Linking Practice Adoption of Patient Engagement Strategies and Relational Coordination to Patient‐Reported Outcomes in Accountable Care Organizations
Open accessAbstract
Policy Points: Accountable care organizations (ACOs) have incentives to promote the adoption of patient engagement strategies such as shared decision making and self‐management support programs to improve patient outcomes and contain health care costs. High adoption of patient engagement strategies among ACO‐affiliated practices did not improve patient‐reported outcomes (PROs) of physical, emotional, and social function among adult patients with diabetes and/or cardiovascular disease over a one‐year time frame, likely because implementing these strategies requires extensive clinician and staff training, workflow redesign, and patient participation over time. A dominant focus on improving clinical measures to meet external requirements may crowd out time needed for care team members to address other outcomes that matter to patients, including PROs. Payers and policy‐makers should explicitly incentivize the collection and use of PROs when contracting with ACOs. Context: Adult primary care practices of accountable care organizations (ACOs) are adopting a range of patient engagement strategies, but little is known about how these strategies are related to patient‐reported outcomes (PROs) and how relational coordination among team members aids implementation. Methods: We used a mixed‐methods cohort study design integrating administrative and clinical data with two data collection waves (2014‐2015 and 2016‐2017) of clinician and staff surveys (n = 764), surveys of adult patients with diabetes and/or cardiovascular disease (CVD) (n = 1,276), and key informant interviews of clinicians, staff, and administrators (n = 103). Multivariable linear regression estimated the relationship of practice adoption of patient engagement strategies, relational coordination, and PROs of physical, social, and emotional function. The mediating role of patient activation was examined using cross‐lagged panel models. Key informant interviews assessed how relational coordination influences the implementation of patient engagement strategies. Findings: There were no differential improvements in PROs among patients of practices with high vs. low adoption of patient engagement strategies or among patients of practices with high vs. low relational coordination. The Patient Activation Measure (PAM) is strongly related to better physical, emotional, and social PROs over time. Relational coordination facilitated the implementation of patient engagement strategies, but key informants indicated that resources and systems to systematically track treatment preferences and goals beyond clinical indicators were needed to support effective implementation. Conclusions: Adult patients with diabetes and/or CVD of ACO‐affiliated practices with high adoption of patient engagement strategies do not have improved PROs of physical, emotional, and social function over a one‐year time frame. Implementing patient engagement strategies increases task interdependence among primary care team members, which needs to be carefully managed. ACOs may need to make greater investment in collecting, monitoring, and analyzing PRO data to ensure that practice adoption and implementation of patient engagement strategies leads to improved physical, emotional, and social function among patients.
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Relational coordination did not differ for practices with high vs. low adoption.
“Relational coordination was high across practices initially and did not differ for practices with high vs. low adoption, although it increased over time in practices with high adoption [83].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [83]
Relational coordination increased over time in practices with high adoption.
“Relational coordination was high across practices initially and did not differ for practices with high vs. low adoption, although it increased over time in practices with high adoption [83].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [83]
Relational coordination was high across primary care practices initially.
“Relational coordination was high across practices initially and did not differ for practices with high vs. low adoption, although it increased over time in practices with high adoption [83].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [83]
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McGuier, E. A., Kolko, D. J., Aarons, G. A., Schachter, A., Klem, M. L., Diabes, M. A., Weingart, L. R., Salas, E., & Wolk, C. B. (2024) · Implementation Science · doi:10.1186/s13012-024-01381-9 · Cited by 70 · see citing works
- Authors
- RODRIGUEZ, H. P., POON, B. Y., WANG, E., & SHORTELL, S. M.
- Affiliations
- Center for Healthcare Organizational and Innovation Research University of California Berkeley
- University of California, Berkeley (US)
- Venue
- The Milbank Quarterly
- Publisher
- Wiley
- Published
- 2019-06-17
- Volume
- 97
- Issue
- 3
- Pages
- 692-735
- ISSN
- 0887-378X (ISSN-L)
- 1468-0009
- PMC
- PMC6739631
- OpenAlex
- W2951164133
- Cited by
- 21
- References
- 46
- Citations by year
- 2025: 1 · 2024: 8 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 1
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Milbank Quarterly (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Patient-Centered Outcomes Research Institute (IHS‐1310‐06821)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- accountable care organizations, patient engagement, shared decision-making, self-management support, relational coordination, patient-reported outcomes, patient activation, diabetes mellitus, cardiovascular disease, primary care practices, implementation, Patient Activation Measure, treatment preferences, health care cost containment, quality incentives, patient-centered care, physical function, care team communication, workflow redesign
- MeSH terms
- Patient Reported Outcome Measures, Adolescent, Adult, Aged, Aged, 80 and over, Chicago, Female, Health Personnel, Humans, Male, Middle Aged, Patient Participation, Surveys and Questionnaires, United States, Los Angeles, Linear Models, Treatment Outcome, Young Adult, Accountable Care Organizations
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