Escarce J J, Bloom B S, Hillman A L, Shea J A, Schwartz J S
Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia.
Med Care. 1995 Mar;33(3):256-71. doi: 10.1097/00005650-199503000-00005.
Introduced in 1989, laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examine the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than three fourths of adopters identified the desire to keep up with the state-of-the-art and improved patient outcomes as very or extremely important reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generally was consistent with expected utility maximization in an uncertain new technological environment. Of particular interest, fee-for-service payment and more competitive practice settings and markets were associated with earlier adoption. These findings suggest that the "technological imperative" and surgeons' perception of the relative clinical and financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Policies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product innovations in health care.
腹腔镜胆囊切除术于1989年引入，迅速成为有症状胆结石的首选治疗方法。本研究描述了腹腔镜胆囊切除术在普通外科医生中的传播情况；评估了外科医生采用该手术的各种原因的重要性；并考察了外科医生、执业情况和医疗保健市场特征对采用时机的影响。数据来自对全国外科医生样本的调查。大多数外科医生（81%）在1992年初采用了腹腔镜胆囊切除术。超过四分之三的采用者认为跟上技术发展水平和改善患者预后是采用该手术的非常重要或极其重要的原因。比例风险回归分析结果表明，在不确定的新技术环境中，个体外科医生的采用行为总体上与预期效用最大化一致。特别值得关注的是，按服务收费以及更具竞争性的执业环境和市场与更早采用相关。这些发现表明，“技术必要性”以及外科医生对腹腔镜胆囊切除术相对临床和财务优势的认知是腹腔镜胆囊切除术迅速传播的重要原因。加快当前基于薪水或人头费支付医生薪酬的趋势并促进多专科团体执业发展的政策可能会减缓医疗保健领域基于医生的新创新产品的传播。
