The purpose of this paper is to examine how a quality register in rheumatoid arthritis care was adopted in the Swedish medical community of rheumatologists and what helped and hindered this.

A mixed methods case study was carried out to collect data covering the development and adoption of the quality register. By performing 17 key informant interviews and document analysis, significant themes focusing on the context, content, process and outcomes of the innovation was sought for. The innovation process proceeded from idea generation, development phase, and consolidation phase to a phase of shared decision-making. Resistance from physicians, perceived threats to the medical consultation, organisational change climate and lack of integration with other health care IT-systems were perceived as barriers to the adoption of the quality register. Access to longitudinal patient and treatment data, change champions, transformational leadership, changes in the physician-patient dialogue and increased control of treatment quality and costs were identified as drivers of innovation spread. These factors can be categorised as belonging to the construct of perceived usefulness.