Innovation Culture Declines Drive Exnovation of Patient Engagement Strategies in Primary Care

Abstract Background Patient engagement strategies (PES) are behavioral and relational in nature. They include using patient-reported outcomes (PROs) for treatment monitoring, using shared decision-making (SDM) tools, and training clinicians in motivational interviewing. The long-term maintenance of PES by primary care practices requires substantial frontline effort, adaptation to workflow, and supportive organizational cultures. Objectives To measure the adoption and exnovation of PES by adult primary care practices and to identify organizational factors associated with the count of exnovated PES, defined as the deliberate or passive removal of previously adopted strategies. Design Retrospective longitudinal cohort study. Participants A national cohort of US adult primary care physician practices ( n = 714), spanning two waves of the National Survey of Healthcare Organizations and Systems (NSHOS I: 2017–2018 and NSHOS II: 2022–2023). Main Measures The outcome was the number of PES that the practice exnovated, on net. Independent variables included baseline measures and change scores for the practice’s innovation culture and health information technology functionalities. Key Results Practice-level adoption of ten PES increased slightly from a mean of 4.2 (SD = 2.5) to 4.8 (SD = 2.7). Nearly half of practices (46%) exnovated PES on net. A decline in organizational culture of innovation was the strongest predictor of net exnovation (IRR 1.10; 95% CI, 1.06–1.15; P < 0.001), followed by an increase in health information technology functionality (IRR 1.11; 95% CI, 1.01–1.22; P = 0.03). Conclusions The exnovation of patient engagement strategies is widespread in primary care, driven by declines in organizational cultures that support innovation. The expansion of health information technology may reduce practice capacity to maintain human resources-intensive relational innovations, such as SDM and motivational interviewing, posing a challenge to improving patient-centered primary care.