Implementation of Innovative Medical Technologies In German Inpatient Care: Patterns of Utilization And Evidence Development

Abstract Background: Innovative medical technologies are commonly associated with positive expectations. At the time of their introduction into care, there is often little evidence available on their benefits and harms. Thus, it happens that some health innovations with a lack of evidence are used widely until or even though adverse study results emerge. Others with strong scientific support remain underused. The study aims at examining the diffusion patterns of innovative medical technologies in German inpatient care between 2005 and 2017 while simultaneously considering evidence development. Methods: Based on a qualitatively derived typology and a quantitative clustering process of the adoption curves, a representative sample of 21 technologies was selected for further evaluation. Published scientific evidence on efficacy and safety of the technologies was identified and extracted in a systematic approach. Derived from a two-dimensional classification according to the degree of utilization and state of scientific evidence, the diffusion processes were then assigned to the categories "Success" (widespread/positive), "Hazard" (widespread/negative), "Overadoption" (widespread/limited or no), "Underadoption" (cautious/positive), "Vigilance" (cautious/negative) and "Prudence" (cautious/ limited or no). Results: Overall, we found limited evidence regarding both the quantity and quality of published randomized controlled trials. Thus, the categories “Prudence” and “Overadoption” together account for nearly three-quarters of the years evaluated, followed by “Success” with 17 percent. Even when evidence is available, the transfer of knowledge into practice seems inhibited. Conclusions: The successful implementation of innovations into practice requires substantial further efforts by policymakers to strengthen systematic knowledge generation and translation. Creating an environment that encourages the conduct of rigorous studies, promotes knowledge translation, and rewards innovations according to their added value are prerequisites for the diffusion of valuable innovations in the health care sector.