title: Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot.
abstract: The surgical robot, a costly technology for treatment of prostate cancer with equivocal marginal benefit, rapidly diffused into clinical practice. We sought to evaluate the role of teaching in the early adoption phase of the surgical robot. Teaching hospitals were the primary early adopters: data from the Healthcare Cost and Utilization Project showed that surgical robots were acquired by 45.5% of major teaching, 18.0% of minor teaching and 8.0% of non-teaching hospitals during the early adoption phase. However, teaching hospital faculty produced little comparative effectiveness research: By 2008, only 24 published studies compared robotic prostatectomy outcomes to those of conventional techniques. Just ten of these studies (41.7%) were more than minimally powered, and only six (25%) involved cross-institutional collaborations. In adopting the surgical robot, teaching hospitals fulfilled their mission to innovate, but failed to generate corresponding scientific evidence.
authors.affiliation: 1 Department of Veterans Affairs New York Harbor Healthcare System, New York, NY.|2 Department of Urology.|3 Department of Population Health.|4 New York University Cancer Institute.|5 Robert F. Wagner Graduate School of Public Service.
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.affiliation: 3 Department of Population Health.|4 New York University Cancer Institute.
authors.forename: Huilin
authors.initials: H
authors.lastname: Li
authors.affiliation: 2 Department of Urology.|4 New York University Cancer Institute.
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
authors.affiliation: 7 Robert Wood Johnson Clinical Scholars Program and Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: 5 Robert F. Wagner Graduate School of Public Service.|6 Department of Medicine New York University, New York, NY.
authors.forename: Jan
authors.initials: J
authors.lastname: Blustein
mesh_terms: D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000517:prevention & control; D065287:Robotic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends
keywords: comparative effectiveness research; diffusion of innovation; new technology; prostate cancer; teaching hospitals