Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework

Abstract

Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure-process-outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2-part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals.

The relationship between hospital adoption and use of high technology medical imaging and in-patient mortality and length of stay

“…From a theoretical perspective, this study investigates the role of adoption and use of medical imaging within a broader framework of quality of hospital care, where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors and hospital outcomes (i.e. quality and efficiency) (Sandoval et al , 2018). This framework distinguishes between adoption and use of these technologies, as they connote different stages in the uptake of an innovation (Nystrom et al , 2002; Rye and Kimberly, 2007).…”

“…From both conceptual and empirical grounds, adoption of advanced imaging should improve the ability of hospitals to deliver high quality and efficient care through at least three main mechanisms, including the use of the technology on patients, the presence of more staff and more qualified care providers, and other elements of organizational capacity capturing an enhanced clinical environment (Sandoval et al , 2018).…”

“…320‐slice CT scanners), provides better image quality and anatomical details typically in less time (Keller, 2005). This results in more accurate and timely diagnosis, which in turn allows treatment to begin more quickly and/or prevents unnecessary, and in some cases painful and expensive, treatments (Sandoval et al , 2018). If a suspected condition is not identified or diagnosed with the use of the technology, there is still value in the information gained, by improving the direction of further care (Baker et al , 2008).…”

“…Treatment also benefits from the use of advanced imaging by informing the course of therapy and complications, and re-directing a patient care strategy if necessary (Mettler et al , 2000). It is not surprising that this sophistication has prompted expanded indications for the use of advanced imaging, and alongside the practice of defensive medicine, short consultation times, and the power of patients who demand more tests has led physicians to increasingly attach more value into these tools rather than their clinical skills (Sandoval et al , 2018). At present, advanced imaging offers a high technology alternative to traditional plain (film) X-rays and ultrasounds, and has become the top choices in disease diagnostics (AHIP, 2008; Laupacis et al , 2005).…”

“…The information obtained can help built evidence to inform and direct additional steps to define appropriate imaging use where it is needed the most. The framework informing this study – described elsewhere – was used to identify the variables examined, which have been investigated in both the literature on quality of hospital care and that on adoption of technological innovations in health provider organizations (Sandoval et al , 2018).…”