Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination. Med Decis Making 2015 Nov;35(8):987-98
Date
09/01/2015Pubmed ID
26314727DOI
10.1177/0272989X15602886Scopus ID
2-s2.0-84942850126 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
BACKGROUND: The benefits of patient decision support interventions (DESIs) have been well documented. However, DESIs remain difficult to incorporate into clinical practice. Relational coordination (RC) has been shown to improve performance and quality of care in health care settings. This study aims to demonstrate how applying RC theory to DESI implementation could elucidate underlying issues limiting widespread uptake.
METHODS: Five primary care clinics in Northern California participated in a DESI implementation project. We used a deductive thematic approach guided by behaviors outlined in RC theory to analyze qualitative data collected from ethnographic field notes documenting the implementation process and focus groups with health care professionals. We then systematically compared the qualitative findings with quantitative DESI distribution data.
RESULTS: Based on DESI distribution rates, clinics were placed into 3 performance categories: high, middle, and low. Qualitative data illustrated how each clinic's performance related to RC behaviors. Consistent with RC theory, the high-performing clinic exhibited frequent, timely, and accurate communication and positive working relationships. The 3 middle-performing clinics exhibited high-quality communication within physician-staff teams but limited communication regarding DESI implementation across the clinic. The lowest-performing clinic was characterized by contentious relationships and inadequate communication.
LIMITATIONS: Limitations of the study include nonrandom selection of clinics and limited geographic diversity. In addition, ethnographic data collected documented only DESI implementation practices and not larger staff interactions contributing to RC.
CONCLUSIONS: These findings suggest that a high level of RC within clinical settings may be a key component and facilitator of successful DESI implementation. Future attempts to integrate DESIs into clinical practice should consider incorporating interventions designed to increase positive RC behaviors as a potential means to improve uptake.
Author List
Tietbohl CK, Rendle KA, Halley MC, May SG, Lin GA, Frosch DLAuthor
Meghan C. Halley PhD, BA, MPH Assistant Professor in the Institute for Health and Humanity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anthropology, CulturalAttitude of Health Personnel
California
Decision Making
Decision Support Techniques
Focus Groups
Humans
Interprofessional Relations
Physician-Patient Relations
Physicians
Primary Health Care
Videodisc Recording
