In his extrapolation of the diffusion of innovation theory to the marketing of high-tech products, Moore12 proposed that there is often a “chasm” between the Early Adopter and Early Majority groups and their 2 seminal phases of innovation adoption (Fig. 1). Initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home Learning Collaborativec may successfully aid in more readily bridging this diffusion of innovation chasm.
Until the mid-1990s, children were often “therapeutic orphans” for whom many medications, including anesthetics, were administered off-label, without pediatric studies to guide drug labeling for clinical indications, dosing, and other therapeutic considerations.13 The 1997 U.S. Food and Drug Administration Pediatric Exclusivity Provision, and its successor, the Best Pharmaceuticals for Children Act of 2002, provided economic incentives (a 6-month patent extension) to pharmaceutical companies to conduct drug studies in children.13,14 The Pediatric Research Equity Act of 2003 further provided the U.S. Food and Drug Administration with the authority to require pediatric studies of drugs if an adult indication also exists in children.13,15 Nevertheless, an analysis of all interventional trials registered at ClinicalTrials.gov from July 2005 to September 2010 revealed only 8.3% to be pediatric trials, which had declined during the time period.16
This historical pattern of delayed diffusion of innovations in pediatric health care is being rigorously addressed by programs such as the UCLA Children’s Discovery and Innovation Institute, Nationwide Children’s Center for Innovation in Pediatric Practice, Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Medical Center, Center for Pediatric Innovation at Emory University, and Institute for Pediatric Innovation in Cambridge, Massachusetts. Furthermore, Boston Children’s Hospital and Children’s National Medical Center are to be commended for being inaugural members of the American Society of Anesthesiologists Perioperative Surgical Home Learning Collaborative. However, unless a more concerted effort is made now, the pediatric surgical population will again be left out, collectively “orphaned” again, as efforts are made in the adult surgical population to achieve and leverage the 3 interdependent goals of the triple aim of health care: (1) improving the individual experience of care, (2) improving the health of populations, and (3) reducing per capita costs of care.17
The Perioperative Surgical Home fundamentally seeks to provide adult care that is more patient-centered and involves greater patient-clinician shared decision making.1 Notably, the American Academy of Pediatrics first adopted a policy statement on Family-Centered Care and the Pediatrician’s Role in 2003.18 In their subsequent collaborative 2012 report, Patient-Centered and Family-Centered Care and the Pediatrician’s Role,19 the American Academy of Pediatrics, and the Institute for Patient-Centered and Family-Centered Care intentionally sought to “more explicitly capture the importance of engaging the family and the patient in a developmentally supportive manner as essential members of the health care team.” This expanded framework recognizes that the “family is the child’s primary source of strength and support and that the child’s and the family’s perspectives and information are important in clinical decision making.”19 It is appropriate and imperative that this expanded emphasis on the patient and family in the delivery of pediatric care also occurs in the surgical setting, a laudable goal that is realistically achievable via the Pediatric Perioperative Surgical Home model espoused by Ferrari et al.4
Given the epidemiology of pediatric chronic diseases and pediatric surgery, and the resources needed to implement a Pediatric Perioperative Surgical Home, it would appear prudent that Innovators such as Ferrari et al. at Boston Children’s Hospital lead the way, followed closely by other children’s hospitals serving as fellow Innovators and then Early Adopters of this new care model.
According to Rogers, there are 5 main factors that influence the adoption of an innovation such as the adult and pediatric versions of the Perioperative Surgical Home (Table 2): Relative Advantage, Compatibility, Complexity, Triability, and Observability.11 The onus remains upon the Innovators and the Early Adopters of adult and pediatric versions of this new care model to demonstrate all 5 of these factors, ideally in a reproducible, incremental manner, which fosters adoption by other individuals and groups positioned later in the diffusion of innovation continuum.
a Enhanced Recovery After Surgery (ERAS®) Society: ERAS® Guidelines. Available at: http://www.erassociety.org/. Accessed November 26, 2014.
b Data Resource Center for Child and Adolescent Health: Child and Adolescent Health Measurement Initiative. Available at: http://childhealthdata.org/browse/survey. Accessed December 1, 2014.
c American Society of Anesthesiologists: Perioperative Surgical Home Learning Collaborative. Available at: http://www.asahq.org/. Accessed November 27, 2014.
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