Variation In Adoption Research Articles

Invited Commentary

The adoption rate of thoracoscopic lobectomy varies widely throughout the world, and some of this variation can be attributed to economic and cultural issues. The variation in the adoption rate of thoracoscopic lobectomy in the United States is equally large, and it can be attributed only to resistance to innovation. This study by Abdelsattar and colleagues [1Abdelsattar Z.M. Allen M.S. Shen K.R. et al.Variation in hospital adoption rates of video-assisted thoracoscopic lobectomy for lung cancer and the effect on outcomes.Ann Thorac Surg. 2017; 103: 454-461Abstract Full Text Full Text PDF Scopus (24) Google Scholar] analyzes the National Cancer Database to assess the variation in adoption of thoracoscopic lobectomy and to identify factors that might explain this variation. In this study, adoption rates in the highest and lowest quintiles were 76% versus 0.6%, respectively. This finding is similar to a recent publication using the National Inpatient Sample Database, demonstrating that the mean hospital utilization of thoracoscopic lobectomy ranged from 3% to 66%, that discordance (actual versus predicted utilization) was as high as 250%, and that complications were less common with the thoracoscopic approach versus open (17% versus 25%; p < 0.05) [2Cooper M.A. Hutfless S. Segev D.L. et al.Hospital level under-utilization of minimally invasive surgery in the United States: retrospective review.BMJ. 2014; 349: g4198Crossref PubMed Scopus (61) Google Scholar]. In the Society of Thoracic Surgeons General Thoracic Surgery Database, the most recent publication demonstrated that approximately 50% of lobectomies are performed thoracoscopically [3Ceppa D.P. Kosinski A.S. Berry M.F. Tong B.C. et al.Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons database analysis.Ann Surg. 2012; 256: 487-493Crossref PubMed Scopus (193) Google Scholar]; in the European Society of Thoracic Surgery Database, less than 25% of lobectomies are performed thoracoscopically [4Falcoz P.-E. Puyraveau M. Thomas P.-A. Decaluwe H. et al.Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer; a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database.Eur J Cardiothorac Surg. 2016; 49: 602-609Crossref PubMed Scopus (269) Google Scholar]. Considering that the adoption rate of thoracoscopic lobectomy since introduction approximately 20 years ago is so low in the United States and worldwide, it can be concluded that we have not yet made it through the “early majority” phase of adoption, with the “late majority” barely on the horizon. In light of the overwhelming evidence of outcome advantages of thoracoscopic lobectomy, continued focus on teaching and training is paramount—in training programs, in regional courses, and in national and international meetings [5Zwischenberger B. D’Amico T.A. Tong B.C. How I teach it: thoracoscopic lobectomy.Ann Thorac Surg. 2016; 101: 846-849Abstract Full Text Full Text PDF Scopus (10) Google Scholar]. It is possible that the development of improved instrumentation, alternate robotic platforms, and three-dimensional optics will improve the conversion of surgeons to “minimally invasive” and increase the adoption rate of thoracoscopic lobectomy and other minimally invasive approaches. The advent of publicly reported outcomes will expose the surgeons “late majority” and “laggard” phases to patients, referring physicians, and payors, which unfortunately may be the most effective force to reduce the practice variation and to improve the outcomes associated with thoracoscopic lobectomy. Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on OutcomesThe Annals of Thoracic SurgeryVol. 103Issue 2PreviewThis study examined the variation in the adoption of video-assisted thoracoscopic surgery (VATS) for lobectomy across United States hospitals from a population-based national database. Full-Text PDF

Factors influencing farmers' adoption of adaptation measures towards climate change and variability in distress prone districts of Vidarbha

This paper analyses the various factors that had influenced the adoption of adaptation measures by the farmers in response to climate change and variability in distress prone districts of Vidarbha region in Maharashtra. The data used in the analysis were obtained through face to face interviews of 300 farmers in 10 villages scattered over 5 tahsils of 2 highly farmers' suicide prone districts in 2012. Influence of 27 independent variables on the adoption of adaptation measures (dependent variable) was studied. The results of regression analysis indicated that the t- value for partial b of adaptive capacity (3.098) was significant. All the 27 variables fitted in a regression equation accounted for 75.30% (R2 = 0.753) variation in adoption of adaptation measures. Regression analysis further revealed that annual income, perception towards climate change, extension contact, farming experience and social participation were the major factors influencing adoption of adaptation measures. Use of different adaptation measures significantly increase for farmers under study area with more access to these factors. Designing policies that aims to improve these factors for small holder farming systems have great potential to improve farmers' adaptation to changes in climate and variability in the region.

ADOPTION OF FARM MANAGEMENT PRACTICES BY SMALLHOLDER COCOA FARMERS IN PRESTEA HUNI-VALLEY DISTRICT, GHANA

As part of Ghana’s que st to increase cocoa production, Cocoa Research Institute of Ghana has recommended farm management practices to help boost production levels. However, adoption of these management practices had been low, leading to yield levels below potential. This study investigates the adoption intensity and factors explaining the variation in adoption among smallholder c ocoa farmers in Prestea Huni - Valley district of Ghana. A sample size of 180 cocoa farm households from eight communities were randomly selected and interviewed through a well - structured questionnaire. M ajority (80%) of the sampled farmers have adopted four to six out of seven cocoa farm management practices identified. The Poison regressi on model was used to examine the determinants of intensity of adoption of the farm management practices. The results generally reveal ed that, marital status of the farmer, household size, educational attainment, membership of farmer - based organization and farmer receiving extension services are all significant variables explaining farmer’s decision to adopt cocoa farm management practices. The study concludes by suggesting that farm level policies such as extension service delivery system should be strengthen in terms of staff and methodologies .

Reviewing the literature, how systematic is systematic?

Introduction Professor Archibald Cochrane, after whom the Cochrane Collaboration is named, was influential in promoting evidence-based clinical practice. He called for “relevant, valid research” to underpin all aspects of healthcare. Systematic reviews of the literature are regarded as a high quality source of cumulative evidence but it is unclear how truly systematic they, or other review articles, are or ‘how systematic is systematic?’ Today’s evidence-based review industry is a burgeoning mix of specialist terminology, collaborations and foundations, databases, portals, handbooks, tools, criteria and training courses. Aim of the review This study aims to identify uses and types of reviews, key issues in planning, conducting, reporting and critiquing reviews, and factors which limit claims to be systematic. Method A rapid review of review articles published in IJCP. Results This rapid review identified 17 review articles published in IJCP between 2010 and 2015 inclusive. It explored the use of different types of review article, the variation and widely available range of guidelines, checklists and criteria which, through systematic application, aim to promote best practice. It also identified common pitfalls in endeavouring to conduct reviews of the literature systematically. Discussion Although a limited set of IJCP reviews were identified, there is clear evidence of the variation in adoption and application of systematic methods. The burgeoning evidence industry offers the tools and guidelines required to conduct systematic reviews, and other types of review, systematically. This rapid review was limited to the database of one journal over a period of 6 years. Although this review was conducted systematically, it is not presented as a systematic review. Conclusion As a research community we have yet to fully engage with readily available guidelines and tools which would help to avoid the common pitfalls. Therefore the question remains, of not just IJCP but potentially all published reviews, ‘how systematic is systematic?’

Leveling with friends: Social networks and Indian farmers' demand for a technology with heterogeneous benefits

Agricultural technologies typically spread as farmers learn about profitability through social networks. This process can be nuanced, however, when net returns for some farmers may not be positive. We investigate how social learning influences demand for a resource-conserving technology in eastern Uttar Pradesh, India. We identify potential adopters through an experimental auction and randomly select a subset to adopt. We exploit this variation in adoption across networks to estimate network effects on demand for the technology one year later using a second auction. Technology benefits vary, and network effects are completely conditional on benefits. Having a benefiting adopter in one's network increased demand by over 50%, whereas having a non-benefiting adopter had no effect. These effects are strong enough to bring average demand in line with expected benefits. For many farmers, however, demand remains below the market price, suggesting that network effects will lead to increased—but not rapid widespread—adoption.

Deriving an index of adoption rate and assessing factors affecting adoption of an agroforestry-based farming system in Dhanusha District, Nepal

This paper attempts to fulfil the gap in measuring adoption in agroforestry studies. It explains the derivation of an index of adoption rate in a Nepalese context and examines the factors affecting adoption of agroforestry-based land management practice (AFLMP) in the Dhanusha District of Nepal. Data about the different farm practices and the factors (bio-physical, socio-economic) influencing adoption were collected during focus group discussion and from the randomly selected households using a household survey questionnaire, respectively. A multivariate regression model was used to determine the factors. The factors (variables) found to significantly affect adoption of AFLMP were: farm size, availability of irrigation water, education of household heads, agricultural labour force, frequency of visits by extension workers, expenditure on farm inputs purchase, household’s experience in agroforestry, and distance from home to government forest. The regression model explained about 75 % of variation in adoption decision. The model rejected ‘erosion hazard’, ‘flood hazard’ and ‘gender’ as determinants of adoption, which in case of single agroforestry practice were major variables and played positive role. Out of eight variables, farm size played the most powerful role in explaining the variation in adoption, followed by availability of irrigation water and education of household heads. The results of this study suggest that policies to promote the provision of irrigation water, extension services and motivation to obtaining higher education would probably provide the incentive to adopt agroforestry elsewhere in the terai of Nepal.

Socioeconomic Determinants of Livestock Production Technology Adoption in Northern Ghana

The Northern region of Ghana hosts the largest number of livestock producers compared to the other regions, but output is still low despite the introduction of improved technologies whi ch have the potential to increase livestock yields when adopted and provide better livelihoods to participating households. Consequently, adoption of improved technologies has been low, slow and uncertain. This study set out to examine factors that influen ce the adoption of livestock production technologies. One hundred and fifty (150) livestock farmers were randomly sampled from six communities in three districts of the region. The data was analysed using descriptive statistics and a logit regression model . The results showed that the low level of awareness of livestock production technologies have contributed to the low adoption by farmers. The logit regression results disclosed that the likelihood to adopt livestock production technology was significantly explained for 56% by extension contact, intent of producing livestock, number of children, herd size (for some animals species), source of stock, farm record keeping, education and gender. 44% of variation in adoption is therefore caused by other factors. It is recommended that any intervention to increase the

Incidence of minimally invasive colorectal cancer surgery at National Comprehensive Cancer Network centers.

Laparoscopic colectomy has been shown to have equivalent oncologic outcomes to open colectomy for the management of colon cancer, but its adoption nationally has been slow. This study investigates the prevalence and factors associated with laparoscopic colorectal resection at National Comprehensive Cancer Network (NCCN) centers. Data on patients undergoing surgery for colon and rectal cancer at NCCN centers from 2005 to 2010 were obtained from chart review of medical records for the NCCN Outcomes Project and included information on socioeconomic status, insurance coverage, comorbidity, and physician-reported Eastern Cooperative Oncology Group (ECOG) performance status. Associations between receipt of minimally invasive surgery and patient and clinical variables were analyzed with univariate and multivariable logistic regression. All statistical tests were two-sided. A total of 4032 patients, diagnosed between September 2005 and December 2010, underwent elective colon or rectal resection for cancer at NCCN centers. Median age of colon cancer patients was 62.6 years, and 49% were men. The percent of colon cancer patients treated with minimally invasive surgery (MIS) increased from 35% in 2006 to 51% in 2010 across all centers but varied statistically significantly between centers. On multivariable analysis, factors associated with minimally invasive surgery for colon cancer patients who had surgery at an NCCN institution were older age (P = .02), male sex (P = .006), fewer comorbidities (P ≤ .001), lower final T-stage (P < .001), median household income greater than or equal to $80000 (P < .001), ECOG performance status = 0 (P = .02), and NCCN institution (P ≤ .001). The use of MIS increased at NCCN centers. However, there was statistically significant variation in adoption of MIS technique among centers.

Adoption of some NRCRI, Umudike, disseminated technologies in Ebonyi State, Nigeria

The paper examined adoption status of selected farm technologies developed and disseminated by National Root Crops Research Institute, Umudike to farmers in Ebonyi State, Nigeria. A field survey was conducted in one randomly selected agricultural zone (Ebonyi North) of the State. Two extension blocks, were randomly selected out of the 6 in the zone. In each block, two circles out of 8 in each block were randomly sampled as well. Twenty five farmers were similarly sampled for each circle. Thus a sample size of 100 respondents was selected for the study. Structured questionnaire were used to collect vital data for the study. Data collected were analyzed by descriptive statistics and multiple regressive analyses to determine factors affecting adoption of the technologies. Results of the analysis showed that out of the 35 technologies examined, 8 had high level of adoption, 17 were at moderate level while adoption level was low in 10 technologies. Also results of the study showed an R2 of 0.958 indicating that 95.8% of variation in adoption of the technologies was accounted for by the variables considered in the study. Specifically the results indicated that age, extension contact, and income were significant but negatively influenced adoption of the technologies. However farming experience, education, extent of involvement in farming, had significant and positive influence on adoption of the technologies. There is therefore the need to intensify promotion of the technologies to improve awareness for increased adoption. Keywords : adoption, disseminated technologies, farmers, constraints, Ebonyi state.

Can Electronic Procurement Improve Infrastructure Provision? Evidence from Public Works in India and Indonesia

This paper examines whether electronic procurement (e-procurement), which increases access to information and reduces personal interactions with potentially corrupt officials, improves procurement outcomes. We develop unique datasets from India and Indonesia and use variation in adoption of e-procurement within both countries. We find no evidence of reduced prices but do find that e-procurement leads to quality improvements. In India, where we observe quality directly, e-procurement improves road quality, and in Indonesia, e-procurement reduces delays. Regions with e-procurement are more likely to have winners come from outside the region. On net, the results suggest that e-procurement facilitates entry from higher quality contractors. (JEL D72, H54, H57, L12, O17, O22, R42)

Capacity for public service delivery: a cross-case analysis of ten small faith-related non-profit organisations

Government-funded contracts are widely known to test the internal capacity of non-profit organisations (NPOs). Smaller faith-related NPOs are considered to be particularly lacking in the capacity needed to manage such contracts. Based on the uneven experiences of ten small faith-related non-profit organisations in a federal initiative in the United States, this article details four capacity areas critical to effective adaptation to the demands of government contracts: professional leadership, human resource management, strategy development and organisational alignment, and prior contract experience. Besides these internal organisational capacities, a key external factor found to predict effective adaptation is the capacity building given by support organisations that share the same faith orientation. However, two other factors explain the lack of pervasive adaptation, namely the financial strength of support organisations and funder perception of effective performance. The research contributes to neo-institutionalist arguments that attention to capacity and capacity builders may explain variations in adoption of practices that support public service delivery among small faith-related NPOs.

O214 State Variation in Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention

O214 State Variation in Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention

Enabling Quality

The Health Resources and Services Administration has supported the adoption of electronic health records (EHRs) by federally funded health centers for over a decade; however, little is known about health centers' current EHR adoption rates, progress toward Meaningful Use, and factors related to adoption. We analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80% of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding; however, there were small variations in adoption by total patient cost and percent of revenue from grants. Findings revealed no evidence of a digital divide among health centers, indicating that health centers are implementing EHRs, in keeping with their mission to reduce health disparities.

Rates, levels, and determinants of electronic health record system adoption: A study of hospitals in Riyadh, Saudi Arabia

ObjectiveOutside a small number of OECD countries, little information exists regarding the rates, levels, and determinants of hospital electronic health record (EHR) system adoption. This study examines EHR system adoption in Riyadh, Saudi Arabia. Materials and methodsRespondents from 22 hospitals were surveyed regarding the implementation, maintenance, and improvement phases of EHR system adoption. Thirty-seven items were graded on a three-point scale of preparedness/completion. Measured determinants included hospital size, level of care, ownership, and EHR system development team composition. ResultsEleven of the hospitals had implemented fully functioning EHR systems, eight had systems in progress, and three had not adopted a system. Sixteen different systems were being used across the 19 adopting hospitals. Differential adoption levels were positively related to hospital size and negatively to the level of care (secondary versus tertiary). Hospital ownership (nonprofit versus private) and development team composition showed mixed effects depending on the particular adoption phase being considered. DiscussionAdoption rates compare favourably with those reported from other countries and other districts in Saudi Arabia, but wide variations exist among hospitals in the levels of adoption of individual items. General weaknesses in the implementation phase concern the legacy of paper data systems, including document scanning and data conversion; in the maintenance phase concern updating/maintaining software; and in the improvement phase concern the communication and exchange of health information. ConclusionThis study is the first to investigate the level and determinants of EHR system adoption for public, other nonprofit, and private hospitals in Saudi Arabia. Wide interhospital variations in adoption bear implications for policy-making and funding intervention. Identified areas of weakness require action to increase the degree of adoption and usefulness of EHR systems.

Multiyear budgets and fiscal performance: Panel data evidence

In the last two decades more than 120 countries have adopted a multiyear budget process (Medium-Term Framework, or MTF) that enables the central government to set multiyear fiscal targets. This paper analyzes a newly-collected dataset of worldwide MTF adoptions during 1990–2008. It exploits within-country variation in adoption in a dynamic panel framework to estimate MTFs' impacts on aggregate as well as sectoral measures of fiscal performance. We find that on average multiyear budgeting improves budget balance by about 2 percentage points with more advanced MTF phases having a larger impact. Higher-phase MTFs also reduce health spending volatility, while only the top-phase MTF has a measurable impact on health sector technical efficiency.

User centered clinical decision support tools: adoption across clinician training level.

Dissemination and adoption of clinical decision support (CDS) tools is a major initiative of the Affordable Care Act's Meaningful Use program. Adoption of CDS tools is multipronged with personal, organizational, and clinical settings factoring into the successful utilization rates. Specifically, the diffusion of innovation theory implies that 'early adopters' are more inclined to use CDS tools and younger physicians tend to be ranked in this category. This study examined the differences in adoption of CDS tools across providers' training level. From November 2010 to 2011, 168 residents and attendings from an academic medical institution were enrolled into a randomized controlled trial. The intervention arm had access to the CDS tool through the electronic health record (EHR) system during strep and pneumonia patient visits. The EHR system recorded details on how intervention arm interacted with the CDS tool including acceptance of the initial CDS alert, completion of risk-score calculators and the signing of medication order sets. Using the EHR data, the study performed bivariate tests and general estimating equation (GEE) modeling to examine the differences in adoption of the CDS tool across residents and attendings. The completion rates of the CDS calculator and medication order sets were higher amongst first year residents compared to all other training levels. Attendings were the less likely to accept the initial step of the CDS tool (29.3%) or complete the medication order sets (22.4%) that guided their prescription decisions, resulting in attendings ordering more antibiotics (37.1%) during an CDS encounter compared to residents. There is variation in adoption of CDS tools across training levels. Attendings tended to accept the tool less but ordered more medications. CDS tools should be tailored to clinicians' training levels.

IT Service Management: A Cross-national Study of ITIL Adoption

IT Service Management (ITSM) is transforming the management of the IT function on a global scale with major changes in work practices. The intent of this study is to empirically explore how IT service management is adopted in today's global economy. The paper examines the adoption of ITSM processes as defined in the IT Infrastructure Library (ITIL®). The adoption of operational processes is compared to that of tactical/strategic level processes and the contribution of country, size and industry sector to variation in adoption of ITIL processes is assessed. Institutional theory is used as a foundation for the study. The analysis is based on 623 responses to three surveys conducted in the UK, USA, DACH (German speaking countries) and Australia. The study found organisations adopting ITIL implemented more operational level processes than the tactical/strategic level processes. DACH countries exhibit higher ITIL process adoption than the UK, USA and Australia. Adoption varied on industry sector, and in part on organisation size. Based on a discussion of theory and practice, the paper derives insights for academics and industry when introducing ITSM in the IT function.

The experiences of mothers of young adults with an intellectual disability transitioning from secondary school to adult life

Background The transition from school to adulthood for young adults with an intellectual disability involves movement from a generally secure and supported school environment to an emerging adult life that may be characterised by a wide variation in adoption of adult roles related to employment, independent living, friendships, and day activities.Method In this study, we investigated the perspectives of 18 mothers of young adults with either Down syndrome or Rett syndrome through qualitative semistructured interviews. The International Classification of Functioning, Disability and Health (ICF) framework was used as a conceptual basis.Results Themes that emerged included adult roles assumed during the day, accommodation, quality of life, living a “good” life, and family impact.Conclusions In contrast with Rett syndrome, mothers of young adults with Down syndrome described more difficult pathways to attaining stability in adult roles. Environmental facilitators and barriers emerged in the area of support, relationships, services, systems, and policies.

Variations in Practice Adoption: The Roles of Conscious Reflection and Discourse

We argue that our understanding of practice adoption has been limited by the prevailing view that variations in adoption stem from consciously made decisions. We counter this position by arguing that a key—and neglected—aspect of the adoption process concerns the level of conscious engagement of those involved. In so doing, we theorize that there are two distinct institutional dimensions necessary for understanding how practice adoption takes place: acceptance and implementation. We develop these dimensions to provide a framework showing that different within-organization responses will be associated with differing levels of acceptance of the need to adopt a practice—the acceptance dimension—and differing levels of conscious reflection during implementation of the practice—the implementation dimension. We then unpack this framework to explain how variations in discourse play a determining role in how practice adoption unfolds. This reveals an interesting institutional paradox: the discursive characteristi...

Physician Specialty and Variations in Adoption of Electronic Health Records

Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored. We conducted a retrospective cross-sectional study to determine the association between physician specialty and the prevalence of EHR adoption, and a retrospective serial cross-sectional study to determine the association of physician specialty and the rate of EHR adoption over time. We used the 2005-2009 National Ambulatory Medical Care Survey. We considered fourteen specialties, and four definitions of EHR adoption (any EHR, basic EHR, full EHR, and a novel definition of EHR sophistication). We used multivariable logistic regression, and adjusted for several covariates (geography, practice characteristics, revenue characteristics, physician degree). Physician specialty was significantly associated with EHR adoption, regardless of the EHR definition, after adjusting for covariates. Psychiatrists, dermatologists, pediatricians, ophthalmologists, and general surgeons were significantly less likely to adopt EHRs, compared to the reference group of family medicine/general practitioners. After adjustment for covariates, these specialties were 44-94% less likely to adopt EHRs than the reference group. EHR adoption increased in all specialties, by approximately 40% per year. The rate of EHR adoption over time did not significantly vary by specialty. Although EHR adoption is increasing in all specialties, adoption varies widely by specialty. In order to insure each individual's network of providers can electronically share data, widespread adoption of EHRs is needed across all specialties.