The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

Abstract

BackgroundThe transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory.MethodsWe conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model “diffusion of innovations in health services organizations” developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis.ResultsAmong the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method.ConclusionsThe findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

Learning effect and diffusion of innovative medical devices: the case of transcatheter aortic valve implantation in Italy

“…The first interpreta- Learning effect & diffusion of innovative medical devices Research Article tion is consistent with the results of a previous empirical study conducted in Italy on coronary stents [36]. The latter is line with a recent qualitative work, which demonstrated that the diffusion of TAVI in Germany has been influenced by multiple factors (e.g., perceived medical advantages of the new technology, social prestige of implanting centers and of clinicians, opinion leaders heading the departments, cooperation between cardiac surgeons and interventional cardiologists) that go beyond the level of reimbursement [37].…”

Hospital contextual factors affecting the implementation of health technologies: a systematic review

“…A total of 216 full texts articled were read. After the screening process, 33 studies, [ 27 – 59 ] reporting original primary data, met the eligibility criteria for this systematic review.

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Transatlantic Editorial on Transcatheter Aortic Valve Replacement

“…Patterns in financial reimbursement may affect the number of TAVR procedures that are currently performed, particularly in Europe. The current reimbursement system allows for liberal use of TAVR in Switzerland, Denmark, and Germany, whereas financial restrictions are quite marked in other European countries (eg, Spain, Portugal, United Kingdom) [47,48]. The number of TAVR might increase in these countries if the financial restrictions disappeared.…”