Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot.

The surgical robot, a costly technology for treatment of prostate cancer with equivocal marginal benefit, rapidly diffused into clinical practice. We sought to evaluate the role of teaching in the early adoption phase of the surgical robot.

Teaching hospitals were the primary early adopters: data from the Healthcare Cost and Utilization Project showed that surgical robots were acquired by 45.5% of major teaching, 18.0% of minor teaching and 8.0% of non-teaching hospitals during the early adoption phase. However, teaching hospital faculty produced little comparative effectiveness research: By 2008, only 24 published studies compared robotic prostatectomy outcomes to those of conventional techniques. Just ten of these studies (41.7%) were more than minimally powered, and only six (25%) involved cross-institutional collaborations. In adopting the surgical robot, teaching hospitals fulfilled their mission to innovate, but failed to generate corresponding scientific evidence.

Medical care research and review : MCRR. 2016 Mar 30 [Epub ahead of print]

Danil V Makarov, Huilin Li, Herbert Lepor, Cary P Gross, Jan Blustein

Department of Veterans Affairs New York Harbor Healthcare System, New York, NY Department of Urology Department of Population Health New York University Cancer Institute Robert F. Wagner Graduate School of Public Service. Department of Population Health New York University Cancer Institute., Department of Urology New York University Cancer Institute., Robert Wood Johnson Clinical Scholars Program and Department of Internal Medicine, Yale University School of Medicine, New Haven, CT., Robert F. Wagner Graduate School of Public Service Department of Medicine New York University, New York, NY.