ArticleJournal of the American Geriatrics Society2020
Assessing Association Between Team Structure and Health Outcome and Cost by Social Network Analysis.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 19 citations in OpenAlex.
- Healthcare cost trajectories with a multidisciplinary team model: a three-year follow-up from Finnish primary and secondary care.Scandinavian journal of primary health care · 2026Article
- Impact of Social Support Networks on Job Satisfaction, Burnout, and Turnover Intentions in Primary Care Teams.Journal of general internal medicine · 2026Article
- Associations of Social Deprivation and Oncology Physician Network Vulnerability With Acute Care Utilization in the SEER-Medicare Population.Health services research · 2026Article
- A Scoping Review of Multilevel Patient-Sharing Network Measures in Health Services Research.Medical care research and review : MCRR · 2025Article
- The Transmission of Nurse Employment Spillovers and Their Impact on Inpatient Care Quality: A Dynamic Connectedness Network Analysis.Risk management and healthcare policy · 2025Article
- The Impact of Interdisciplinary Team-Based Care on the Care and Outcomes of Chronically Ill Patients: A Systematic Review.Journal of multidisciplinary healthcare · 2025Review
- Evaluation via simulation of statistical corrections for network nonindependence.Health services & outcomes research methodology · 2024Article
- Provision of evaluation and management visits by nurse practitioners and physician assistants in the USA from 2013 to 2019: cross-sectional time series study.BMJ (Clinical research ed.) · 2023Article
- Using social network analysis methods to identify networks of physicians responsible for the care of specific patient populations.BMC health services research · 2022Article
- Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study.BMC primary care · 2022Article
- Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan.PloS one · 2022Article
- Making sense of the French public hospital system: a network-based approach to hospital clustering using unsupervised learning methods.BMC health services research · 2021Article
- Methodology of a Social Network Survey in Primary Care Practices With Medical Home Attributes.The Journal of ambulatory care managementArticle
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
BACKGROUND/
objectiveTo assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care.
designCross-sectional study.
settingData from 20% randomly selected primary care service areas in the 2015 Medicare claims were used to identify primary care practices.
participants449,460 patients with diabetes, heart failure, or chronic obstructive pulmonary disease cared for by the identified primary care practices. MEASUREMENTS: Social network analysis measures, including edge density, degree centralization, and betweenness centralization for each practice.
resultsWhen compared with practices with MDs and nurse practitioners (NPs) or/and physicians assistants (PAs), the practices with MDs had only lower degree of centralization and higher MD-to-MD connectedness. Within the primary care practices comprising MDs, NPs, or/and PAs, the nonphysician providers were more connected (measured as edge density) to all providers in the practice but with higher degree of centralization compared with the MDs in the practice. After adjusting for patient characteristics and type of practice, higher edge density was associated with lower odds of hospitalization (odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.79-0.99), emergency department (ER) admission (OR = 0.80, 95% CI = 0.70-0.92), and total spending (cost ratio (CR) = 0.86, standard error of the mean (SE) = 0.038). Conversely, higher degree centralization was associated with higher rates of hospitalization (OR = 1.15, 95% CI = 1.03-1.28), ER admission (OR = 1.23, 95% CI = 1.08-1.40), and total spending (CR = 1.14, SE = 0.037). However, higher degree centralization was associated with lower rates of potentially inappropriate medications (OR = 0.90, 95% CI = 0.81-0.99). Team leadership by an NP versus an MD was similar in the rate of ER admissions, hospitalizations, or total spending.
conclusionOur findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer ER admissions, and less total spending; findings likely reflecting better communication and more coordinated care of older patients.
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