Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.
Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.
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DOI：
10.1111/acer.12831
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发表时间：
2015-10
期刊：
影响因子：
--
通讯作者：
Carayon P
中科院分区：
文献类型：
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作者：
Mundt MP;Zakletskaia LI;Shoham DA;Tuan WJ;Carayon P
在初级保健中识别和参与过度饮酒者可能是改善患者健康状况，减少酒精相关急性护理事件和降低成本的有效方法。关于初级保健团队沟通的结构与酒精相关的患者结果相关的知之甚少。使用社会计量学调查的初级保健诊所沟通，本研究评估了团队沟通网络和酒精相关的利用护理和成本之间的关系。2013年5月至2013年12月期间，6家初级保健诊所的155名医疗保健员工参加了一项关于团队沟通的调查。三层分层模型评估了护理团队内的连通性与每个团队的初级护理患者面板在过去12个月内与酒精相关的急诊科就诊次数，住院天数和相关医疗费用之间的联系。RN显示更强（至少每天）面对面联系和更强（至少每天）电子通信联系的团队（n = 31）与酒精相关的住院天数减少10%（RR = 0.90; 95%CI：0.84，0.97）。此外，在平均团队规模为19人的团队中，在过去12个月内，每增加一名团队成员，在整个团队中建立强互动关系，每1000名团队患者的酒精相关患者医疗保健成本降低1030美元（95% CI：-1819美元，-241美元）。相反，团队的初级保健医生有更强的面对面的沟通关系，更弱的（每周或每周几次）电子通讯联系与酒精有关的住院天数增加了12%（RR = 1.12; 95：CI：1.03，1.23）和$1428（95%CI：$378，$2478）在过去12个月内每1000例患者的酒精相关医疗费用增加。分析控制了患者年龄、性别、保险和合并症诊断。过度饮酒的病人可能会更好地照顾，如果由团队的面对面和电子通信网络，包括更多的团队成员，其通信到PCP已精简到更少的团队成员。
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. 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. 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. 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.