{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:15:55Z","timestamp":1774530955263,"version":"3.50.1"},"reference-count":52,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T00:00:00Z","timestamp":1560729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["IHS\u20101310\u201006821"],"award-info":[{"award-number":["IHS\u20101310\u201006821"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:label\/><jats:p><jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:caption><jats:title>Policy Points<\/jats:title><\/jats:caption><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Accountable care organizations (ACOs) have incentives to promote the adoption of patient engagement strategies such as shared decision making and self\u2010management support programs to improve patient outcomes and contain health care costs.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>High adoption of patient engagement strategies among ACO\u2010affiliated practices did not improve patient\u2010reported outcomes (PROs) of physical, emotional, and social function among adult patients with diabetes and\/or cardiovascular disease over a one\u2010year time frame, likely because implementing these strategies requires extensive clinician and staff training, workflow redesign, and patient participation over time.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>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.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Payers and policy\u2010makers should explicitly incentivize the collection and use of PROs when contracting with ACOs.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:boxed-text><\/jats:p><\/jats:sec><jats:sec><jats:title>Context<\/jats:title><jats:p>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\u2010reported outcomes (PROs) and how relational coordination among team members aids implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used a mixed\u2010methods cohort study design integrating administrative and clinical data with two data collection waves (2014\u20102015 and 2016\u20102017) of clinician and staff surveys (<jats:italic>n =<\/jats:italic> 764), surveys of adult patients with diabetes and\/or cardiovascular disease (CVD) (<jats:italic>n =<\/jats:italic> 1,276), and key informant interviews of clinicians, staff, and administrators (<jats:italic>n =<\/jats:italic> 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\u2010lagged panel models. Key informant interviews assessed how relational coordination influences the implementation of patient engagement strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adult patients with diabetes and\/or CVD of ACO\u2010affiliated practices with high adoption of patient engagement strategies do not have improved PROs of physical, emotional, and social function over a one\u2010year 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1468-0009.12400","type":"journal-article","created":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T17:11:23Z","timestamp":1560791483000},"page":"692-735","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Linking Practice Adoption of Patient Engagement Strategies and Relational Coordination to Patient\u2010Reported Outcomes in Accountable Care Organizations"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6564-2229","authenticated-orcid":false,"given":"HECTOR P.","family":"RODRIGUEZ","sequence":"first","affiliation":[{"name":"Center for Healthcare Organizational and Innovation Research University of California Berkeley"},{"name":"Division of Health Policy and Management UC Berkeley School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8679-7852","authenticated-orcid":false,"given":"BING YING","family":"POON","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organizational and Innovation Research University of California Berkeley"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EMILY","family":"WANG","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organizational and Innovation Research University of California Berkeley"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"STEPHEN M.","family":"SHORTELL","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organizational and Innovation Research University of California Berkeley"},{"name":"Division of Health Policy and Management UC Berkeley School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,6,17]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1103602"},{"key":"e_1_2_6_3_1","volume-title":"Growth and Dispersion of Accountable Care Organizations: June 2012 Update","author":"Muhlestein D","year":"2012"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12234"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2911-0"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1133"},{"key":"e_1_2_6_7_1","unstructured":"American Diabetes Association.Data from the 2011 National Diabetes Fact Sheet.2013.http:\/\/www.diabetes.org\/diabetes-basics\/diabetes-statistics\/. 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