title: Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination.
abstract: 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.
  
  
  
  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.
  
  
  
  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 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.
  
  
  
  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.
authors: University of California, Los Angeles, Los Angeles, CA, USA (CKT, DLF)|Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, MCH, SGM, DLF)
authors: Caroline K
authors: CK
authors: Tietbohl
authors: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, MCH, SGM, DLF)|Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA (KASR)
authors: Katharine A S
authors: KA
authors: Rendle
authors: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, MCH, SGM, DLF)
authors: Meghan C
authors: MC
authors: Halley
authors: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, MCH, SGM, DLF)|Precision Health Economics, Los Angeles, CA, USA (SGM)
authors: Suepattra G
authors: SG
authors: May
authors: University of California, San Francisco, CA, USA (GAL)
authors: Grace A
authors: GA
authors: Lin
authors: University of California, Los Angeles, Los Angeles, CA, USA (CKT, DLF)|Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (CKT, KASR, MCH, SGM, DLF)|Gordon and Betty Moore Foundation, Palo Alto, CA, USA (DLF).
authors: Dominick L
authors: DL
authors: Frosch
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002140:California; D003657:Decision Making; D003661:Decision Support Techniques; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care; D014742:Videodisc Recording
keywords: decision support interventions; implementation; patient engagement; qualitative methodologies; relational coordination