Decisions to adopt new technologies at the hospital level: Insights from Israeli medical centers

Abstract

Objectives: New medical technologies have been identified as the leading cause of increasing health-care expenditures. Adoption of a new technology is one of the most important decisions in medical centers. The objectives of this study were to map and describe the function of hospital decision-makers within the area of new technology assessment and adoption, and to examine relevant considerations, sources of information, and decision-making processes in the adoption of a new technology.Methods: A questionnaire was mailed to hospital executives and referred to (i) the considerations for and against adoption of a new technology, (ii) the decision-making process, (iii) information sources used in the decision-making process.Results: The most frequent criteria favoring adoption included increased cost-effectiveness, increased efficacy, and decrease in complication rates. An increase in complication rates or side effects and decreased efficacy were the top ranked criteria against adoption. The final decision-making responsibility varied among technologies; the medical director frequently made the final decision when a new device was involved, but this responsibility decreased when a new drug or a new procedure was considered. Participation in scientific meetings, opinions of local experts, medical journals, and Food and Drug Administration clearance documents were the most important information sources used in the decision-making process. However, these were not necessarily the optimal sources of information. Significant barriers in adoption decision-making are lack of timely data regarding the safety of the new technology, its cost-effectiveness, and efficacy.Conclusion: To improve the adoption decisions, hospitals must develop criteria upon which the decision-making will be based.

Priority setting for technology adoption at a hospital level: Relevant issues from the literature

“…(Clearly, for high expensive and risky investments, more accurate criteria, such as the Net Present Value, should be applied.) The two issues are: (i) degree of self funding [9,20,30]; (ii) ratio of fixed costs to variable costs during the implementation stage [13,16,21]. This is coherent to the current practice in hospitals, that generally use different templates for technology assessment according the investment size and the level of novelty/risk for the hospital.…”

“…Greenberg et al [9] investigated the main factors in favour or against the adoption of a new technology. They sent a questionnaire to 132 hospital executives, yielding 61 responses.…”

“…[9,[11][12][13]) -that investigate the main factors that characterise a "suitable" context for adopting and institutionalising new technology at a hospital level. In particular, three of them are recent extensive literature reviews, while the others deepen specific issues.…”

“…The literature review remarks that various issues should to be taken into account in adopting a technology. These issues have been summarised into five domains (refer to Table 2 for details and references): Any investment requires an Economic Sustainability [9,30]. The budget committee should understand the yearly impacts in term of running costs and cash out because of technology adoption.…”

“…Reeleder et al claimed that priority setting for technology adoption at a hospital level is largely overlooked and wide research efforts should be paid to this emerging issue [6]. Other authors stated that HTA guidelines should be extended at a hospital level in order to facilitate the creation of a culture of responsibility and accountability among hospitals [7][8][9][10]. Recently, the Health Technology Assessment International (HTAi) network minted the term "hospital-based HTA" to remark both the relevance and the peculiarities of HTA at a hospital level.…”