Diffusion of Procedure Innovation Among Cardiac Catheterization Operators at the Veterans Health Administration

Abstract

This research is an important first step in understanding the role of physicians as front-line adopters of innovative cardiac intervention procedures. Previous research has demonstrated that innovative coronary intervention procedures are adopted at different rates across Veterans Health Administration (VHA/VA) hospitals and remains unclear about what drives this difference. For example, interventions can occur via the femoral or radial artery, yet the novel radial-access method is unevenly adopted. Clinical decisions by interventional cardiologists (i.e., operators) in community hospitals have been shown to vary widely even within the same facility, suggesting operators as drivers of adoption. A prevailing hypothesis in implementation theory is that social networks play a role in individuals conforming to dominant norms via interpersonal influences. To our knowledge, no study has examined conformity among operator use of innovative coronary procedures or how much variation is attributable to patients, individual operators, or hospitals within VHA. This retrospective analysis of all diagnostic and interventional cardiac catheterizations between June 2011 and March 2021, based on the VA Clinical Assessment Reporting and Tracking Program (CART), sought to: •Aim 1: Determine the variation in adoption of 4 innovative coronary intervention procedures attributable to hospital, operator, and patient. Random-effects models were used to quantify patient, clinician, and hospital-level variability. •Aim 2: Assess if early career interventional cardiologists (i.e., operators practicing for less than 5 years since clinical fellowship training) are more likely to perform innovative procedures. We used logistic regression models to estimate the association between being an early-stage career operator and innovation adoption. •Aim 3: Determine how the arrival of a radial-dominant operator affects the use of the trans-radial approach among existing operators in a hospital. We used mixed-effects logistic regression to estimate the association between being in a hospital exposed to a radial-dominant operator and use of radial-access. Findings from this research provide preliminary evidence to support strategies for improved implementation of innovative, recommended, and/or evidence-based care and ultimately, a medical culture that can integrate new ideas and dynamics to achieve sustained change.