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Factors effecting adoption of new neonatal and pediatric respiratory technologies

  • Pediatric Brief Report
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Abstract

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.

Design, setting, participants

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.

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Author information

Authors and Affiliations

  1. Mountains Community Hospital, PO Box 70, 92352, Lake Arrowhead, CA, USA

    Thomas E. Bachman

  2. California State University San Bernardino, 92407-2317, San Bernardino, CA, USA

    Norton E. Marks

  3. Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland

    Peter C. Rimensberger

Authors
  1. Thomas E. Bachman
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  2. Norton E. Marks
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  3. Peter C. Rimensberger
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Corresponding author

Correspondence to Thomas E. Bachman.

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Key questions

Key questions

“When new clinical concepts are emerging personal interest,” ranging across the five-point Likert scale from “eager to use” to “no interest”. “Use of HFV for VLBW infants,” ranging across the five-point Likert scale from “first intention” to “only rescue”. “Use of HFV for pediatric and term infants with ARDS,” ranging across the five-point Likert scale from “early” to “last choice for rescue”. “Use of nCPAP to prevent the need for mechanical ventilation,” ranging across the five-point Likert scale from “always” to “never”. “Use of nCPAP to prevent the need for mechanical ventilation,” ranging across the five-point Likert scale from “always” to “never”.

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Bachman, T.E., Marks, N.E. & Rimensberger, P.C. Factors effecting adoption of new neonatal and pediatric respiratory technologies. Intensive Care Med 34, 174–178 (2008). https://doi.org/10.1007/s00134-007-0914-6

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  • DOI: https://doi.org/10.1007/s00134-007-0914-6

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