PMID- 26314727
OWN - NLM
STAT- MEDLINE
DCOM- 20160826
LR  - 20180501
IS  - 1552-681X (Electronic)
IS  - 0272-989X (Linking)
VI  - 35
IP  - 8
DP  - 2015 Nov
TI  - Implementation of Patient Decision Support Interventions in Primary Care: The 
      Role of Relational Coordination.
PG  - 987-98
LID - 10.1177/0272989X15602886 [doi]
AB  - 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.
CI  - (c) The Author(s) 2015.
FAU - Tietbohl, Caroline K
AU  - Tietbohl CK
AD  - University of California, Los Angeles, Los Angeles, CA, USA (CKT, DLF)
AD  - Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, 
      MCH, SGM, DLF)
FAU - Rendle, Katharine A S
AU  - Rendle KA
AD  - Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, 
      MCH, SGM, DLF)
AD  - Cancer Prevention Fellowship Program, Division of Cancer Prevention, National 
      Cancer Institute, Bethesda, MD, USA (KASR)
FAU - Halley, Meghan C
AU  - Halley MC
AD  - Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, 
      MCH, SGM, DLF)
FAU - May, Suepattra G
AU  - May SG
AD  - Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, 
      MCH, SGM, DLF)
AD  - Precision Health Economics, Los Angeles, CA, USA (SGM)
FAU - Lin, Grace A
AU  - Lin GA
AD  - University of California, San Francisco, CA, USA (GAL)
FAU - Frosch, Dominick L
AU  - Frosch DL
AD  - University of California, Los Angeles, Los Angeles, CA, USA (CKT, DLF)
AD  - Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, 
      MCH, SGM, DLF)
AD  - Gordon and Betty Moore Foundation, Palo Alto, CA, USA (DLF).
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150827
PL  - United States
TA  - Med Decis Making
JT  - Medical decision making : an international journal of the Society for Medical 
      Decision Making
JID - 8109073
SB  - IM
MH  - Anthropology, Cultural
MH  - *Attitude of Health Personnel
MH  - California
MH  - *Decision Making
MH  - *Decision Support Techniques
MH  - Focus Groups
MH  - Humans
MH  - Interprofessional Relations
MH  - *Physician-Patient Relations
MH  - Physicians/*psychology
MH  - Primary Health Care
MH  - Videodisc Recording
OTO - NOTNLM
OT  - decision support interventions
OT  - implementation
OT  - patient engagement
OT  - qualitative methodologies
OT  - relational coordination
EDAT- 2015/09/01 06:00
MHDA- 2016/08/27 06:00
CRDT- 2015/08/29 06:00
PHST- 2013/10/11 00:00 [received]
PHST- 2015/07/15 00:00 [accepted]
PHST- 2015/08/29 06:00 [entrez]
PHST- 2015/09/01 06:00 [pubmed]
PHST- 2016/08/27 06:00 [medline]
AID - 0272989X15602886 [pii]
AID - 10.1177/0272989X15602886 [doi]
PST - ppublish
SO  - Med Decis Making. 2015 Nov;35(8):987-98. doi: 10.1177/0272989X15602886. Epub 2015 
      Aug 27.