Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.
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.
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Marlon P
MP
Mundt
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Larissa I
LI
Zakletskaia
Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois.
David A
DA
Shoham
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Wen-Jan
WJ
Tuan
College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
Pascale
P
Carayon
D000437:Alcoholism / Q000191:economics / Q000517:prevention & control*; D003142:Communication; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration*; D014922:Wisconsin
Alcohol; Communication; Primary Care; Social Network; Team