Scholarlink

Background <p>Patient engagement strategies (PES) are behavioral and relational in nature. They include using patient-reported outcomes (PROs) for treatment monitoring, using shared decision-making (SDM) tools, and training clinicians in motivational interviewing. The long-term maintenance of PES by primary care practices requires substantial frontline effort, adaptation to workflow, and supportive organizational cultures.</p> Objectives <p>To measure the adoption and exnovation of PES by adult primary care practices and to identify organizational factors associated with the count of exnovated PES, defined as the deliberate or passive removal of previously adopted strategies.</p> Design <p>Retrospective longitudinal cohort study.</p> Participants <p>A national cohort of US adult primary care physician practices (<i>n</i> = 714), spanning two waves of the National Survey of Healthcare Organizations and Systems (NSHOS I: 2017–2018 and NSHOS II: 2022–2023).</p> Main Measures <p>The outcome was the number of PES that the practice exnovated, on net. Independent variables included baseline measures and change scores for the practice’s innovation culture and health information technology functionalities.</p> Key Results <p>Practice-level adoption of ten PES increased slightly from a mean of 4.2 (SD = 2.5) to 4.8 (SD = 2.7). Nearly half of practices (46%) exnovated PES on net. A decline in organizational culture of innovation was the strongest predictor of net exnovation (IRR 1.10; 95% CI, 1.06–1.15; <i>P</i> &lt; 0.001), followed by an increase in health information technology functionality (IRR 1.11; 95% CI, 1.01–1.22; <i>P</i> = 0.03).</p> Conclusions <p>The exnovation of patient engagement strategies is widespread in primary care, driven by declines in organizational cultures that support innovation. The expansion of health information technology may reduce practice capacity to maintain human resources-intensive relational innovations, such as SDM and motivational interviewing, posing a challenge to improving patient-centered primary care.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Innovation Culture Declines Drive Exnovation of Patient Engagement Strategies in Primary Care

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月20日

查看全文
  • Hector P. Rodriguez,
  • Matthew B. Mackwood,
  • Stephen M. Shortell,
  • Elliott S. Fisher,
  • Karen E. Schifferdecker

摘要

Background

Patient engagement strategies (PES) are behavioral and relational in nature. They include using patient-reported outcomes (PROs) for treatment monitoring, using shared decision-making (SDM) tools, and training clinicians in motivational interviewing. The long-term maintenance of PES by primary care practices requires substantial frontline effort, adaptation to workflow, and supportive organizational cultures.

Objectives

To measure the adoption and exnovation of PES by adult primary care practices and to identify organizational factors associated with the count of exnovated PES, defined as the deliberate or passive removal of previously adopted strategies.

Design

Retrospective longitudinal cohort study.

Participants

A national cohort of US adult primary care physician practices (n = 714), spanning two waves of the National Survey of Healthcare Organizations and Systems (NSHOS I: 2017–2018 and NSHOS II: 2022–2023).

Main Measures

The outcome was the number of PES that the practice exnovated, on net. Independent variables included baseline measures and change scores for the practice’s innovation culture and health information technology functionalities.

Key Results

Practice-level adoption of ten PES increased slightly from a mean of 4.2 (SD = 2.5) to 4.8 (SD = 2.7). Nearly half of practices (46%) exnovated PES on net. A decline in organizational culture of innovation was the strongest predictor of net exnovation (IRR 1.10; 95% CI, 1.06–1.15; P < 0.001), followed by an increase in health information technology functionality (IRR 1.11; 95% CI, 1.01–1.22; P = 0.03).

Conclusions

The exnovation of patient engagement strategies is widespread in primary care, driven by declines in organizational cultures that support innovation. The expansion of health information technology may reduce practice capacity to maintain human resources-intensive relational innovations, such as SDM and motivational interviewing, posing a challenge to improving patient-centered primary care.