Organizational Climate and Decision Aid Sustainability in Lupus Care: Mixed Methods Study

Area of Science:

• Health Informatics
• Patient Engagement
• Rheumatology

Background:

• Digital decision aids (DAs) support shared decision-making for complex conditions like systemic lupus erythematosus (SLE).
• Limited evidence exists on organizational factors influencing the long-term sustainability of digital health tools in clinical practice.
• This study investigates organizational climate's role in the sustained use of an electronic DA for lupus patients.

Purpose of the Study:

• To examine the relationship between learning climate, change readiness, and the perceived permanence of a lupus DA.
• To assess these factors across 15 diverse rheumatology clinics in the United States.

Main Methods:

• Concurrent mixed methods design integrating longitudinal quantitative surveys and qualitative interviews.
• Quantitative data collected at 3 time points (6, 12, 24 months) from 204 clinic staff.
• Qualitative data from 36 semistructured interviews explored sustainment barriers.

Main Results:

• Clinic's change efficacy climate positively associated with perceived DA permanence (β=4.00; P<.001).
• Internal and external learning climates negatively associated with DA permanence (β=-1.39; P<.05 and β=-2.11; P<.01, respectively).
• Change commitment was not statistically significant; qualitative data revealed workflow and buy-in challenges.

Conclusions:

• Sustaining digital health tools requires a supportive organizational climate beyond technical integration.
• Clinic's change efficacy is critical for DA sustainment, while learning climates may present barriers.
• Assessing organizational readiness and tailoring implementation strategies are crucial for fostering DA use.