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Innovation and Diffusion of Health-Related Technologies: A Conceptual Framework

Published online by Cambridge University Press:  10 March 2009

Renaldo N. Battista
Renaldo N. Battista
Affiliation:
The Montreal General Hospital
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Extract

The development and diffusion of health-related technologies constitute an extremely complex process. This article examines the phenomenon of technological innovation; discusses the factors determining the diffusion of high, medium, and low technologies; and suggests strategies for controlling the diffusion of these technologies. A research program is also proposed that should improve our understanding of the process of development and diffusion of health-related technologies.

Type
General Essay
Information
International Journal of Technology Assessment in Health Care , Volume 5 , Issue 2 , April 1989 , pp. 227 - 248
Copyright
Copyright © Cambridge University Press 1989

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References

REFERENCES

Altman, S. H., & Wallack, S. S. Technology on trial–Is it the culprit behind rising health costs? In Medical technology: The culprit behind health care costs? Hyattsville, MD: National Center for Health Statistics, 1979; DHEW Pub. No. (PHS) 79–3216, 24–38.Google Scholar
Anderson, N.Critical steps in the development of new health technology. Paper prepared for the Conference on Health Care Technology and Quality of Care, Boston University, 11 19–20, 1976. Boston: Boston University, Program on Public Policy for Quality Health Care, 1976.Google Scholar
Avorn, J., & Soumerai, S. B.Improving drug-therapy decisions through educational outreach: A randomized clinical trial of academically based “detailing”. New England Journal of Medicine, 1983, 308, 1457–63.Google Scholar
Banta, H. D., Behney, C. J., & Willens, J. S.Toward rational technology in medicine. New York: Springer Verlag, 1981.Google Scholar
Battista, R. N.Adult cancer prevention in primary care: Patterns of practice in Québec. American Journal of Public Health, 1983, 73, 1036–39.Google Scholar
Battista, R. N., & Spitzer, W. O.Adult cancer prevention in primary care: Contrasts among primary care practice settings in Québec. American Journal of Public Health, 1983b, 73, 1040–41.Google Scholar
Battista, R. N., Palmer, C. S., Marchand, B. M., & Spitzer, W. O.Patterns of preventive practice in New Brunswick. Canadian MedicalAssociation Journal, 1985, 132, 1013–15.Google Scholar
Battista, R. N., Spasoff, R. A., & Spitzer, W. O. Choice of technique: Patterns of medical practices. In Evans, R. G. & Stoddard, G. L. (eds.), Medicare at maturity: Achievements, lessons and challenges. Calgary: University of Calgary Press, 1986, 181–213.Google Scholar
Battista, R. N., Williams, J. I., & MacFarlane, L. A.Determinants of primary medical practice in adult cancer prevention. Medical Care, 1986, 24, 216–24.Google Scholar
Battista, R. N., Contandriopoulos, A.-P., Champagne, F., Williams, J. I., Pineault, R., & Boyle, P. An integrative framework for health-related research (submitted for publication).Google Scholar
Battista, R. N., Williams, J. I., & MacFarlane, L. A. Determinants of preventive practice in fee-for-service primary care. Submitted for publication.Google Scholar
Becker, M. H.Sociometric location and innovativeness: Reformation and extension of the diffusion model. American Sociological Review, 1970, 35, 267–82.Google Scholar
Blendon, R. J., & Moloney, T. W. Perspectives on the growing debate over the cost of medical technologies. In Medical technology: The culprit behind health care costs? Hyattsville, MD: National Center for Health Statistics, 1979; DHEW Publ. No. (PHS) 79–3216, 10–23.Google Scholar
Blumenthal, D.Federal policy toward health care technology: The case of the National Center. Milbank Memorial Fund Quarterly, 1983, 61, 584–613.Google Scholar
Bollinger, L., et al. A review of literature and hypotheses on new technology-based firms. Research Policy, 1983, 12, 1–14.Google Scholar
Brook, R. H., & Williams, K. N.Effect of medical care review on the use of injection. Annals of Internal Medicine, 1976, 85, 509.Google Scholar
Canadian Task Force on the Periodic Health Examination. The periodic health examination. Canadian Medical Association Journal, 1979, 121, 1193–254.Google Scholar
Canadian Task Force on the Periodic Health Examination. The periodic health examination: 1984 update. Canadian Medical Association Journal, 1984, 130, 1276–92.Google Scholar
Canadian Task Force on the Periodic Health Examination. The periodic health examination: 1985 update. Canadian Medical Association Journal, 1986, 134, 721–29.Google Scholar
Canadian Task Force on the Periodic Health Examination. The periodic health examination: 1987 update. Canadian Medical Association Journal, 1988, 138, 617–26.Google Scholar
Clute, K. F.The general practitioner. A study of medical education and practice in Ontario and Nova Scotia. Toronto: University of Toronto Press, 1963.Google Scholar
Coles, J., Davison, A., & Wickings, I.Allocating budgets to wards: An experiment. The Hospital and Health Services Review, 1976, 72, 309–12.Google Scholar
Coleman, J. S., Katz, E., & Menzel, H.Medical innovation: A diffusion study. Indianapolis: Bobbs-Merrill, 1966.Google Scholar
Contandriopoulos, A.-P.Stimulants économiques et utilisateur des services médicaux. 'Actualité économique, 1980 (04 – 06), 264–96.Google Scholar
Cyert, R. M., & March, J. G.A behavioral theory of the firm. Englewood Cliffs: Prentice Hall, 1963.Google Scholar
Dahl, R.Who governs? New Haven, CT: Yale University Press, 1961.Google Scholar
Davis, D., Haynes, R. B., Chambers, L., et al. The impact of CME: A methodological review of the continuing medical education literature. Evaluation and the Health Profession, 1984, 7, 251–83.Google Scholar
Deber, R. B., Thompson, G. G., & Leatt, P.Technology acquisition in Canada: Control in a regulated market. International Journal of Technology Assessment in Health Care, 1988, 2, 185–206.Google Scholar
Detsky, A. S., Stacey, S. R., & Bombardier, C.The effectiveness of a regulatory strategy in containing hospital costs: The Ontario experience, 1967–1981. New England Journal of Medicine, 1983, 309, 151-59.Google Scholar
Detsky, A. S., Abrams, H. B., Ladha, L., & Stacey, S. R.Global budgeting and the teaching hospital in Ontario. Medical Care, 1986, 24, 89–94.Google Scholar
Downs, G. W., & Mohr, L. B.Conceptual issues in the study of innovation. Paper delivered at the Annual Meeting of the American Political Science Association, San Francisco, CA. 1975.Google Scholar
Dumbaugh, K. A. Technology assessment and diffusion in the health care sector in West Germany. In Banta, H. D. & Kemp, K. B. (eds.), The management of health care technology in nine countries. New York: Springer Verlag, 1982, 127–49.Google Scholar
Eisenberg, J. M.Doctors'decisions and the cost of medical care. Ann Arbor, MI: Health Administration Press Perspectives, 1986.Google Scholar
Elling, R. The hospital support game in urban centres. In Friedson, E. (ed.), The hospital in modern society. New York: The Free Press, 1963.Google Scholar
Ellul, J.The technological society. New York: Alfred A. Knopf, 1964, xxv.Google Scholar
Evans, R. G. The fiscal management of medical technology: the case of Canada. In Banta, H. D. (Ed.), Resources for health: Technology assessment for policy making. New York:Praeger, 1982.Google Scholar
Farquharson, A. Self-help groups: A health resource. In Coburn, D., D'Arcy, C., New, P., & Torrance, G. (eds.), Health and Canadian society: Sociological perspectives. Markham, Ontario: Fitzhenry and Whiteside, 1981, 313–21.Google Scholar
Feeny, D. New health technologies: Their effect on health and the cost of health care. In Health care technology: effectiveness, efficiency, and public policy. Institute for Research and Public Policy, 1986, 5–24.Google Scholar
Fineberg, H. V., & Hiatt, H. H.Evaluation of medical practices – the case for technology assessment. New England Journal of Medicine, 1979, 301, 1086–91.Google Scholar
Fineberg, H. V. Clinical chemistries: The high costs of low-cost diagnostic tests. In Medical technology: The culprit behind health care costs? Hyattsville, MD: National Center for Health Statistics, 1979 DHEW Pub. No. (PHS) 79–3216, 144–65.Google Scholar
Fineberg, H. V., & Pearlman, L. A.Low-cost medical practices. Annual Review of Public Health, 1982, 3, 225–48.Google Scholar
France, G.Emerging policies for controlling medical technology in Italy. International Journal of Technology Assessment in Health Care, 1988, 2, 207–27.Google Scholar
Freeman, C. Economics of research and development. In Spiegel-Rösing, D., & Price, S. (eds.), Science, technology and society. London: Sage, 1977, 223–75.Google Scholar
Fuhrer, R. Policy for medical technology in France. In Banta, H. D. & Kemp, K. B. (eds.), The management of health care technology in nine countries. New York: Springer Verlag, 1982, 100–26.Google Scholar
Gaensler, E. H. L., Jonsson, E., & Neuhauser, D. Controlling medical technology in Sweden. In Banta, H. D. & Kemp, K. B. (eds.), The management of health care technology in nine countries. New York: Springer Verlag, 1982, 167–92.Google Scholar
Glaser, W. American and foreign hospitals: Some sociological comparisons. In Freidson, E. (ed.), The hospital in modern society. New York: The Free Press, 1963, 37–72.Google Scholar
Glass, G. V., McGaw, B., & Smith, M. L.Meta-analysis in social research. Beverly Hills, CA: Sage Publications, 1981.Google Scholar
Gordon, G., & Becker, S.Changes in medical practice bring shifts in the patterns of power. The Modern Hospital, 1964, 21 (02), 102–06.Google Scholar
Gordon, G., Fischer, G. L. (eds.). The diffusion of medical technology: Policy and planning perspectives. Cambridge: Ballinger Publishing Co., 1975.Google Scholar
Greenwald, H. P., Peterson, M. L., Garrison, L. P., et al. , Interspecialty variation in officebased care. Medical Care, 1984, 22, 14–29.Google Scholar
Greer, A. L. Advances in the study of diffusion of innovation in health care organizations: In McKinlay, J. B. (ed.), Technology and the future of health care. Cambridge, MA: Milbank Reader MIT Press, 1982, 271–98.Google Scholar
Hage, G., & Aiken, M.Program change and organizational properties: A comparative analysis. American Journal of Sociology, 1967, 72, 503–19.Google Scholar
Harvey, E., & Mills, R. Patterns of organizational adaptation: A political perspective. In Zald, M. N. (ed.), Power in organizations. Nashville, TN: Vanderbilt University Press, 1970.Google Scholar
Havighurst, C. C.Regulation of health facilities and services by certificate-of-need. Virginia Law Review, 1973, 599, 1143–232.Google Scholar
Hayami, Y., & Rutman, V. M.Agricultural development: an international perspective. Baltimore, MD: Johns Hopkins University Press, 1971.Google Scholar
Hedges, L. V., & Olkin, I.Statistical methods for meta-analysis. Orlando, FL: Academic Press Inc., 1985.Google Scholar
Hellinger, F. J.The effect of certificate-of-need legislation on hospital investment. Inquiry, 1976, 13, 187–93.Google Scholar
Hiatt, H. H.Protecting the medical commons: Who is responsible? New England Journal of Medicine, 1975, 293, 235–41.Google Scholar
Iglehart, J. K. The cost and regulation of medical technology: future policy directions. In McKinlay, J. B. (ed.), Technology and the future of health care. Cambridge, MA: Milbank Reader MIT Press, 1982, 69–103.Google Scholar
Iglehart, J. K.Another chance for technology assessment. New England Journal of Medicine, 1983, 309, 509–12.Google Scholar
Iglehart, J. K.Canada's health care system (Part II). New England Journal of Medicine, 1986, 315, 778–84.Google Scholar
Institute of Medicine (committee for evaluating medical technologies in clinical use). Effects of clinical evaluation on the diffusion of medical technology. In Assessing medical technologies. Washington, DC: National Academy Press, 1985, 176–210.Google Scholar
Institute of Medicine (committee for evaluating medical technologies in clinical use). Methods of technology assessment. In Assessing medical technologies. Washington, DC: National Academy Press, 1985, 70–175.Google Scholar
Jacob, R., & Renaud, L.La technologie et le système de sante du Québec. Document préparé par l'Association des physiciens et ingénieurs biomédicaux du Québec. 05 1986. [in French].Google Scholar
Jacoby, I.Biomedical technology: information dissemination and the NIH consensus development process. Knowledge: creation, diffusion, Utilization, 1983, 5, 245–61.Google Scholar
Jennett, B.High technology medicine- benefits and burdens. Oxford: Oxford Medical Publications, 1986.Google Scholar
Krause, E. A.Health and the politics of technology. Inquiry, 1971, 8, 51–59.Google Scholar
Light, R. J., & Smith, P. V.Accumulating evidence: Procedures for resolving contradictions among different research studies. Harvard Education Review, 1971, 41, 429–71.Google Scholar
Linn, L. S., Yager, J., Leake, B. D. et al. , Differences in the numbers and costs of tests ordered by internists, family physicians and psychiatrists. Inquiry, 1984, 21, 266–75.Google Scholar
Louis, T. A., Fineberg, H. V., & Mosteller, F.Findings for public health from meta-analysis. Annual Review of Public Health, 1985, 6, 1–20.Google Scholar
Luft, H. S.Health maintenance organizations: Dimensions of performance. New York: Wiley, 1981.Google Scholar
Luft, H. S.Variations in clinical practice patterns. Archives of Internal Medicine, 1983, 143, 1861–62.Google Scholar
Manga, P. Medical technology: Status quo or more regulation? Health Management Forum, 1980, 14–18.Google Scholar
Manning, W. G., Leibowitz, A., Goldberg, G. A. et al. , A controlled trial of the effect of a prepaid group practice on use of services. New England Journal of Medicine, 1984, 310, 1505–10.Google Scholar
March, J., & Simon, H.Organizations. New York: Wiley, 1958.Google Scholar
Marquis, M. S.Laboratory test ordering by physicians: the effect of reimbursement policies. Santa Monica, CA: Rand Corporation, 1982. Rand Corporation Pub. R-2901-HCFA.Google Scholar
Martin, A. R., Wolf, M. A., Thibodeau, L. A. et al. , A trial of two strategies to modify the test-ordering behavior of medical residents. New England Journal of Medicine, 1980, 303, 1330–36.Google Scholar
McKinlay, J. B.Epidemiological and political determinants of social policies regarding the public health. Social Science and Medicine, 1979, 13a, 541–58.Google Scholar
McPherson, K., Strong, P. M., Epstein, A., & Jones, L.Regional variations in the use of common surgical procedures; within and between England and Wales, Canada and the United States of America. Social Science and Medicine, 1981, 15a, 273–88.Google Scholar
National Academy of Sciences. Medical technology and the health care system: A study of the diffusion of equipment-embodied technology. A report by the Committee on Technology and Health Care, Assembly of Engineering. Washington, DC: National Research Council and Institute of Medicine, 1979.Google Scholar
National Science Foundation. The process of technological innovation: Reviewing the literature. Washington, DC: Productivity Improvement Research Section, Division of Industrial Science and Technological Innovation, 1983.Google Scholar
Needleman, J. The management of medical technology in Canada. In Banta, H. D. & Kemp, K. B. (eds.), The management of health care technology in nine countries. New York: Springer Verlag, 1982, 28–59.Google Scholar
Newhouse, J. P., Manning, W. G., Morris, C. N. et al. , Some interim results from a controlled trial of cost sharing in health insurance. New England Journal of Medicine, 1981, 305, 1501–07.Google Scholar
Noren, J., Frazier, T., Altman, I. et al. , Ambulatory medical care: A comparison of internists and family general practitioners. New England Journal of Medicine, 1980, 302, 11–16.Google Scholar
Office of Technology Assessment, Congress of the United States. Assessing the efficacy and safety of medical technologies. Washington, DC: Government Printing Office, 1978.Google Scholar
Perkoff, G. T.Economic versus professional incentives for cost control. New England Journal of Medicine, 1982, 307, 1399–401.Google Scholar
Perrow, C.Complex organizations: A critical essay. Glenview, IL: Scott Foresman, 1972.Google Scholar
Perry, S.The brief life of the National Center for Health Care Technology. New England Journal of Medicine, 1982, 307, 1095–100.Google Scholar
Peterson, O. L., Andrews, L. P. et al. , An analytic study of North Carolina general practice. Journal of Medical Education, 1956, 31, 1.Google Scholar
Pineault, R.The effect of prepaid group practice on physicians' utilization behavior. Medical Care, 1976, 14, 121–36.Google Scholar
President's Biomedical Research Panel. Report of the President's Biomedical Research Panel, Appendix B: Approaches to policy development for biomedical research: Strategy for budgeting and movement from invention to clinical application. Washington, DC: Government Printing Office, 1976; DHEW Pub. No. (OS) 76–502.Google Scholar
President's Biomedical Research Panel. Report of the President's Biomedical Research Panel, supplement 1: Analysis of selected biomedical research programs: Case histories. Washington, DC: Government Printing Office, 1976; DHEW Pub. No. (OS) 76–506.Google Scholar
Rand Corporation. Submission to the Office of Management and Budget of supporting statements and data collection instruments for assessing the effectiveness of the NIH Consensus Development Program, 1983.Google Scholar
Relman, A. S.Assessment of medical practices: A simple proposal. New England Journal of Medicine, 1980, 303, 153–54.Google Scholar
Relman, A. S.An institute for health care evaluation. New England Journal of Medicine, 1982, 306, 669-70.Google Scholar
Renaud, M., Beauchemin, J., Lalonde, C. et al. , Practice settings and prescribing profiles: The simulation of tension headaches to general practitioners working in different practice settings in the Montreal area. American Journal of Public Health, 1980, 70, 1068.Google Scholar
Rice, T.The impact of changing Medicare reimbursement rates on physician-induced demand. Medical Care, 1983, 21, 803–15.Google Scholar
Riedel, R. L., & Riedel, D. C.Practice and performance: an assessment of ambulatory care. Ann Arbor, MI: Health Administration Press, 1979.Google Scholar
Rogers, E. M., & Shoemaker, F. F.Communication of innovations: A cross-cultural approach. New York: The Free Press, 1971.Google Scholar
Rogers, E. M.Diffusion of innovations, 3rd ed.New York: The Free Press, 1983.Google Scholar
Romeo, A. A., Wagner, J. L., & Lee, R. H.Prospective reimbursement and the diffusion of new technologies in hospitals. Journal of Health Economics, 1984, 3, 1–24.Google Scholar
Roos, N. P., Schermerhorn, J. R., & Roos, L. L.Hospital performance: Analyzing power and goals. Journal of Health and Social Behavior, 1974, 15, 78–92.Google Scholar
Roos, N. P.Hysterectomy: Variations in rates across small areas and across physicians' practices. American Journal of Public Health, 1984, 74, 327–35.Google Scholar
Rosenthal, G. Anticipating the costs and benefits of new technology: A typology for policy. In Medical technology: the culprit behind health care costs? Hyattsville, MD: National Center for Health Statistics, 1979, DHEW Pub. No. (PHS) 79–3216, 77–87.Google Scholar
Ross, C. E., & Duff, R. S.Quality of outpatient pediatric care: The influence of physicians' background, socialization and work/information environment on performance. Journal of Health and Social Behavior, 1978, 19, 348.Google Scholar
Russell, L. B., & Burke, U. S.Technological diffusion in the hospital sector. Washington, DC: National Planning Association, 1975.Google Scholar
Russell, L. B.The diffusion of new hospital technologies in the United States. International Journal of Health Services, 1976, 6, 557–80.Google Scholar
Russell, L. B.Technology in hospitals: medical advances and their diffusion. Washington, DC: The Brookings Institution, 1979.Google Scholar
Russell, L. B., & Sisk, J. E.Medical technology in the United States-The last decade. International Journal of Technology Assessment in Health Care, 1988, 4, 269–86.Google Scholar
Rutkow, I. M.The surgical decision-making process: Determinants of surgical rates. Health Services Research, 1982, 17, 379–85.Google Scholar
Rutten, F., & Banta, H. D.Health care technologies in the Netherlands – Assessment and policy. International Journal of Technology Assessment in Health Care, 1988, 4, 229–38.Google Scholar
Sackett, D. L., & Haynes, R. B.Compliance with therapeutic regimens. Baltimore, MD: Johns Hopkins University Press, 1976.Google Scholar
Sacks, H. S., Berrier, J., Reitman, D. et al. , Meta-analysis of randomized clinical trials. New England Journal of Medicine, 1987, 316, 450–55.Google Scholar
Salkever, D. S., & Bice, T. W. The impact of certificate-of-need controls on hospital investment. In McKinlay, J. B. (ed.), Technology and the future of health care. Cambridge, MA: Milbank Reader MIT Press, 1982, 301-30.Google Scholar
Sanders, C. A. Technology and the hospital. In Medical technology: the culprit behind health care costs? Hyattsville, MD: National Center for Health Statistics, 1979; DHEW Pub. No. (PHS) 79–3216, 57–76.Google Scholar
Sax, S. Australian health care systems and medical technology. In Banta, H. D., & Kemp, K. B. (eds.), The management of health care technology in nine countries. New York: Springer Verlag, 1982, 60–82.Google Scholar
Schon, D. A.Technology and change. New York: De la Corte Press, 1967.Google Scholar
Stocking, B.Medical technology in the United Kingdom. International Journal of Technology Assessment in Health Care, 1988, 4, 171–83.Google Scholar
Stoddard, G., & Feeny, D. Policy options for health care technology. In Health care technology: Effectiveness, efficiency, and public policy. Institute for Research and Public Policy, 1986, 225-58.Google Scholar
Thompson, J. D.Organizations in action. New York: McGraw-Hill, 1967.Google Scholar
U.S. Federal Council for Science and Technology. Report of the Executive Subcommittee of the Committee on Government Patent Policy, University Patent Policy Ad Hoc Subcommittee, 1975.Google Scholar
Utterback, J. M.Innovation in industry and the diffusion of technology. Science, 1974, 183, 620–26.Google Scholar
Vayda, E., Morison, M., & Anderson, G. D.Surgical rates in the Canadian provinces, 1968–1972: A five year analysis. Canadian Journal of Surgery, 1976, 19, 235-42.Google Scholar
Wagner, J. L., & Zubkoff, M. Medical technology and hospital costs. In McKinlay, J. B. (ed.), Technology and the future of health care. Cambridge, MA: Milbank Reader MIT Press, 1982, 104–30.Google Scholar
Walker, J. L.The diffusion of innovations among the American states. American Political Science Review, 1969, 63, 880–89.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.Google Scholar
Wennberg, J.E., & Gittelsohn, A. M.Small area variations in health care delivery. Science, 1973, 182, 1102-08.Google Scholar
Whitted, G. S. Medical technology diffusion and its effects in the modern hospital. HCM Review, 1981 (Spring), 159–68.Google Scholar
Wickings, I., Coles, J. M., Flux, R., et al. Review of clinical budgeting and costing experiments. British Medical Journal, 1983, 1, 575–78.Google Scholar
Wilson, J. Q. Innovation in organization: Notes toward a theory. In Thompson, J. D. (ed.), Approaches to organizational design. Pittsburgh: University of Pittsburgh Press, 1966, 193–218.Google Scholar
Winner, L.Autonomous technology. Cambridge, MA: The MIT Press, 1977, 5–7.Google Scholar
Wortman, P. M., & Vinokur, A.Evaluation of the NIH consensus development process. Phase I: final report. Ann Arbor, MI: Center for Research on Utilization of Scientific Knowledge, University of Michigan, 1982.Google Scholar
Zaltman, G., Duncan, R., & Holbeck, J.Innovations and organizations. New York: Wiley, 1973.Google Scholar