Agent-based computational models to explore diffusion of medical innovations among cardiologists

Background: Diffusion of medical innovations among physicians rests on a set of theoretical assumptions, including learning and decision-making under uncertainty, social-normative pressures, medical expert knowledge, competitive concerns, network performance effects, professional autonomy or individualism and scientific evidence. Objectives: The aim of this study was to develop and test four real data-based, agent-based computational models (ABM) to qualitatively and quantitatively explore the factors associated with diffusion and application of innovations among cardiologists. Methods: Four ABM were developed to study diffusion and application of medical innovations among cardiologists, considering physicians' network connections, leaders' opinions, "adopters' categories", physicians' autonomy, scientific evidence, patients' pressure, affordability for the end-user population, and promotion from companies. Results: Simulations demonstrated that social imitation among local cardiologists was sufficient for innovation diffusion, as long as opinion leaders did not act as detractors of the innovation. Even in the absence of full scientific evidence to support innovation, up to one-fifth of cardiologists could accept it when local leaders acted as promoters. Patients' pressure showed a large effect size (Cohen's d > 1.2) on the proportion of cardiologists applying an innovation. Two qualitative patterns (speckled and granular) appeared associated to traditional Gompertz and sigmoid cumulative distributions. Conclusions: These computational models provided a semiquantitative insight on the emergent collective behavior of a physician population facing the acceptance or refusal of medical innovations. Inclusion in the models of factors related to patients' pressure and accesibility to medical coverage revealed the contrast between accepting and effectively adopting a new product or technology for population health care.