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

Published online by Cambridge University Press:  10 March 2009

Ann Lennarson Greer
Affiliation:
University of Wisconsin, Milwaukee

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.

Type
Special Section: Technology Assessment and the Alteration of Medical Practices
Copyright
Copyright © Cambridge University Press 1988

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References

Allen, T. J. The role of person-to-person communications in the transfer of technological knowledge. In Roberts, E. B.Levy, R. I.Finkelstein, S. N.Moskowitz, J. & Sondik, E. J. (eds.), Biomedical innovation. Cambridge, MA: MIT Press, 1981, 3449.Google Scholar
Banta, H. D. Major issues facing biomedical innovation. In Roberts, E. B.Levy, R. I.Finkelstein, S. N.Moskowitz, J. & Sondik, E. J. (eds.), Biomedical innovation. Cambridge, MA: MIT Press, 1981, 352–78.Google Scholar
Barnes, B. A. Discarded operations: surgical innovation by trial and error. In Bunker, J. P.Barnes, B. A, & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977, 109–23.Google Scholar
Barsamian, E. M. The rise and fall of internal mammary artery litigation in the treatment of angina pectoris and the lessons learned. In Bunker, J. P.Barnes, B. A., & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977, 212–20.Google Scholar
Becker, H. S., Geer, V., Hughes, E. C., & Strauss, A. S. Boys in white: Student culture in medical school. New Brunswick, NJ: Transaction Books, 1977.Google Scholar
Becker, M. H.Sociometric location and innovativeness: reformulation and extension of the diffusion model. American Sociological Review, 1970, 35, 267–82.Google Scholar
Bingham, R. D.Innovation, bureaucracy and public policy: a study of innovation adoption by local government. Western Political Quarterly, 1978, 31, 178205.CrossRefGoogle Scholar
Bucher, R., & Strauss, A.Professions in process. American Journal of Sociology, 1961, 46, 325–34.CrossRefGoogle Scholar
Bunker, J. P., Hinkley, D., & McDermott, W. V. Surgical innovation and its evaluation. Science, 1978.CrossRefGoogle Scholar
Cohen, M. D., & March, J. D.Leadership and ambiguity. New York: McGraw-Hill, 1974.Google Scholar
Coleman, J. S., Katz, E., & Menzel, H.Medical innovation: a diffusion study. Indianapolis: Bobbs-Merrill, 1966.Google Scholar
Daft, R. L., & Becker, S. W.Innovation in organizations. New York: Elsevier, 1978.Google Scholar
Dimow, J.Primary physician referral patterns and access to treatment alternatives: the case of breast cancer. M. A.Paper, Department of Urban Affairs, University of Wisconsin–Milwaukee, 1985.Google Scholar
Doubilet, P., & Abrams, H. L.The cost of underutilization. New England Journal of Medicine, 1984, 310, 95101.Google Scholar
Downs, G. W., & Mohr, L. B.Conceptual issues in the study of innovation. Administrative Science Quarterly, 1976, 21, 700–14.Google Scholar
Feeny, D.Neglected issues in the diffusion of health care technologies: The role of skills and learning. International Journal of Technology Assessment in Health Care, 1985, 1, 681–92.CrossRefGoogle ScholarPubMed
Fineberg, H. V. Gastric freezing: A study of diffusion of a medical innovation. In Institute of Medicine, Medical technology and the health care system: a study of the diffusion of equipment-embodied technology. Washington, DC: National Academy of Sciences, 1979, 173200.Google Scholar
Fineberg, H. V., & Hiatt, H.Evaluation of medical practices: The case for technology assessment. New England Journal of Medicine, 1979, 301, 1086–91.CrossRefGoogle ScholarPubMed
Finland, M. Lies, damn lies, and statistics. In Ingelfinger, F. J., Ebert, R. V., Finland, M., & Relman, A. S. (eds.) Controversy in internal medicine II. Philadelphia: W. B. Saunders, 1974, 3537.Google Scholar
Fletcher, S. W., Fletcher, R. H., & Greganti, A. Clinical research trends in general medical journals, 1946–1976. In Roberts, E. B., Levy, R. I., Finkelstein, S. N., Moskowitz, J., & Sondik, E. J. (eds.). Biomedical innovation. Cambridge, MA: MIT Press, 1981, 284300.Google Scholar
Fox, R. C.Experiment perilous. Philadelphia: University of Pennsylvania Press, 1959.Google Scholar
Geertsma, R. H., Parker, R. C., & Whitbourne, S. K.How physicians view the process of change in their practice behavior. Journal of Medical Education, 1982, 57, 752–61.Google ScholarPubMed
Gilber, J. P., McPeek, B., & Mosteller, F., Progress in surgery and anesthesia: Benefits and risks of innovative therapy. In Bunker, J. P.Barnes, B. A. & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977, 124–69.Google Scholar
Gittelsohn, A. M., & Wennberg, J. E. On the incidence of tonsillectomy and other common surgical procedures. In Bunker, J. P., Barnes, B. A., & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977.Google Scholar
Goodwin, J. S., & Goodwin, J. M.Failure to recognize efficacious treatments. A history of salicylate therapy in rheumatoid arthritis. Perspectives in Biology and Medicine, 1981, 25, 7892.Google Scholar
Goodwin, J. S., & Goodwin, J. M. The tomato effect: Rejection of highly efficacious therapies. Journal of the American Medical Association, 1984, 2380–90.Google Scholar
Greer, A. L.Adoption of medical technology: The hospital's three decision-systems. International Journal of Technology Assessment in Health Care, 1985, 1, 669–80.CrossRefGoogle ScholarPubMed
Greer, A. L.Advances in the study of the diffusion of innovation in health care organizations. The Milbank Memorial Fund Quarterly, 1977, 55, 505–32.Google Scholar
Greer, A. L. Medical conservatism and technological acquisitiveness: The paradox of hospital technology adoptions. In Roth, J. & Ruzak, S. (eds.), Research in the sociology of health care IV: the adoption and social consequences of medical technology. Greenwich, CT.: JAI Press, 1986, 185235.Google Scholar
Greer, A. L.Medical technology: Assessment, adoption, and utilization. A review of the literature. Journal of Medical Systems, 1981, 5, 129–45.CrossRefGoogle Scholar
Greer, A. L.Medical technology and professional dominance theory. Social Science and Medicine, 1984, 18, 809–17.CrossRefGoogle ScholarPubMed
Hiatt, H. H.Protecting the medical commons: Who is responsible? New England Journal of Medicine, 1975, 293, 235–41.Google Scholar
Ingelfinger, F. J., Ebert, R. V., Finland, M., & Relman, A. S. (eds.). Controversy in internal medicine II. Philadelphia: W. B. Saunders, 1974.Google Scholar
Jennett, B.High technology medicine: Benefits and burdens. New York: Oxford University Press, 1986.Google Scholar
Kaluzny, A. D., Gentry, J. T., & Veney, J. E.Innovation of health services: A comparative study of hospitals and health departments. The Milbank Memorial Fund Quarterly, 1974, 52, 51.Google Scholar
Kaluzny, A. D., & Hernandez, S. R. Organizational change and innovation. In Shortell, S. M. & Kaluzny, A. D., Health care management: A text in organization theory and behavior. New York: Wiley, 1983.Google Scholar
Katz, J.Why doctors don't disclose uncertainty. Hastings Center Report, 1984, 1, 3544.CrossRefGoogle Scholar
Lazarsfeld, P. F., Berelson, B., & Gaudet, H.The people's choice. New York: Columbia University Press, 1948.Google Scholar
Levy, R. I., & Sondik, E. J.Decision-making in planning large-scale comparative studies. Annals of the New York Academy of Sciences, 1978, 304, 441–57.Google Scholar
McKinlay, J. B., McKinlay, S. M., Jennings, S., & Grant, K. Mortality, morbidity and the inverse care law. In Greer, A. L. & Greer, S. (eds.), Cities and sickness: Health care in urban America. Beverly Hills: Sage, 1983, 99138.Google Scholar
Mumford, E.Interns: From students to physicians. Cambridge, MA: Harvard University Press, 1970.CrossRefGoogle Scholar
Office of Technology Assessment, U.S. Congress. Assessing the efficacy and safety of medical technologies. Washington, DC: U.S. Government Printing Office, 1980.Google Scholar
Office of Technology Assessment, U.S. Congress. The health technology case study series, vol. 1–37. Washington, DC: U.S. Government Printing Office, 1986.Google Scholar
Potchen, E. J. The value of efficacy studies. In Roberts, E. B., Levy, R. I., Finkelstein, S. N., Moskowitz, J., & Sondik, E. J. (eds.), Biomedical innovation. Cambridge, MA: MIT Press, 1981, 275–83.Google Scholar
Reed, , John, , Interview, 08 5, 1985.Google Scholar
Reiser, S. J.Assessment and the technological present. International Journal of Technology Assessment in Health Care, 1986, 2, 712.Google Scholar
Report of the Committee for the Assessment of Biometric Aspects of Controlled Trials of Hypoglycemic Agents. Journal of the American Medical Association, 1975, 231, 583608.CrossRefGoogle Scholar
Rogers, E. M., & Shoemaker, F. F.Communication of innovations. A cross-cultural approach. New York: Free Press, 1971.Google Scholar
Stross, J. K., & Harlan, W. R.The dissemination of new medical information. Journal of the American Medical Association, 1979, 241, 2622–24.Google Scholar
Warner, K. E.The need for some innovative concepts of innovation: An examination of research on the diffusion of innovations. Policy Sciences, 1974, 5, 433–51.CrossRefGoogle Scholar
Wennberg, J. E.Dealing with medical practice variations: A proposal for action. Health Affairs, 1984, 3, 632.Google Scholar
Wennberg, J. E.Should the cost of insurance reflect the cost of use in local hospital markets? New England Journal of Medicine, 1981, 307, 1374–81.CrossRefGoogle Scholar
Wennberg, J. E., & Gittelsohn, A.Small area variations in health care delivery. Science, 1973, 182, 1102–8.CrossRefGoogle ScholarPubMed
Wyngaarden, J. B.The Clinical Investigator as an Endangered Species. New England Journal of Medicine, 1979, 301, 1254–59.CrossRefGoogle ScholarPubMed
Young, D. A. Communications linking clinical research and clinical practice. In Roberts, E. B., Levy, R. I., Moskowitz, J., & Sondik, E. J. (eds.), Biomedical innovation. Cambridge, MA: MIT Press, 1981, 177–99.Google Scholar