Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs

Abstract

Background Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Methods Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team’s primary care patient panel. Results Teams (n=31) whose RNs displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (RR=0.90; 95% CI: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1030 (95% CI: −$1819, −$241) lower alcohol-related patient health care costs per 1000 team patients in the past 12 months. Conversely, teams whose primary care practitioner had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR=1.12; 95: CI: 1.03, 1.23) and $1428 (95% CI: $378, $2478) higher alcohol-related healthcare costs per 1000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and co-morbidity diagnoses. Conclusions Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members.

Use of social network analysis methods to study professional advice and performance among healthcare providers: a systematic review

“…Our searches returned 5970 articles, which after double screening yielded six articles meeting our inclusion criteria [ 43 – 48 ]. Figure 1 documents the review process using a PRISMA flow chart.…”

“…Networks only examined at one point in time. Mundt et al (2015) [ 48 ] USA Study objectives : To understand what team communication structures contribute to alcohol-related utilization of care and medical costs. Research questions : What primary care team communication networks are associated with alcohol-related utilization of care and medical costs for primary care patients?…”

“…Not a single study that met our search criteria was conducted in a low- or middle-income country. All studies took place in either the USA [ 43 , 45 – 48 ] or Australia [ 44 ].…”

“…None of the studies took place in a community-based setting. Only one study took place in a primary healthcare context [ 48 ]. The other five studies took place in tertiary level facilities including hospital units and specialist care facilities like hemodialysis centers or nursing homes [ 43 – 47 ].…”

Professional Communication Networks and Job Satisfaction in Primary Care Clinics

“…10 Flexible professional communication between team members that is not constricted by authority gradients could enhance professional job satisfaction because it leverages the strengths of all health care practitioners. [11][12][13][14] Ineffective professional communication might hinder job satisfaction and severely limit sensemaking, coordination, and collaboration if there are clinic hierarchies for communication and/or if there are bottlenecks in clinic communication flow. 15,16 Poor team communication among primary care professionals might lead to worse job satisfaction if there is a dual organization, for example, in which some team members are isolated from interacting with the rest of the clinic staff.…”