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

Authors: Mundt, M. P.; Zakletskaia, L. I.; Shoham, D. A.; Tuan, W. J.; Carayon, P.
Article Title: 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 registered nurses 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 (rate ratio [RR] = 0.90; 95% confidence interval [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 $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) 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 $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity 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.
Journal Title: Alcoholism, Clinical and Experimental Research
Volume: 39
Issue: 10
ISSN: 1530-0277; 0145-6008
Publisher: Unknown  
Journal Place: England
Date Published: 2015
Start Page: 2003
End Page: 2015
Language: eng
Notes: LR: 20151007; CI: Copyright (c) 2015; GR: K01 AA018410/AA/NIAAA NIH HHS/United States; GR: KL2 TR000428/TR/NCATS NIH HHS/United States; GR: R01 HD061978/HD/NICHD NIH HHS/United States; GR: UL1 TR000427/TR/NCATS NIH HHS/United States; JID: 7707242; NIHMS707145; OID: NLM: NIHMS707145 [Available on 10/01/16]; OID: NLM: PMC4592408 [Available on 10/01/16]; OTO: NOTNLM; PMCR: 2016/10/01 00:00; 2014/12/18 [received]; 2015/06/29 [accepted]; 2015/09/09 [aheadofprint]; ppublish