Objective to explore physician organizations' adoption of chronic care guidelines in order entry systems and to investigate the organizational and market-related factors associated with this adoption.

Design a quantitative nationwide survey of all primary care medical groups in the United States with 20 or more physicians; data were collected on 1,104 physician organizations, representing a 70% response rate.

Measurements presence of an asthma, diabetes or congestive heart failure guideline in a physician organization's order entry system, size, age of the organization, number of clinic locations, type of ownership, HMO market penetration, urban/rural location, presence of external incentives to improve quality of care care.

Results only 27% of organizations reported access to order entry with decision support for chronic disease care. External incentives for quality is the only factor significantly associated with adoption of these tools. Organizations experiencing greater external incentives for quality are more likely to adopt order entry with decision support.

Conclusion because external incentives are strong drivers of adoption, policies requiring reporting of chronic care measurements and rewarding improvement as well as financial incentives for use of specific information technology tools are likely to accelerate adoption of order entry with decision support.