title: Patterns of change in nesiritide use in patients with heart failure: how hospitals react to new information.
abstract: OBJECTIVE
  This study sought to determine hospital patterns of change in use of nesiritide over a 6-year period after publications of safety concerns in 2005 and to identify hospital characteristics associated with these patterns.
  
  
  BACKGROUND
  The changing nature of medical evidence often requires a change in practice. Nesiritide was commercialized in 2001 for early relief of dyspnea in patients with decompensated heart failure. In 2005, concerns about its safety led to recommendations to restrict its use. Little is known about how hospitals responded to this information.
  
  
  METHODS
  We analyzed data from the Premier database, including 403 hospitals contributing 813,783 hospitalizations with heart failure from 2005 to 2010. We applied a growth mixture modeling approach to hospital-level, risk-standardized, quarterly use rates of nesiritide to distinguish hospital groups on the basis of their patterns of change in use.
  
  
  RESULTS
  The proportion of hospitalizations using nesiritide declined from 15.4% in 2005 to 1.2% in 2010. The level and speed of change varied markedly among hospitals. After adjusting for differences in patient characteristics across hospitals and years, we identified 3 distinct groups of hospitals: "low users," "fast de-adopters," and "slow de-adopters." In multivariate regression analysis, these groups did not differ in traditional hospital characteristics, such as size, urban setting, or teaching status.
  
  
  CONCLUSIONS
  We identified 3 distinct hospital groups characterized by their patterns of change in nesiritide use. These trajectory curves can provide hospitals with important feedback on how fast and effectively they react to new information compared with other hospitals. Uncovering factors that promote organizational learning requires further research.
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut. Electronic address: chohrehpartovi@gmail.com.
authors.forename: Chohreh
authors.initials: C
authors.lastname: Partovian
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Li
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Comparative Effectiveness Research, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: John
authors.initials: J
authors.lastname: Hwa
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D045283:Natriuretic Agents / Q000009:adverse effects*; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects*
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain
keywords: drug use; heart failure; hospital; organizational learning; practice patterns; response to new evidence