Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease

ABSTRACT 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 com...

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Bibliographic Details
Published in:Annals of family medicine 2015-03, Vol.13 (2), p.139-148
Main Authors: Mundt, Marlon P., PhD, Gilchrist, Valerie J., MD, Fleming, Michael F., MD, MPH, Zakletskaia, Larissa I., MA, Tuan, Wen-Jan, MS, MPH, Beasley, John W., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Ambulatory Care - economics
Ambulatory Care - utilization
Blood Pressure
Cardiovascular Diseases - blood
Cardiovascular Diseases - economics
Cardiovascular Diseases - therapy
Cholesterol, LDL - blood
Emergency Service, Hospital - economics
Emergency Service, Hospital - utilization
Female
Health Care Costs
Health Personnel - organization & administration
Hospitalization - economics
Hospitalization - statistics & numerical data
Humans
Internal Medicine
Interprofessional Relations
Male
Middle Aged
Original Research
Patient Care Team - organization & administration
Patient Outcome Assessment
Primary Health Care - organization & administration
Quality of Health Care
Social Support
Sociometric Techniques
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Summary:ABSTRACT 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 high-quality cardiovascular disease care at a lower cost.
ISSN:1544-1709
1544-1717
DOI:10.1370/afm.1754