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Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study

机译：糖尿病患者的初级保健团队沟通网络，团队氛围，护理质量和医疗费用：一项横断面研究

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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. Participants: 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 (b = 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.
机译：背景：基层医疗团队在为糖尿病患者提供最佳护理质量方面发挥着重要作用。关于团队沟通网络和团队氛围如何促进高质量糖尿病护理的证据很少。目的：确定初级保健团队的沟通和团队氛围是否与健康结果，医疗保健利用率以及糖尿病患者的相关费用有关。方法：对初级保健团队成员进行的横断面调查收集了有关与其他保健团队成员就患者护理和团队氛围进行交流的频率的信息。从电子健康记录中提取了过去12个月中团队糖尿病患者小组的患者结果（血糖，胆固醇和血压控制，急诊就诊，急诊就诊，医院就诊天数，医疗费用）。使用嵌套的（诊所/团队/患者）广义线性混合模型分析数据。参与者：2013年5月至2013年12月，有来自美国6家初级保健诊所的155名卫生专业人员参加。结果：团队成员之间日常面对面交流较多的初级保健团队的关联率为52％（比率= 0.48，在过去12个月中，每位糖尿病患者的住院天数减少了95％CI：0.22、0.94），而医疗费用则降低了1220美元（95％CI：2416、24美元）。相比之下，每增加一名与初级保健医生（PCP）日常就患者护理进行日常面对面交流的注册护士（RN），团队糖尿病患者的HbA1c控制较少（几率= 0.83，CI为95％ ：0.66、0.99），住院天数增加（RR = 1.57、95％CI：1.10、2.03）和更高的医疗保健费用（b = 877美元，95％CI：42美元，1713美元）。共同的团队愿景是衡量团队氛围的一种方式，在很大程度上调节了团队沟通与患者结果之间的关系。

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