title: Effects of primary care team social networks on quality of care and costs for patients with cardiovascular disease.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin marlon.mundt@fammed.wisc.edu.
authors.forename: Marlon P
authors.initials: MP
authors.lastname: Mundt
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Gilchrist
authors.affiliation: Departments of Psychiatry and Family Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Fleming
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Larissa I
authors.initials: LI
authors.lastname: Zakletskaia
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Wen-Jan
authors.initials: WJ
authors.lastname: Tuan
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: John W
authors.initials: JW
authors.lastname: Beasley
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000191:economics / Q000628:therapy*; D008078:Cholesterol, LDL / Q000097:blood; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006282:Health Personnel / Q000458:organization & administration*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D063868:Patient Outcome Assessment; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D012944:Social Support; D012963:Sociometric Techniques
chemical_list: D008078:Cholesterol, LDL
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