflect the cost of the technology. Processes for determining the payment varied across hospitals, with rates based on supporting evidence of the technology's benefits most common. While a good concept in principle, only about one-third of respondents believed innovation payments were effective in meeting their aims in practice. ConclusionsImprovements to the current approach to innovation payments are needed.

US nationwide trends in carotid revascularization: is there a clinical opportunity cost associated with the introduction of novel medical devices?

Nationwide practice patterns during the implementation of novel technology, such as carotid angioplasty and stenting (CAS) and embolic protection devices (EPD), and the clinical impact thereof have received less attention. The Nationwide Inpatient Sample, constituting a 20% representative sample of non-federal US hospitals, was analyzed from years 1998 to 2007. Hospital outcome was stratified into in-hospital mortality (IHM), long-term facility discharge, and home/ short-term facility discharge (HSF). Discharge outcome improved for CAS over the decade. However, this improvement occurred in two phases with a period of worsening (2003-2005) in between. During this transition period, the risk of IHM following CAS was increased (RR 1.29-2.43) and was lower for good outcome (HSF: RR 0.97-0.99) when compared with 2002/2003. During the same transition period, carotid endarterectomy (CEA) was associated with a lower risk of IHM (RR 0.75-1.00), but also a lower risk of HSF (RR 0.98-0.99). The results lead to the hypothesis that the nationwide introduction of CAS-EPD may have been associated with temporary increases in in-hospital mortality and discharge morbidity. If such 'clinical opportunity costs' exist with the widespread introduction and adoption of new medical technology with proven efficacy in randomized trials, effective mechanisms are needed for mitigation or prevention during the transition period.

As Health Care Spending Tops $2 Trillion, President Bush Proposes a Freeze for LTC

As Health Care Spending Tops $2 Trillion, President Bush Proposes a Freeze for LTC

Targeted Array CGH

Targeted Array CGH

Socioeconomic Differences in the Adoption of New Medical Technologies.

New medical technologies hold tremendous promise for improving population health, but they also raise concerns about exacerbating already large differences in health by socioeconomic status (SES). If effective treatments are more rapidly adopted by the better educated, SES health disparities may initially expand even though the health of those in all groups eventually improves. Hypertension provides a useful case study. It is an important risk factor for developing cardiovascular disease, the condition is relatively common, and there are large differences in rates of hypertension by education. This paper examines the short and long-term diffusion of two important classes of anti-hypertensives - ACE inhibitors and calcium channel blockers - over the last twenty-five years. Using three prominent medical surveys, we find no evidence that the diffusion of these drugs into medical practice favored one education group relative to another. The findings suggest that - at least for hypertension - SES differences in the adoption of new medical technologies are not an important reason for the SES health gradient.

Relationship between HMO market share and the diffusion and use of advanced MRI technologies

Background Financial incentives associated with managed care may shift incentives associated with the adoption of new medical technologies. This study examined whether managed-care activity was associated with the adoption rate of magnetic resonance imaging (MRI) equipment during the 1990s. Data and methods Data from three nationwide “censuses” of MRI sites conducted in 1993, 1997, and 1999 were used. The number of MRI sites and magnets; magnet field strength; MRI procedures; the use of contrast media; and the presence of power injectors, echoplanar imaging, cardiac MRI, and interventional MRI were measured in each of 322 metropolitan statistical areas each year. Regression analysis was used to assess the relationship between area MRI availability and overall area health maintenance organization (HMO) market share, controlling for potential confounders. Results Areas with higher HMO activity had markedly lower adoption and use of MRI. By 1999, high-HMO areas had about 40% fewer MRI scanners per 100,000 people than low-HMO areas (1.02 vs. 1.73, P < .01). High-HMO areas had fewer 1.5-T scanners than low areas in all 3 years and tended to use contrast media less often in 1993 and 1997 (all P < .01). There were statistically insignificant trends toward less availability of echoplanar imaging, cardiac MRI, and interventional MRI in high-HMO areas. Conclusions The fact that managed care is associated with the slower adoption of MRI and less availability of some of the most advanced MRI equipment suggests the need for attention to the potential for managed care to have important effects on the quality of care and health care spending by influencing technology growth.

Causal modelling innovation, manufacturing, diffusion and adoption/rejection (IMDAR) processes for new, superior medical technologies

Examining the available evidence on the creation-design, diffusion, and adoption of superior, new medical technologies (NMTs) is useful for developing a grounded behavioural theory of the realised strategies on all three behaviours. Evidence from several case studies and large survey studies supports the following propositions: 1) Lead-users (e.g. innovating surgeons) seek out manufacturers to assist in turning crude sketches of new product designs into working prototypes, as well as providing engineering specifications and revised manufacturing of prototypes. 2) The involvement of third -parties (individuals and firms peripheral to the development, marketing, and adoption of NMTs) dramatically influences the efficiency and efficacy of the innovation and adoption processes. 3) Inter-organisational networks emerge and develop as a consequence of interactions and behaviours of multiple persons in multiple firms. 4) New inter-organisational relationships for NMTs often become necessary to overcome the ‘installed-base effect’. We present a general framework that includes some core research findings from field studies on NMT innovation-manufacturing-marketing-diffusion-adoption-rejection processes.

Managed care and technology diffusion: the case of MRI.

A growing body of evidence suggests that managed care can reduce overall health care costs but provides little insight into how this could happen. One possibility is that managed care influences the adoption of new medical technologies. In examining the relationship between health maintenance organization (HMO) activity and market-level availability and use of magnetic resonance imaging (MRI), we find that high HMO market share is associated with low levels of MRI availability and use. This suggests that managed care may be able to reduce health care costs by influencing the adoption and use of new medical equipment and technologies.

Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century by Joel Howell (review)

tions. James Neel unknowingly prepared for an event that was not supposed to happen: atomic bombs exploding over two major cities. The possible effects oflongterm radiation on a large human population in or near Chernobyl's fallout will draw on his team's contributions to the effect of radiation on future generations. Voles occupying the same area have shown an obvious increase in mitochondrial (and presumably nuclear) DNA damage. Neel had a charmed career. From the coincidence of moving to Wooster, Ohio, where he could walk to Wooster College and an independent research project mentored by an outstanding Drosophila geneticist, Warren Spencer, Neel went to the University of Rochester for a doctoral degree in genetics with Curt Stern. After a postdoctoral experience at Columbia University and the Cold Spring Harbor Laboratory , he decided a doctor would be more useful than a geneticist in an anticipated war. After thorough training in genetics and a medical degree, Neel was probably the most qualified geneticist to evaluate the effects of A-bomb radiation on the progeny of the exposed inhabitants of the two cities. Although the expected surge ofmutants has not yet appeared, the procedures and record keeping by the commission will have value in the future and certainly in monitoring the population exposed to Chernobyl's radiation. After Neel presented the evidence to support a monogenic basis for sickle-cell trait and disease, his pioneering field trips to study the gene pool of isolated Amerindian tribes set the standard for comparable efforts in other parts of the world. His global view of the possible future of Homo sapiens in terms of its gene pool in a rapidly expanding population may some day be seen as a Silent Spring. While his writing style may seem somewhat pedestrian, this autobiography of a pioneer in a field of considerable interest is a fascinating account of preparation and accomplishment . E. D. Garber Dept. Ecohgy and Evolution University of Chicago Technology in the Hospital: TransformingPatient Care in the Early Twentieth Century. ByJoel Howell. Baltimore:Johns Hopkins Univ. Press, 1995. Pp. 356. $47.50. Joel Howell, a physician and medical historian, studied the adoption of medical technology in the Pennsylvania Hospital and the NewYork Hospital during the first decades of the 20th century. His study tries to "lay to rest some persistent myths about the relationship between science, medicine, technology, hospitals and U.S. society." In particular, he argues against the idea that medical technology is adopted only after it is shown to be useful. Instead, he suggests that the adoption of new medical technology is a response to a much more complex set of social, political, and economic forces. Some useful technologies, such as radiographs, were not rapidly adopted. Other technologies, such as repeated urinalyses on hospitalized patients, were rapidly adopted even though they were not obviously useful. The relationship between new technology, new science, and new organizational forms of health care delivery remains relevant. Doctors claimed to be "scientific" •ectives in Biology and Medicine, 40, 3 ¦ Spring 1997 | 457 long before their research met rigorous scientific standards, and hospitals thrived long before the services they provided could be evaluated or shown to be shown useful. Today, activities in the medical sector undergo rigorous scrutiny, but it remains unclear, as it has throughout the 20th century, what evaluative standards should apply and what goals should be sought. Howell argues that the first major transformation of hospitals in the 20th century was not the introduction of new medical technology but the introduction of new accounting techniques. In particular, "Hospital managers began to use cost accounting in an explicit attempt to emulate businesses, including not only railroads but also factories, the arena in which many American at the turn of the twentieth century saw science as having its most visible successes." It was only after hospitals were administratively transformed to resemble businesses or factories that they became receptive and able to profit from new forms of medical technology. By this argument, hospitals consciously created themselves as the image and symbol of science, which they recognized as having enormous marketing value, even before it had any clinical value. "Like the public at large," he notes, "the medical profession saw graphs...

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals.

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

The Two Cultures of Biomedicine: Can There Be Consensus?

There is a tendency to assume that medical science, medical research, and medical practice are identical, or worse, hierarchically arranged. Medical practice does operate under the umbrella of medical science, but medical practitioners do not take practice directives from medical researchers. In conceptualizing and promoting a notion of medical consensus that is different from scientific certainty, the National Institutes of Health has taken a giant step toward bridging the gap between research and practice, but the task is a tough one. My vantage point is from personal interviews with more than 300 mostly nonacademic practicing physicians in three countries who described adoption of new medical technology. 1-3 The first step in conceptualizing the relationship between science and practice should be to reject the idea that practitioners are merely slow scientists. Just as science is not practice, practice is not merely applied science. Different purposes lead to different activities, associations, information,

INNOVATION AND HEALTH EXPENDITURES: SOME EMPIRICAL RESULTS FOR A DIAGNOSTIC TECHNOLOGY

There is debate on whether the adoption of new medical technologies has been a contributing factor to rising health expenditures. This literature is critically reviewed and another approach is advocated. This alternative approach rests on the distinction between product and process innovations. It is argued that the relationship between innovations and health expenditures can be illuminated, for process innovations, by determining if they are used as substitutes. The empirical results provide no indication that alternative technologies for diagnosing diseases/conditions of the upper gastrointestinal tract have been utilised by Australian medical practitioners, operating on a fee-for-service basis, as substitutes. The study provides new empirical support for the view that medical innovations contribute to rising health expenditures.