Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study.
Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study.
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DOI：
10.1016/j.ijnurstu.2016.01.013
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发表时间：
2016-06
影响因子：
8.1
通讯作者：
Gilchrist VJ
中科院分区：
文献类型：
--
作者：
Mundt MP;Agneessens F;Tuan WJ;Zakletskaia LI;Kamnetz SA;Gilchrist VJ
初级保健团队在为糖尿病患者提供最佳质量的护理方面发挥着重要作用。关于团队沟通网络和团队氛围如何有助于高质量的糖尿病护理的证据很少。确定初级保健团队沟通和团队氛围是否与糖尿病患者的健康结局、医疗保健利用率和相关费用相关。一项对初级保健团队成员的横断面调查收集了与其他护理团队成员就患者护理和团队气氛进行沟通的频率信息。从电子健康记录中提取过去12个月团队糖尿病患者面板的患者结局（血糖、胆固醇和血压控制、紧急护理访视、急诊科访视、医院访视天数、医疗费用）。使用嵌套（诊所/团队/患者）广义线性混合模型分析数据。2013年5月至12月，美国6家初级保健诊所的155名卫生专业人员参加了该项目。在过去的12个月里，团队成员之间日常面对面交流次数较多的初级保健团队与每名团队糖尿病患者的住院天数减少52%（率比=0.48，95% CI：0.22，0.94）和医疗保健费用减少1220美元（95% CI：-2416美元，-24美元）相关。相比之下，对于报告与初级保健医生（PCP）就患者护理进行频繁日常面对面交流的每一名额外注册护士（RN），团队糖尿病患者的HbA 1c控制较差（比值比=0.83，95% CI：0.66，0.99），住院天数增加（RR=1.57，95% CI：1.10，2.03），医疗费用增加（β= 877美元，95% CI：42美元，1713美元）。共享的团队愿景，团队气氛的措施，显着介导的团队沟通和病人的结果之间的关系。初级保健团队依赖于更多团队成员之间频繁的日常面对面沟通，并且有一个RN向PCP传达患者护理信息，具有更大的共享团队愿景，更好的患者结局，以及更低的糖尿病患者面板医疗成本。
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. 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. 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. 155 health professionals at 6 U.S. primary care clinics participated from May through December 2013. 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. 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.