JMIR Publications

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 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:

An explanatory, multiple-case study on the adoption of a patient-controlled information app for the co-production of care that places the patient at the center of the decision-making process. Data collection and analysis were guided by the Non-adoption, Abandonment, Spread, Scale-up, and Sustainability framework and Complexity Assessment Tool (NASSS-CAT). Data included user-activity levels of patients and qualitative interviews with staff at nine clinics (eight in Sweden, one in the USA). We performed a statistical process control (SPC) analysis of user-activity data. Qualitative data was subjected to content analysis, a complexity analysis, and used to generate process maps. All data was then triangulated in a cross-case analysis.

Results:

We grouped clinics into high, middle, and low adoption clusters based on patient user-activity levels. Higher perceived complexity by providers was associated with lower adoption. Research on the innovation and new features positively impacted adoption. Early adoption and a champion-reliant adoption process negatively impacted sustainability.

Conclusions:

Health care providers played a significant role in the adoption of the patient-driven innovation. Providers who worked to reduce variation in care processes reported a lower level of perceived complexity, and developed co-ownership of the innovation through research, patient training, and a team effort to integrate the innovation into existing care processes. These clinics demonstrated a higher capability to support the adoption and sustainability of innovative ideas developed by patients. For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and perspectives on what generates value is essential.