title: Primary care in the United States: practice-based innovations and factors that influence adoption.
abstract: OBJECTIVE
  This study aims to explore the use of specific innovations in primary care practices. The research seeks to examine whether a relationship exists between environmental factors and organizational characteristics and the level of innovation in primary care practices in Virginia.
  
  
  METHODS
  The study utilized multiple secondary data sets and an organizational survey of primary care practices to define the external environment and the level of innovation. Institutional theory was used to explain the connection between innovations in primary care practices and institutional forces within the environment. Resource dependency theory was used to explain motivators for change based on a dependence on scarce financial, human, and information resources.
  
  
  RESULTS
  Results show a positive association between organizational size, organizational relationships, and stakeholder expectations on the level of innovation. A negative association was found between competition and the level of innovation. No relationship was found between degree of Medicare and managed care penetration and innovation, nor between knowledge of, and difficulty complying with, payer organization requirements and innovation.
  
  
  CONCLUSIONS
  Primary care physician practices exist in a market-driven environment characterized by high pressure from regulatory sources, decreasing reimbursement levels, increasing rate of change in technologies, and increasing patient and community expectations. This study contributes new information on the relationship between organizational characteristics, the external environment and specific innovations in primary care practices. Information on the contributing factors to innovation in primary care is important for improving delivery of health care services and the ability of these practices to survive.
authors.affiliation: Department of Health Policy, George Washington University, Washington, District of Columbia, USA. debora.goetz-goldberg@gwumc.edu
authors.forename: Debora Goetz
authors.initials: DG
authors.lastname: Goldberg
mesh_terms: D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D006801:Humans; D011216:Practice Management, Medical; D011320:Primary Health Care; D014481:United States; D014768:Virginia