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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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| Published in: | Annals of family medicine 2015-03, Vol.13 (2), p.139-148 |
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| container_end_page | 148 |
| container_issue | 2 |
| container_start_page | 139 |
| container_title | Annals of family medicine |
| container_volume | 13 |
| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1370/afm.1754 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4369607</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1544170915300081</els_id><sourcerecordid>1662427663</sourcerecordid><originalsourceid>FETCH-LOGICAL-c427t-16b8197c2bcc911676fdd9119cbe8ac2a2500620217f544b151d4fb6060e9b983</originalsourceid><addsrcrecordid>eNpVkU9v1DAQxS0EoqUg8QmQj1y2eJzY3lyQ0FL-SBUUtYijNXHG1G0St3ayaL89Di1bOHks__T83jzGXoI4hsqIN-iHYzCqfsQOQdX1CgyYx_tZNAfsWc5XQkiQlXzKDqQySolKHbJ04j25KfPo-VkKA6Yd32AifkE48PPoAvb8C02_Yrou0Mi_zdiHabfwfzgcO76JuSj4mPgZToHGcvkRpssF6ELcYnZzj4m_D5kw03P2xGOf6cX9ecS-fzi52HxanX79-Hnz7nTlammmFeh2DY1xsnWuAdBG-64rQ-NaWqOTKJUQWpZMxpecLSjoat9qoQU1bbOujtjbO92buR2oc8VXwt7e3KW0EYP9_2UMl_Zn3Nq60o0Wpgi8vhdI8XamPNkhZEd9jyPFOVvQWharWlcPqEsx50R-_w0Iu1RkS0V2qaigr_61tQf_dvLgm8pytoGSdX0Yg8P-mnaUr-KcxrI3CzZLK-z50vJSMqhKCLGG6jcHaKG4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1662427663</pqid></control><display><type>article</type><title>Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease</title><source>NCBI_PubMed Central（免费）</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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.</description><identifier>ISSN: 1544-1709</identifier><identifier>EISSN: 1544-1717</identifier><identifier>DOI: 10.1370/afm.1754</identifier><identifier>PMID: 25755035</identifier><language>eng</language><publisher>United States: American Academy of Family Physicians</publisher><subject>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</subject><ispartof>Annals of family medicine, 2015-03, Vol.13 (2), p.139-148</ispartof><rights>Annals of Family Medicine, Inc.</rights><rights>2015 Annals of Family Medicine, Inc.</rights><rights>2015 Annals of Family Medicine, Inc. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-16b8197c2bcc911676fdd9119cbe8ac2a2500620217f544b151d4fb6060e9b983</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369607/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369607/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,730,783,787,888,27936,27937,53804,53806</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25755035$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mundt, Marlon P., PhD</creatorcontrib><creatorcontrib>Gilchrist, Valerie J., MD</creatorcontrib><creatorcontrib>Fleming, Michael F., MD, MPH</creatorcontrib><creatorcontrib>Zakletskaia, Larissa I., MA</creatorcontrib><creatorcontrib>Tuan, Wen-Jan, MS, MPH</creatorcontrib><creatorcontrib>Beasley, John W., MD</creatorcontrib><title>Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease</title><title>Annals of family medicine</title><addtitle>Ann Fam Med</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Ambulatory Care - economics</subject><subject>Ambulatory Care - utilization</subject><subject>Blood Pressure</subject><subject>Cardiovascular Diseases - blood</subject><subject>Cardiovascular Diseases - economics</subject><subject>Cardiovascular Diseases - therapy</subject><subject>Cholesterol, LDL - blood</subject><subject>Emergency Service, Hospital - economics</subject><subject>Emergency Service, Hospital - utilization</subject><subject>Female</subject><subject>Health Care Costs</subject><subject>Health Personnel - organization & administration</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Interprofessional Relations</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Patient Care Team - organization & administration</subject><subject>Patient Outcome Assessment</subject><subject>Primary Health Care - organization & administration</subject><subject>Quality of Health Care</subject><subject>Social Support</subject><subject>Sociometric Techniques</subject><issn>1544-1709</issn><issn>1544-1717</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNpVkU9v1DAQxS0EoqUg8QmQj1y2eJzY3lyQ0FL-SBUUtYijNXHG1G0St3ayaL89Di1bOHks__T83jzGXoI4hsqIN-iHYzCqfsQOQdX1CgyYx_tZNAfsWc5XQkiQlXzKDqQySolKHbJ04j25KfPo-VkKA6Yd32AifkE48PPoAvb8C02_Yrou0Mi_zdiHabfwfzgcO76JuSj4mPgZToHGcvkRpssF6ELcYnZzj4m_D5kw03P2xGOf6cX9ecS-fzi52HxanX79-Hnz7nTlammmFeh2DY1xsnWuAdBG-64rQ-NaWqOTKJUQWpZMxpecLSjoat9qoQU1bbOujtjbO92buR2oc8VXwt7e3KW0EYP9_2UMl_Zn3Nq60o0Wpgi8vhdI8XamPNkhZEd9jyPFOVvQWharWlcPqEsx50R-_w0Iu1RkS0V2qaigr_61tQf_dvLgm8pytoGSdX0Yg8P-mnaUr-KcxrI3CzZLK-z50vJSMqhKCLGG6jcHaKG4</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Mundt, Marlon P., PhD</creator><creator>Gilchrist, Valerie J., MD</creator><creator>Fleming, Michael F., MD, MPH</creator><creator>Zakletskaia, Larissa I., MA</creator><creator>Tuan, Wen-Jan, MS, MPH</creator><creator>Beasley, John W., MD</creator><general>American Academy of Family Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150301</creationdate><title>Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-16b8197c2bcc911676fdd9119cbe8ac2a2500620217f544b151d4fb6060e9b983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Ambulatory Care - economics</topic><topic>Ambulatory Care - utilization</topic><topic>Blood Pressure</topic><topic>Cardiovascular Diseases - blood</topic><topic>Cardiovascular Diseases - economics</topic><topic>Cardiovascular Diseases - therapy</topic><topic>Cholesterol, LDL - blood</topic><topic>Emergency Service, Hospital - economics</topic><topic>Emergency Service, Hospital - utilization</topic><topic>Female</topic><topic>Health Care Costs</topic><topic>Health Personnel - organization & administration</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Interprofessional Relations</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Patient Care Team - organization & administration</topic><topic>Patient Outcome Assessment</topic><topic>Primary Health Care - organization & administration</topic><topic>Quality of Health Care</topic><topic>Social Support</topic><topic>Sociometric Techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mundt, Marlon P., PhD</creatorcontrib><creatorcontrib>Gilchrist, Valerie J., MD</creatorcontrib><creatorcontrib>Fleming, Michael F., MD, MPH</creatorcontrib><creatorcontrib>Zakletskaia, Larissa I., MA</creatorcontrib><creatorcontrib>Tuan, Wen-Jan, MS, MPH</creatorcontrib><creatorcontrib>Beasley, John W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of family medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mundt, Marlon P., PhD</au><au>Gilchrist, Valerie J., MD</au><au>Fleming, Michael F., MD, MPH</au><au>Zakletskaia, Larissa I., MA</au><au>Tuan, Wen-Jan, MS, MPH</au><au>Beasley, John W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease</atitle><jtitle>Annals of family medicine</jtitle><addtitle>Ann Fam Med</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>13</volume><issue>2</issue><spage>139</spage><epage>148</epage><pages>139-148</pages><issn>1544-1709</issn><eissn>1544-1717</eissn><abstract>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.</abstract><cop>United States</cop><pub>American Academy of Family Physicians</pub><pmid>25755035</pmid><doi>10.1370/afm.1754</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease |
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