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adoption, diffusion, hospital, medical device register, process innovation



  1. Sternkopf, Jan
  2. Schultz, Carsten


Background: Hospitals in many countries do not record and analyze artificial hip and knee joint surgeries systematically, leading to a lack of reliable quality assurance data. Arthroplasty registers have the potential to alleviate this and improve quality of care and health care expenditures. In Germany, the current introduction of the Arthroplasty Register acts as a prototype for various medical device registers. However, participation is voluntary for hospitals in most countries, leading to problems with nonadoption.


Purpose: Implementing successful registers requires adoption by most relevant hospitals. Therefore, we assess variables influencing medical device register adoption.


Methodology: We collect longitudinal data from 343 hospitals that are potential adopters of the German Arthroplasty Register in two surveys. The first survey on the implementation process is conducted in 2014; the second survey is conducted in 2016 to collect data on actual adoption of the surveyed hospitals in 2014. The survey data are matched with published hospital characteristics and administrative data. The hypotheses are tested with a mediated regression model, using partial least squares structural equation modeling.


Findings: Hospital specialization positively affects adoption, directly and indirectly, depending on top management support and user involvement. Quality benefits and hospital size impact adoption positively; economic benefits impact adoption negatively.


Conclusion: Important factors influencing adoption of medical device registers for the first time were revealed in this study, providing a starting point to influence adoption proactively and avoid nonadoption.


Practice Implications: The results provide important guidelines for decision-makers at hospitals, registers, and health insurance companies and policy makers about how to foster register adoption and encourage hospitals toward adopting medical device registers.