At present, growth of the integrated care system (ICS) is accelerating worldwide [1-4]. In China, acting as an important carrier of ICS, many regional medical consortiums (RMCs) provides a good opportunity to promote the communication and collaboration between different levels of health institutions [5,6]. Meanwhile, it also puts forward higher requirements on the integration ability of health resources and the service quality of primary health institutions [7,8]. Although some achievements have been made in the integration of health resources in the RMC, problem of under-utilization of health technology still exists in practice, and the value of many health technologies have not been given full play [9]. Taking des-ganmma-carboxy prothrombin (DCP) for example, DCP is a tumor marker of primary hepatocellular carcinoma, and the security, effectiveness and economy of DCP test in early detection of primary hepatocellular carcinoma have been reported in many clinical practices and studies [10-13]. However, even in the context of RMC, the utilization of DCP is mainly limited to the large hospitals, which constrained the full play of its diagnostic and therapeutic functions in a wider range. Since the dynamic mechanism of health technology diffusion in ICS remained largely unknown, to provide theoretical guidance and supporting tool for promoting effective integration of health technology, this study aims to take DCP test as an example to develop a scale for measuring the dynamics of health technology diffusion in the context of integrated care system.
Theories in technology diffusion
A lot of researches on technology diffusion have carried out in the disciplines of sociology, behavior, psychology and so on. And many classical theories have been proposed and guided the practices, such as the Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), Innovation Diffusion Theory (IDT) and Technology-Organization-Environment framework (TOE). TPB suggests individual’s behavior is ultimately influenced by behavioral intention, which is a function of attitude toward behavior, subjective norms and perception of the ease with the behavior can be performed [14]. TAM implies perceived usefulness and perceived ease of use as two crucial factors, which focuses on the impact of technology natures [15]. IDT demonstrates that properties of technology and interpersonal communication can affect technology use [16]. TOE infers that the effect of technology, organization and external environment should be considered [17].
Domains and Dimensions
Since there were insufficient explanations in terms of health technology diffusion from different perspectives and facets, we integrate these theories to provide some clues on the potential factors affecting health technology diffusion, and explore the dynamics of health technology diffusion in ICS from four domains, namely domain of personal beliefs, domain of technical drivers, domain of organizational readiness and domain of external environment (Figure 1).
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In this study, personal beliefs refer to the physicians’ perceptions on DCP test and its use. It is one of the domains strongly associated with health technology diffusion, which mainly depend upon two major factors: attitudes and subjective norms. Attitude has been perceived as one of the most powerful predictor in technology adoption and use, while subjective norms are kind of perceived criterions and pressures from important individuals’ judgements. With respect to DCP test adoption and use, physicians’ positive or negative attitude reflects different predispositions [18,19]. And for the physicians working in a clear hierarchy system such as the RMC, opinions on DCP test from leaders, supervisors and colleagues are forces to be reckoned with [20-22].
The technical drivers, which involves the nature of technology including ease of use and price rationality, acts as an indispensable domain concerned with diffusion dynamics of health technology [23]. Innate properties of health technology can influence behavioral tendency [24]. Taking DCP test for instance, ease of use is a degree to which the physicians expect the DCP test can be performed with ease, while price rationality is an underlying important source of motivation [25,26]. These are of vital importance for the primary health centers and county hospitals within the RMC. Because of limited funding support and human resource, these organizations tend to adopt technologies easier to perform with price rationality.
Moreover, studies have mentioned the importance of domain of organizational readiness, which reflects the overall preparedness for health technology and preference tendency of the entire staff, it consists of three factors: organizational culture, technology absorptive willingness and technology sharing willingness. Organizational culture is the ensemble of values, norms, beliefs, language patterns and operating behaviors shared by individuals or groups within an organization, such as RMC or a hospital within it [27,28]. Technology absorptive willingness show the willingness and readiness situations of introducing a new health technology into the organization [29], while technology sharing willingness is a degree of sharing knowledge with the other organizations [30,31].
Domain of external environment is generally considered as an important factor affecting the health technology diffusion, which usually focuses on industry competition pressure [32,33]. In the context of RMC with well integration of health service delivery, in most cases, competition still occurs among hospitals of the same type and grade. Even in some conditions for soliciting more patients, there are some intense competitions among different levels of medical institutions within RMC. Both the trend in the market and the tendency of business partners are main concerns of the hospital managers while making decision on whether adopting certain technology [34].