Department of Economics and Public Policy, Business School, Imperial College London, UK; Organisation for Economic Co-operation and Development (OECD), UK.
Department of Economics and Public Policy, Business School, Imperial College London, UK; Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, UK.
Soc Sci Med. 2021 Mar;272:113715. doi: 10.1016/j.socscimed.2021.113715. Epub 2021 Jan 28.
Little is known about the role of clinicians in accounting for adoption and diffusion of medical innovations, especially within the English National Health System. This study examines the importance of surgical consultants and their work-based networks on the diffusion of an important innovation, minimally invasive elective laparoscopic colectomy for colorectal cancer. The study used linked patient-level and workforce data on 260,110 elective colectomies and 1288 consultants between 2000 and 2014, to examine adoption of laparoscopic colectomy pre- and post-introduction of clinical guidelines and total share of colectomies performed laparoscopically by adopters. Laparoscopy as a share of elective colectomy increased from 0% in 2000 to 53% in 2014. Surgeons, rather than hospitals, were the principal agents accounting for the increase and explain 46.6% of the variance in laparoscopic colectomy use. Female surgeons, surgeons trained outside the United Kingdom, and recent graduates had higher rates of laparoscopy adoption. More experienced surgeons and surgeons with more peers who perform laparoscopy were more likely to adopt, adopt early and have greater use of laparoscopy. Targeting clinicians, rather than hospitals, is central to increasing adoption and diffusion of new medical technologies.
人们对临床医生在解释和推广医学创新方面的作用知之甚少，尤其是在英国国家医疗服务体系内。本研究考察了外科顾问及其工作网络在推广一项重要创新（即微创择期腹腔镜结直肠切除术治疗结直肠癌）方面的重要性。该研究使用了 2000 年至 2014 年间 260110 例择期结直肠切除术和 1288 名顾问的患者层面和劳动力层面的相关数据，以检验腹腔镜结直肠切除术在临床指南引入前后的采用情况，以及采用者进行的腹腔镜结直肠切除术的总比例。腹腔镜结直肠切除术的比例从 2000 年的 0%增加到 2014 年的 53%。推动这一增长的主要因素是外科医生，而不是医院，并且外科医生解释了腹腔镜结直肠切除术使用比例变化的 46.6%。女外科医生、在英国以外受训的外科医生和应届毕业生的腹腔镜采用率更高。经验更丰富的外科医生和更多进行腹腔镜手术的同行的外科医生更有可能采用、更早采用并更多地使用腹腔镜手术。以临床医生为目标，而不是以医院为目标，对于增加和推广新的医疗技术至关重要。
