The State of the Art Versus the State of the Science: The Diffusion of New Medical Technologies into Practice

Abstract

This paper offers a theory to explain the diffusion of new medical technologies into local practice. Based on several hundred interviews with community hospital physicians, it anchors technology decisions in the norms and relationships of local practice. Physician descriptions of their use of different types of assessment information provide insight into the way in which local consenses on appropriate practice are formed, guide behavior, and change. To understand new technology adoption, it is necessary to (a) differentiate "formed" (complete) and "dynamic" (still developing) technologies, and (b) appreciate the extent to which medical practice is locally organized. Concepts from organizational literature, then, become useful in explaining the penetration of these medical communities and the circumstances under which a new modality takes hold in them. Within the framework presented, previously puzzling findings regarding variations in local practice and the poor relationship between practice behavior and the published literature become understandable.

Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

“…This is consistent with previous research that has found that local opinion leaders can influence change in the clinical practices of health professionals (Lomas 1991). It is suggested that such people may perform a "sanctioning function" for new procedures (Greer 1988), or impact on peer attitudes and beliefs (Mittman et al 1992).…”

Words Without Action? The Production, Dissemination, and Impact of Consensus Recommendations

“…Although this approach satisfies the apparent role of the consensus process in synthesizing research information, it can conflict with the credibility to a community practitioner audience. In other work, researchers found significant resistance among community practition ers to "ivory tower" medicine as espoused by academic consensus panels (35,56). There is no obvious balance between these potentially competing de mands on consensus group membership.…”

The Formation of Peer Reputation among Physicians and Its Effect on Technology Adoption

“…New medical technologies are frequently introduced by pharmaceutical companies and medical device manufacturers, sometimes with involvement of physicians. However, when a technology is introduced, the timing of its adoption and the extent to which it is used may vary across those who utilize it (Freiman 1985;Greer 1988;Escarce et al 1995;Escarce 1996;Hirth, Fendrick, and Chernew 1996;Burt and Sisk 2005;Gans et al 2005). It has been argued that the heterogeneity in the timing and extent of adoption may be linked to peer relations and that the nature of professional ties may lead to either underutilization or overutilization of new technologies from a welfare perspective (Escarce 1996).…”