--- title: "Pt decision spt in primary care: relational coordination | Sutter Health" description: "A high level of relational coordination within clinical settings may be a key component and facilitator of successful patient decision support implementations." url: "https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Pt decision spt in primary care: relational coordination # Implementation of patient decision support interventions in primary care: the role of relational coordination. Tietbohl CK, Rendle KA, Halley MC, May SG, Lin GA, & Frosch DL. _Med Decis Making. 35(8):987-98. doi: 10.1177/0272989X15602886. Epub 2015 Aug 27._ 2015-11-01 ## Abstract 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. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/26314727) ## Research topics - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Implementing shared decision-making: consider all the consequences.](https://www.sutterhealth.org/research/publications/shared-decision-making-allconsequences-1055312516) Elwyn G, Frosch DL, Kobrin S. Implement Sci. 11:114. doi: 10.1186/s13012-016-0480-9. 2016 Aug 08 - Publication ### [Communicating with physicians about medical decisions: a reluctance to disagree.](https://www.sutterhealth.org/research/publications/comm-with-mds-re-med-decs-reluctant-to-disagree-1055312531) Adams JR, Elwyn G, Légaré F, Frosch DL. Arch Intern Med. 2012 Aug 13;172(15):1184-6. doi: 10.1001/archinternmed.2012.2360. 2012 Aug 13 - Publication ### [An exploratory mixed-methods crossover study comparing DVD- vs. Web-based patient decision support in three conditions: The importance of patient perspectives.](https://www.sutterhealth.org/research/publications/dvd-vs-web-based-pt-decision-spt-1055312529) Halley MC, Rendle KA, Gillespie KA, Stanley KM, Frosch DL. Health Expect. 18(6):2880-91. doi: 10.1111/hex.12273. Epub 2014 Sep 29. 2015 Dec 01 - Publication ### [Enhancing shared decision making through carefully designed interventions that target patient and provider behavior.](https://www.sutterhealth.org/research/publications/enhance-sdm-target-pt-and-provider-behavior-1055312395) Tai-Seale M, Elwyn G, Wilson CJ, Stults C, Dillon EC, Li M, Chuang J, Meehan A, Frosch DL. Send to: Health Aff (Millwood). 35(4):605-12. doi: 10.1377/hlthaff.2015.1398. 2016 Apr 01 - Publication ### [Decision or no decision: how do patient-physician interactions end and what matters?](https://www.sutterhealth.org/research/publications/pt-md-endings-decision-or-no-1055312572) Tai-Seale M, Bramson R, Bao X. J Gen Intern Med. 22(3):297-302. 2007 Mar 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Pt decision spt in primary care: relational coordination"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888#medicalscholarlyarticle","name":"Implementation of patient decision support interventions in primary care: the role of relational coordination.","headline":"Pt decision spt in primary care: relational coordination","abstract":"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.","description":"A high level of relational coordination within clinical settings may be a key component and facilitator of successful patient decision support implementations.","keywords":["Disease Management","Health Services"],"datePublished":"2015-11-01","url":"https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26314727"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1177/0272989X15602886"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26314727/","https://doi.org/10.1177/0272989X15602886"],"isPartOf":{"@type":"Periodical","name":"Med Decis Making"},"author":[{"@type":"Person","name":"Tietbohl CK"},{"@type":"Person","name":"Rendle KA"},{"@type":"Person","name":"Halley MC"},{"@type":"Person","name":"May SG"},{"@type":"Person","name":"Lin GA"},{"@type":"Person","name":"Frosch DL"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888#breadcrumblist"}}} ```