PDF(Pubmed)
Abstract：
BACKGROUND: Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective.
OBJECTIVE: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics.
METHODS: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9%, in Sweden; n=1, 11.1%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis.
RESULTS: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16%-23%), middle (25%-47%), or high (58%-95%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers\' perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability.
CONCLUSIONS: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers\' perspectives on what generates value is essential.
OBJECTIVE: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics.
METHODS: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9%, in Sweden; n=1, 11.1%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis.
RESULTS: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16%-23%), middle (25%-47%), or high (58%-95%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers\' perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability.
CONCLUSIONS: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers\' perspectives on what generates value is essential.
摘要：
背景：患者驱动的医疗保健创新是一种新兴现象，对慢性病患者有益，例如囊性纤维化(CF)。然而,以前的研究还没有从提供者的角度研究什么可能促进或阻碍这些创新的实施。
目的：本研究的目的是解释CF诊所采用患者驱动创新的差异。
方法：对采用患者控制的应用程序进行了多案例比较研究，以支持与医疗保健专业人员（HCP）的自我管理和合作。数据收集和分析以不采用为指导，放弃,传播，扩大规模，以及可持续性和复杂性评估工具(NASSS-CAT)框架。数据包括患者的用户活动水平和对9家诊所工作人员的定性访谈(n=8，88.9%，在瑞典；n=1，11.1%，在美国）。我们计算了每个诊所活跃用户的最大和平均百分比，并进行了统计过程控制（SPC）分析，以探索用户活动水平如何随时间变化。对定性数据进行内容分析和复杂性分析，并用于生成流程图。然后在交叉案例分析中对所有数据进行三角测量。
结果：我们没有发现未采用或明确放弃该应用程序的证据。根据每个诊所的最大最终用户活动，可以识别不同的创新采用模式。我们标记为低(16%-23%)，中等（25%-47%），或高采用率（58%-95%）。SPC图表表明，引入新的应用程序功能和与研究相关的活动对用户活动水平产生了积极影响。采用率的变化与提供者对护理过程复杂性的看法有关。价值主张的更高感知复杂性，采用者系统，和组织与较低的采用率有关。在早期采用创新的诊所或依赖冠军的诊所，用户活动趋于平稳或下降，表明对可持续性的负面影响。
结论：为了在医疗保健中采用和维持患者驱动的创新，了解患者与提供者的相互依赖关系和提供者对产生价值的观点是至关重要的。
目的：本研究的目的是解释CF诊所采用患者驱动创新的差异。
方法：对采用患者控制的应用程序进行了多案例比较研究，以支持与医疗保健专业人员（HCP）的自我管理和合作。数据收集和分析以不采用为指导，放弃,传播，扩大规模，以及可持续性和复杂性评估工具(NASSS-CAT)框架。数据包括患者的用户活动水平和对9家诊所工作人员的定性访谈(n=8，88.9%，在瑞典；n=1，11.1%，在美国）。我们计算了每个诊所活跃用户的最大和平均百分比，并进行了统计过程控制（SPC）分析，以探索用户活动水平如何随时间变化。对定性数据进行内容分析和复杂性分析，并用于生成流程图。然后在交叉案例分析中对所有数据进行三角测量。
结果：我们没有发现未采用或明确放弃该应用程序的证据。根据每个诊所的最大最终用户活动，可以识别不同的创新采用模式。我们标记为低(16%-23%)，中等（25%-47%），或高采用率（58%-95%）。SPC图表表明，引入新的应用程序功能和与研究相关的活动对用户活动水平产生了积极影响。采用率的变化与提供者对护理过程复杂性的看法有关。价值主张的更高感知复杂性，采用者系统，和组织与较低的采用率有关。在早期采用创新的诊所或依赖冠军的诊所，用户活动趋于平稳或下降，表明对可持续性的负面影响。
结论：为了在医疗保健中采用和维持患者驱动的创新，了解患者与提供者的相互依赖关系和提供者对产生价值的观点是至关重要的。
