title: [Which non-clinical factors influence the use of innovative implants? The example of drug-releasing coronary stents in patients with acute myocardial infarction: a multilevel regression analysis].
abstract: OBJECTIVE
  The aim of this paper is to identify characteristics that inhibit or encourage the diffusion of novel implants in the German health care system using the example of drug-eluting stents (DES). After their introduction in the early 2000s, DES were considered as an effective innovative technology. Hypotheses that link the use of DES to characteristics on patient-level, hospital-level, regional-level as well as on state-level are generated on existing literature. These hypotheses are tested using administrative data from a German sickness fund.
  
  
  METHODS
  The analysis is based on the administrative sickness fund data of 6 777 patients with a hospital admission due to an acute myocardial infarction (AMI) and an implantation of either a DES or a bare-metal stent. The sickness fund data was merged with information on reimbursement surcharges for DES implantations, information from the German Hospital Registry and information on county level provided by the German National Statistical Office. Logistic regressions with random intercepts on hospital and county level as well as fixed effects on state level were estimated to identify characteristics that are correlated with DES use.
  
  
  RESULTS
  All levels do have an impact on the treatment decision whereas the patient-level is of major importance. In particular, young age, admission to a university or a privately owned hospital and a hospital located in a county with a low level of bankruptcies are positively correlated with DES use.
  
  
  CONCLUSIONS
  Although individual characteristics are of major importance for DES use in the German health care system, characteristics at the hospital and regional level do have an impact on the use of DES. Further research on the influence of reimbursement mechanisms in the German setting is needed.
authors.affiliation: Fachgebiet Management im Gesundheitswesen, Technische Universität, Berlin.
authors.forename: M
authors.initials: M
authors.lastname: Bäumler
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D003627:Data Interpretation, Statistical; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D004651:Employment; D005260:Female; D005858:Germany / Q000453:epidemiology; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011474:Prosthesis Design; D012044:Regression Analysis; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult