GEN Universidade de Vigo, Vigo, Spain.
Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
BMC Health Serv Res. 2021 Nov 27;21(1):1278. doi: 10.1186/s12913-021-07225-2.
This article examines what the adoption and use of advanced medical technologies - computed tomography (CT) and magnetic resonance imaging (MRI) - by public hospitals depend on and to what extent.
From a sample of panel data for all public hospitals in the health service of Galicia (a subregion of the Galicia-North of Portugal Euroregion) for the 2010-2017 period, we grouped explanatory variables into inputs (resources), outputs (activities) and socio-demographic variables. Factor analysis was used to reduce as much as possible the number of analysed variables, discriminant analysis to examine the technologies adoption decision, and multiple regression analysis to investigate their use.
Factor analysis identified motivators on adoption and use of CT and MRI medical technologies as follows: hospital inputs/outputs (Factor 1); radiology studies and adoption of CT by public hospitals (Factor 2); research/teaching role and big-ticket diagnostic and therapeutic (lithotripsy) technologies (Factor 3); number of transplants (Factor 4); cancer diagnosis/treatment (Factor 5); and catchment area geographical dispersion (Factor 6). Cronbach's alpha of 0.881 indicated an acceptable degree of reliability of the factor variables. Regarding adoption of these technologies, Factor 1 is the most influential, explaining 37% of the variance and showing adequate global internal consistency, whereas Factor 2 is limited to 13% of the variance. In the discriminant analysis, values for Box's M test and canonical correlations such as Wilks's lambda for the two technologies underpin the reliability and predictive capacity of the discriminant equations. Finally, and according to the regression analysis, the factor with the greatest influence on CT and MRI use is Factor 2, followed by Factors 1 and 3 in the case of CT use, and Factors 3 and 5 in the case of MRI use.
CT and MRI adoption by public hospitals is mainly determined by hospital inputs and outputs. However, the use of both medical technologies is mainly influenced by conventional radiology studies and CT adoption. These results suggest that both choices - adoption and use of advanced medical technology - may be separate decisions as they are taken possibly by different people (the former by managers and policymakers and the latter by physicians).
本文研究了公立医院采用和使用先进医疗技术（计算机断层扫描（CT）和磁共振成像（MRI））的原因及其程度。
我们对加利西亚卫生服务（加利西亚-葡萄牙北部欧洲地区的一个次区域）所有公立医院的面板数据（2010-2017 年）进行了抽样，将解释变量分为投入（资源）、产出（活动）和社会人口变量。我们使用因子分析尽可能减少分析变量的数量，使用判别分析检查技术采用决策，使用多元回归分析调查其使用情况。
因子分析确定了 CT 和 MRI 医疗技术采用和使用的驱动因素如下：医院投入/产出（因子 1）；放射科研究和公立医院 CT 采用（因子 2）；研究/教学角色和大笔诊断和治疗（碎石术）技术（因子 3）；移植数量（因子 4）；癌症诊断/治疗（因子 5）；和集水区地理分布（因子 6）。因子变量的 Cronbach's alpha 为 0.881，表明可靠性程度可接受。关于这些技术的采用，因子 1 的影响最大，解释了 37%的方差，具有足够的全局内部一致性，而因子 2 仅限于 13%的方差。在判别分析中，Box 的 M 检验值和典型相关系数（如两种技术的 Wilks lambda）为判别方程的可靠性和预测能力提供了支持。最后，根据回归分析，对 CT 和 MRI 使用影响最大的因素是因子 2，其次是 CT 使用的因子 1 和 3，以及 MRI 使用的因子 3 和 5。
公立医院采用 CT 和 MRI 主要取决于医院的投入和产出。然而，这两种医疗技术的使用主要受常规放射学研究和 CT 采用的影响。这些结果表明，先进医疗技术的采用和使用这两个决策可能是由不同的人做出的（前者由管理者和政策制定者做出，后者由医生做出）。
