title: Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study.
abstract: BACKGROUND
  Primary care teams play an important role in providing the best quality of care to patients with diabetes. Little evidence is available on how team communication networks and team climate contribute to high quality diabetes care.
  
  
  OBJECTIVE
  To determine whether primary care team communication and team climate are associated with health outcomes, health care utilization, and associated costs for patients with diabetes.
  
  
  METHODS
  A cross-sectional survey of primary care team members collected information on frequency of communication with other care team members about patient care and on team climate. Patient outcomes (glycemic, cholesterol, and blood pressure control, urgent care visits, emergency department visits, hospital visit days, medical costs) in the past 12 months for team diabetes patient panels were extracted from the electronic health record. The data were analyzed using nested (clinic/team/patient) generalized linear mixed modeling.
  
  
  METHODS
  155 health professionals at 6 U.S. primary care clinics participated from May through December 2013.
  
  
  RESULTS
  Primary care teams with a greater number of daily face-to-face communication ties among team members were associated with 52% (rate ratio=0.48, 95% CI: 0.22, 0.94) fewer hospital days and US$1220 (95% CI: -US$2416, -US$24) lower health-care costs per team diabetes patient in the past 12 months. In contrast, for each additional registered nurse (RN) who reported frequent daily face-to-face communication about patient care with the primary care practitioner (PCP), team diabetes patients had less-controlled HbA1c (Odds ratio=0.83, 95% CI: 0.66, 0.99), increased hospital days (RR=1.57, 95% CI: 1.10, 2.03), and higher healthcare costs (β=US$877, 95% CI: US$42, US$1713). Shared team vision, a measure of team climate, significantly mediated the relationship between team communication and patient outcomes.
  
  
  CONCLUSIONS
  Primary care teams which relied on frequent daily face-to-face communication among more team members, and had a single RN communicating patient care information to the PCP, had greater shared team vision, better patient outcomes, and lower medical costs for their diabetes patient panels.
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53715, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53715, USA. Electronic address: marlon.mundt@fammed.wisc.edu.
authors.forename: Marlon P
authors.initials: MP
authors.lastname: Mundt
authors.affiliation: Surrey Business School, University of Surrey, Guildford, UK.
authors.forename: Filip
authors.initials: F
authors.lastname: Agneessens
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53715, USA.
authors.forename: Wen-Jan
authors.initials: WJ
authors.lastname: Tuan
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53715, USA.
authors.forename: Larissa I
authors.initials: LI
authors.lastname: Zakletskaia
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53715, USA.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Kamnetz
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53715, USA.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Gilchrist
mesh_terms: D003142:Communication; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D015146:Midwestern United States; D011320:Primary Health Care; D011787:Quality of Health Care; D000078329:Workforce
keywords: Communication; Diabetes; Nurse; Primary care; Social network; Team; Team climate