Spillover effects and other determinants of medical device uptake in the presence of a medical guideline: an analysis of drug-eluting stents in Germany and Italy

We investigated the role of spillover effects among hospitals in the diffusion of drug-eluting stents (DES) in Germany and Italy during a period in which the relevant medical guideline clearly recommended their use over bare-metal stents. We used administrative data of hospitalized patients treated with ST-elevation myocardial infarction from 2012 to 2016 to estimate spatial panel models allowing for global spillover effects. We used an inverse-distance weights matrix to capture the geographical proximity between neighboring hospitals and assigned a lower weight to more distant neighbors. For both countries, we found significant positive spatial autocorrelation in most years based on the global Moran's I test, and a significant, positive spatial lag parameter across model specifications, indicating positive spillover effects among neighboring hospitals. We found that private for-profit hospital ownership and hospital competition in Germany and the number of inpatient cases with circulatory system diseases in Italy were other significant determinants of DES adoption. Our results underline the importance of spillover effects among peers for the diffusion of medical devices even in the presence of a positive guideline recommendation. Policymakers might therefore consider promoting various forms of exchange and collaboration among medical staff and hospitals to ensure the appropriate use of medical technologies

Do existing real-world data sources generate suitable evidence for the HTA of medical devices in Europe? Mapping and critical appraisal.

Aim Technological and computational advancements offer new tools for the collection and analysis of real-world data (RWD). Considering the substantial effort and resources devoted to collecting RWD, a greater return would be achieved if real-world evidence (RWE) was effectively used to support Health Technology Assessment (HTA) and decision making on medical technologies. A useful question is: To what extent are RWD suitable for generating RWE? Methods We mapped existing RWD sources in Europe for three case studies: hip and knee arthroplasty, transcatheter aortic valve implantation (TAVI) and mitral valve repair (TMVR), and robotic surgery procedures. We provided a comprehensive assessment of their content and appropriateness for conducting the HTA of medical devices. The identification of RWD sources was performed combining a systematic search on PubMed with gray literature scoping, covering fifteen European countries. Results We identified seventy-one RWD sources on arthroplasties; ninety-five on TAVI and TMVR; and seventy-seven on robotic procedures. The number, content, and integrity of the sources varied dramatically across countries. Most sources included at least one health outcome (97.5%), with mortality and rehospitalization/reoperation the most common; 80% of sources included resource outcomes, with length of stay the most common, and comparators were available in almost 70% of sources. Conclusions RWD sources bear the potential for the HTA of medical devices. The main challenges are data accessibility, a lack of standardization of health and economic outcomes, and inadequate comparators. These findings are crucial to enabling the incorporation of RWD into decision making and represent a readily available tool for getting acquainted with existing information sources

Children with Incarcerated Parents : a Longitudinal Study of the Effect of Parental Incarceration on Adolescent Externalizing Behaviors

Over the past two decades, the number of imprisoned adults in the United States has quadrupled. Mirroring this trend is the rapidly increasing population of children with incarcerated parents. The initial findings of research on the effects of parental incarceration on children are disturbing, indicating a vulnerable group of children at risk for poor outcomes. Yet, research on these children remains limited. Several studies have focused on the description of these children, yet few have analyzed the relationship between parental incarceration and child outcomes in conjunction with other risk and protective factors. Understanding these relationships is crucial to the development of effective programs and policies for these children. Based on elements of risk and resilience theories, this study investigates the relationships between key risk and protective factors for children of incarcerated parents through the analysis of a longitudinal data set gathered as part of the Linking the Interests of Families and Teachers (LIFT) investigation started in 1990 (Eddy, Reid, Stoolmiller, & Fetrow, 2003). Through the LIFT investigation, 671 youth and their families were followed over 14 years. The main aims of the current study were to (a) explore differences in social advantage, parent health, and parenting of families with and without an incarcerated parent, and (b) test models that postulate that the relationship between parental incarceration and youth\u27s externalizing behaviors and delinquency is mediated by social advantage, parents\u27 health, and parenting skills. The study revealed that parental incarceration is associated with higher levels of externalizing behaviors and delinquency in children. These associations were mediated by family\u27s social advantage, the parents\u27 health, and parenting strategies. For externalizing behaviors, the mediation model explained approximately 60% of the variance in youth externalizing behaviors in the 5th and 8th grades, and 20% of the variance in 10th grade. The study found that while a similar model operated in youth delinquency, it explained only 8% of the variance. The findings highlight the important predictive and potentially protective relationship that family\u27s social advantage, parent health, and effective parenting skills have with youth externalizing behaviors and serious delinquency for children with incarcerated parents