How Important is the Scientific Literature in Guiding Clinical Decisions?: The Case of Magnetic Resonance Imaging

Abstract

Little is known about how information diffuses to clinicians and influences their purchase and use of new technology. This is especially true about the role of the scientific literature. As a case study, we examined the literature for magnetic resonance imaging (MRI) during the years preceding and the first five years following its clinical introduction. Using a computerized retrieval system, we identified approximately 1,700 citations in which MRI was the major topic. The clinical literature on MRI was heavily concentrated in radiology journals. Less than 28% of articles compared MRI with alternative diagnostic technologies. During the first five years of clinical availability, the diffusion patterns of scientific articles and operational units mirrored the example set by computerized tomography (CT), in that a substantial number of units were purchased in both research and nonresearch settings before studies were available comparing them to alternative diagnostic technologies. These patterns of diffusion, combined with other studies of the MRI literature's content and methodology, suggest that less comprehensive and objective sources of information were important in early purchasing decisions. This study also suggests that the present readership and publication patterns of professional journals may not facilitate effective, rapid information dissemination about innovations to a broad spectrum of clinicians.

The Adoption of Innovations by Provider Organizations in Health Care

“…Finally, very little research focuses on how demonstrated efficacy may influence the adoption of innovations in organizations. Some research suggests that organizations may adopt innovations before there is evidence that they actually produce their intended effects, particularly in health care, where the impact of medical innovation on patients is sometimes ambiguous (Ramsey et al 1993). Thus, research should focus on the role of evidence in adoption decisions as well as on how emerging evidence influences disengagement.…”

Physicians' Opinions and Use of Controversial Technologies: The Case of Mammographic Screening in Norway

“…Most physicians in favor of mammographic screening indicated reduced mortality (an epidemiological issue) as the most important argument, but few radiologists mentioned epidemiological publications as the basis of their opinion. In conclusion, the basis of opinions remains somewhat unclear, but it is conceivable that imperfect information (30) underlies the diffusion and use of mammography.…”