Teplensky J D, Pauly M V, Kimberly J R, Hillman A L, Schwartz J S
Health Systems Management Center, Weatherhead School of Management, Case Western Reserve University, Cleveland, OH 44106, USA.
Health Serv Res. 1995 Aug;30(3):437-65.
This study examines hospital motivations to acquire new medical technology, an issue of considerable policy relevance: in this case, whether, when, and why hospitals acquire a new capital-intensive medical technology, magnetic resonance imaging equipment (MRI).
We review three common explanations for medical technology adoption: profit maximization, technological preeminence, and clinical excellence, and incorporate them into a composite model, controlling for regulatory differences, market structures, and organizational characteristics. All four models are then tested using Cox regressions.
The study is based on an initial sample of 637 hospitals in the continental United States that owned or leased an MRI unit as of 31 December 1988, plus nonadopters. Due to missing data the final sample consisted of 507 hospitals. The data, drawn from two telephone surveys, are supplemented by the AHA Survey, census data, and industry and academic sources.
Statistically, the three individual models account for roughly comparable amounts of variance in past adoption behavior. On the basis of explanatory power and parsimony, however, the technology model is "best." Although the composite model is statistically better than any of the individual models, it does not add much more explanatory power adjusting for the number of variables added.
The composite model identified the importance a hospital attached to being a technological leader, its clinical requirements, and the change in revenues it associated with the adoption of MRI as the major determinants of adoption behavior. We conclude that a hospital's adoption behavior is strongly linked to its strategic orientation.
本研究考察医院购置新医疗技术的动机，这是一个具有相当政策相关性的问题：在本案例中，即医院是否、何时以及为何购置一种新的资本密集型医疗技术——磁共振成像设备（MRI）。
我们回顾了关于医疗技术采用的三种常见解释：利润最大化、技术卓越和临床卓越，并将它们纳入一个综合模型，同时控制监管差异、市场结构和组织特征。然后使用考克斯回归对所有四个模型进行检验。
该研究基于美国大陆637家医院的初始样本，这些医院截至1988年12月31日拥有或租赁了一台MRI设备，另外还包括未采用者。由于数据缺失，最终样本由507家医院组成。这些数据来自两次电话调查，并辅以美国医院协会调查、人口普查数据以及行业和学术来源。
从统计学角度来看，这三个单独的模型在过去采用行为的方差解释量上大致相当。然而，基于解释力和简约性，技术模型是“最佳”的。虽然综合模型在统计学上比任何一个单独模型都要好，但在考虑增加的变量数量后，它并没有增加太多的解释力。
综合模型确定了医院对成为技术领先者的重视程度、其临床需求以及与采用MRI相关的收入变化是采用行为的主要决定因素。我们得出结论，医院的采用行为与其战略导向密切相关。
