Cardiovascular nuclear medicine exercise studies may serve as a screening method to be used in making decisions to refer patients for catheterization and coronary artery bypass surgery. In...

Sex bias in considering coronary bypass surgery

Neglected issues in the diffusion of health care technologies. The role of skills and learning.

This article describes and discusses three major kinds of gaps that hinder knowledge dissemination and utilization. The gaps concern the structure of the field, the processes by which the dissemination literature is aggregated, and the lack of information aboutwho uses the knowledge that has been disseminated and its impact on behavior and society. Further delineation is given through discussions of subcomponents, such as problems created by the information explosion and the methods and policies governing organization of the literature. Recommendations and areas for future research are given.

Gaps in the Dissemination/Knowledge Utilization Base:

The rapid growth of cardiac catheterization has raised questions about the availability of less costly, noninvasive tests such as cardiac scintigraphy and echocardiography. To assess their availability and rates of use, we surveyed 3778 non-federal short-term US hospitals in June, 1983. Overall, 2605 hospitals (69%) offered /sup 201/Tl myocardial perfusion scans, 2580 (68%) 99mTc equilibrium gated blood pool scans, and 2483 (67%) cardiac shunt scans; 1679 hospitals (44%) offered M-mode and/or 2-dimensional echocardiography, and 768 (20%) pulsed Doppler echocardiography. Volumes of procedures varied enormously among hospitals capable of performing them. High volumes of both scintigraphy and echocardiography were performed in a small number of hospitals. Larger, voluntary, and teaching hospitals performed higher volumes of both procedures. Despite widespread availability of these noninvasive technologies, high volumes of both cardiac scintigraphy and echocardiography procedures are concentrated in a small number of US hospitals.

http://jnm.snmjournals.org/content/27/10/1635.full.pdf

Imaging the heart: cardiac scintigraphy and echocardiography in U.S. hospitals (1983).

Medical technology disadoption, a topic which has not previously been studied in great detail by health economists, is of great importance in a health care system where technology is understood to be a major driver of expenditure growth and the adoption of new technologies is consistently promoted by cultural norms and financial incentives. The disadoption of technologies with sub-optimal efficacy or safety is a key to improving the quality and value of care, and thus there is obvious utility to learning more about factors that influence technology disadoption. This dissertation establishes a novel theoretical framework to characterize the disadoption process along multiple dimensions, and then develops a simple mathematical model to describe physician disadoption behavior. Disadoption is examined empirically by analyzing the use of coronary drug-eluting stents (DES) in 2006-07(following their rapid adoption in 2003-04) using New York and Florida hospital discharge data, national practice organization data, and physician characteristic data. Preceding DES adoption behavior and physician group size are the primary factors studied for association with DES disadoption behavior. Empirical analyses indicate that faster DES adoption may be weakly associated with later DES disadoption, which may be consistent with physician risk aversion or product loyalty playing roles in disadoption decisions. Also, analyses suggest that there may be a week negative relationship between group size and timing of DES disadoption, suggesting that physicians in larger groups may begin the disadoption process later. These empirical results, which are subjected to instrumental variable analysis and extensive robustness checks, generally lack statistical significance, which highlights the current level of uncertainty surrounding disadoption behavior, including the observation that it does not appear to be empirically either similar or related to adoption behavior. Thus, this work both promotes and guides future research on medical disadoption and its determinants. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Health Care Management & Economics First Advisor Guy David

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An Examination of Medical Technology Disadoption and its Relation to Technology Adoption and Physician Organization

A national survey was conducted to examine the extent of adoption and use of nuclear imaging procedures in cardiology in hospitals by 1979 and to develop estimates for 1983. The data are based on the responses of 171 hospitals from a representative 200-hospital sample stratified for region, bed-size, and teaching status. Extrapolating the data, it is estimated that 2,106 hospitals nationally use cardiac nuclear imaging. In 1979, hospitals with at least 200 beds performed an estimated 396,000 cardiac nuclear imaging studies at a cost of $93 million. By 1983, it is estimated that 4,061 hospitals had the capability to perform cardiac nuclear imaging and that national expenditures would exceed $200 million ( noninflated dollars). Although cardiac nuclear imaging procedures have been demonstrated to be valuable in detecting coronary artery disease or measuring ventricular function, these procedures were rapidly being adopted by the medical community at a time when only limited information about their effectiveness and efficiency are available.

Strauss Hw

Papers

Cardiac nuclear imaging. Adoption of an evolving technology.