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 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. 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. RESULTS

Availability of primary care team members can improve teamwork and readiness for change

“…Our findings are consistent with recent research indicating that team members with lower professional status often experience challenges ''voicing'' their concerns and suggestions to improve unit functioning (Nembhard, Labao, & Savage, 2014). Strategies to improve primary care team member role recognition and clarity facilitate reliable access to interdisciplinary team member expertise, and improved teamwork experiences may hold promise for improving readiness for change.…”

“…Recent research also highlights the importance of tight team structures and teamwork for members of lower professional status. For example, recent research found that primary care staff are more likely to report that it was not safe to speak up about issues in their work environments (Nembhard, Yuan, Shabanova, & Cleary, 2015). In this study, a greater disconnect between physicians and staff was predictive of lower performance on measures of patients' experiences of access and care coordination.…”

“…To our knowledge, this is the first study to measure team member availability and examine relationships of availability with team and organizational processes. The density of primary care team member interactions has been associated with fewer hospital days and lower medical care costs (Mundt et al, 2015), suggesting that aspects of team structure can impact patient, team, and organizational outcomes.…”

Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study

“…To minimize response bias and enhance data validity, the study team assured participants of the confidentiality and anonymity of their responses, that the data would not be shared with the clinic administration and management, and that results would be reported in aggregate format. 27,28 A more detailed description of the study questionnaire is available in Mundt et al 29 …”

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

“…1 In addition, outcomes are significantly better for patients who receive care from teams rather than from individual clinicians, 6 especially when team members constantly interact and have a shared team vision. 7 Thus, primary care is being transformed into care delivered in teams comprised of clinicians from multiple disciplines, including nurse practitioners (NPs) and physician assistants. 8,9 Policy recommendations are supportive of this trend as a means to increase access, improve care, and control costs.…”