Factors effecting adoption of new neonatal and pediatric respiratory technologies.
OBJECTIVE
There remains significant variation in the level and rate of adoption of new pediatric respiratory technologies, in spite of two decades of focus on "evidence-based medicine". Nearly 50 years ago Rogers introduced a rubric for understanding issues that effect the adoption of technologies that included four factors plus evidence of advantage. We sought to determine whether Rogers' factors were useful in understanding contrasts between clinical utilization of technology and evidence of advantage.


METHODS
We conducted a written survey at two international neonatal/pediatric respiratory conferences. We asked about use of four specific indications for high-frequency ventilation (HFV) and nasal continuous positive airway pressure (nCPAP).


RESULTS
These four specific respiratory therapies were aggressively used by most, despite significant differences in the evidence supporting their utility: elective use of HFV (57.4%); HFV to treat ARDS (62.7%); nCPAP for weaning following extubation (83.9%); and nCPAP to avoid intubation (82.1%).


CONCLUSIONS
Evidence of outcomes advantage should be the key factor in assessing potentially beneficial technologies. However, we suggest that understanding the influence of observe-ability, complexity and subjectivity of relative advantage explains much of the contrast between adoption level and outcome evidence. These factors described by Rogers, that encourage adoption of mediocre technologies or that retard adoption of potentially beneficial technologies, should be understood and acknowledged. This perspective can be applied not only to national adoption patterns, but also to adoption of best practices within an individual unit.
Bachman
Thomas E
TE
Mountains Community Hospital, PO Box 70, Lake Arrowhead 92352, CA, USA. tom.bachman@mchcares.com
Marks
Norton E
NE
Rimensberger
Peter C
PC
D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D019538:Health Care Surveys; D006612:High-Frequency Ventilation / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D010818:Practice Patterns, Physicians'; D012128:Respiratory Distress Syndrome / Q000628:therapy*