TY - JOUR
T1 - Effects of primary care team social networks on quality of care and costs for patients with cardiovascular disease
AU - Mundt, Marlon P.
AU - Gilchrist, Valerie J.
AU - Fleming, Michael F.
AU - Zakletskaia, Larissa I.
AU - Tuan, Wen Jan
AU - Beasley, John W.
N1 - Funding Information:
Funding support: Dr Mundt received support from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) , grant K01AA018410-04 for the design and conduct of the study.
Publisher Copyright:
© 2015, Annals of Family Medicine, Inc. All right reserved.
PY - 2015
Y1 - 2015
N2 - PURPOSE Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. METHODS Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. RESULTS Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50-0.77) and lower medical care costs (–$556; 95% CI, –$781 to –$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09-1.94) and greater costs ($506; 95% CI, $202-$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. CONCLUSIONS Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver highquality cardiovascular disease care at a lower cost.
AB - PURPOSE Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. METHODS Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. RESULTS Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50-0.77) and lower medical care costs (–$556; 95% CI, –$781 to –$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09-1.94) and greater costs ($506; 95% CI, $202-$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. CONCLUSIONS Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver highquality cardiovascular disease care at a lower cost.
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U2 - 10.1370/afm.1754
DO - 10.1370/afm.1754
M3 - Article
C2 - 25755035
AN - SCOPUS:84924298874
SN - 1544-1709
VL - 13
SP - 139
EP - 148
JO - Annals of family medicine
JF - Annals of family medicine
IS - 2
ER -