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.

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.

Keywords: cardiovascular diseases; electronic health records; emergency departments; face-to-face communication; hospital days; patient care team; patient outcome assessment; primary health care; social networks; team vision.

Figure 1

Primary care team communication networks about patient care. CM = clinic manager; LT = laboratory technician; MA = medical assistant; MD = physician; MR = medical receptionist; RN = registered nurse; RT = radiology technician. Note: Symbol size proportional to number of connections.

Figure 1

Primary care team communication networks about patient care. CM = clinic manager; LT = laboratory technician; MA = medical assistant; MD = physician; MR = medical receptionist; RN = registered nurse; RT = radiology technician. Note: Symbol size proportional to number of connections.

Figure 2

Structural equation model of team social networks and quality of care for patients with cardiovascular disease (n = 31 primary care teams, n = 7,457 patients). CVD = cardiovascular disease; ED = emergency department. Notes: Pathway coefficients between boxes denote the standardized change in end point outcome variable associated with a 1 SD increase in lead predictor variable. By multiplying pathway coefficients between structure, process, and outcome measures, the analysis estimates team social network impact on health care utilization. As an example, for every 1 SD increase in face-to-face interaction density, urgent care visits, emergency department visits, and hospital days decrease by 0.562 (0.816*0.689), 0.420 (0.816*0.515), and 0.380 (0.816*0.466) SDs, respectively. ^aP = <.001. ^bP = <.01.