| While advances in technology are frequently blamed for the expanding healthcare budget, factors that affect the adoption and diffusion of that new technology by individual physicians have rarely been studied. The objective of this study was to estimate the effects of communication channels between physicians and between physicians and other stakeholders on the adoption of a recent procedural technology---drug-eluting cardiac stents (DES). Retrospective analysis of all inpatient discharges for Arizona, New Jersey, and Washington in 2003 was conducted. Patients receiving cardiac stents were identified using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) procedure codes and physicians were identified using a synthetic physician identifier code. Information about hospitals and healthcare markets was obtained from the American Hospital Association annual survey and physician and hospital market variables were obtained from the Area Resource File. Physician adoption rates were plotted over time. Multivariable logistic regression analysis was completed to estimate the effect of communication channels on physician adoption. Fixed hospital and market effects were controlled for to reduce confounding.;In this analysis, 55% of physicians adopted DES for at least 10% of their stent placements within 5 weeks of FDA approval, producing an almost vertical adoption curve for every, suggesting extremely rapid adoption and possible over-adoption of DES. Factors found to be significant in the adoption of DES technology by the earliest innovators were physician competition and the promotion efforts of a change agent. Variables found to be associated with the adoption of DES technology for the majority of adopters were physician competition, communication channels amongst cardiologists, and the promotion efforts of a change agent. The only variable significantly influencing the adoption of DES by physicians at hospitals where early adopting physicians work was physician competition. Within six months of DES technology being approved by the U.S. Food and Drug Administration, 50% of physicians in this study were placing DES in the majority of their patients. Variables found to be associated with the rapid adoption of incremental innovations such as DES can be leveraged by policy makers to shape the diffusion and adoption of new healthcare technologies in the future. |
