An examination of the direct consequences and the individual characteristics influencing physician adoption of a practice guideline innovation

In 1991, Americans spent 13.2 percent of gross domestic product (GDP) on healthcare, while other countries spent less than 10 percent. One of every seven dollars, 14.3 percent of GDP, was spent by Americans on health services in 1993. According to The Annual Report of the Council of Economic Advisors, Economic Report of the President February 1994, the United States spends more per capita and allocates a much larger share of its income to health care than any other country in the world. Currently, in 1996, as a result of industry-driven cost containment measures, the U.S. health care system's spiraling costs appear to have stabilized, representing slightly less than 14% of the GDP (Gaus, 1997).;The adoption of a new practice guideline by physicians is a managerial technological innovation as defined by Kimberly (1981) and Rogers (1995a, 1995b) That is, it is a new program or technique that departs from the "state of the art" at the time it first appears, affecting the nature, quantity, or quality of information that is available in the decision-making process (Kimberly, 1981). Today, innovations are being generated and adopted (implemented) at an increasing rate in all economic sectors of our society (Backer, 1995).;There are three major objectives of this study. First, to broadly review the extant literature on diffusion of innovations theory development, over the more than five decades of research, regarding how new ideas are spread (Rogers, 1995a). Second, to perform a focused review of the literature, regarding the impact of hospital strategic change intervention programs, on adoption by physicians of locally developed practice guidelines, introduced by physician opinion leaders or change agents. Finally, to seek answers to the general research question: "Do physicians guidelines have an impact in changing physicians (practice pattern) behavior? In other words, do physicians comply with practice guidelines and recommendations?" (Rogers, 1995b). An analysis of the empirical data, resulted in the absence of statistical evidence supporting both physician adoption of the practice guideline and the subsequent attainment by the health care system of its strategic objective of reduced direct costs, the direct consequence.;In today's health care industry environment of cost containment and scarce health care resources, it is necessary to implement methods to achieve high levels of efficiency and effectiveness. Increasingly, hospitals are assessing physician practice patterns in an effort to reduce wasted resources (O'Conner, 1993, p. 572).