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Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost

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Reiss-Brennan, Brenda, Brunisholz, Kimberly D., Dredge, Carter, Briot, Pascal, Grazier, Kyle, Wilcox, Adam, Savitz, Lucy, James, Brent·2016·JAMA
DOI 10.1001/jama.2016.11232
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Abstract

IMPORTANCE: The value of integrated team delivery models is not firmly established. OBJECTIVE: To evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices (usual care) with patient outcomes, health care utilization, and costs. DESIGN: A retrospective, longitudinal, cohort study to assess the association of integrating physical and mental health over time in TBC practices with patient outcomes and costs. SETTING AND PARTICIPANTS: Adult patients (aged ≥18 years) who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and had yearly encounters with Intermountain Healthcare through 2013, including some patients who received care in both TBC and TPM practices. EXPOSURES: Receipt of primary care in TBC practices compared with TPM practices for patients treated in internal medicine, family practice, and geriatrics practices. MAIN OUTCOMES AND MEASURES: Outcomes included 7 quality measures, 6 health care utilization measures, payments to the delivery system, and program investment costs. RESULTS: During the study period (January 2010-December 2013), 113,452 unique patients (mean age, 56.1 years; women, 58.9%) accounted for 163,226 person-years of exposure in 27 TBC practices and 171,915 person-years in 75 TPM practices. Patients treated in TBC practices compared with those treated in TPM practices had higher rates of active depression screening (46.1% for TBC vs 24.1% for TPM; odds ratio [OR], 1.91 [95% CI, 1.75 to 2.08), adherence to a diabetes care bundle (24.6% for TBC vs 19.5% for TPM; OR, 1.26 [95% CI, 1.11 to 1.42]), and documentation of self-care plans (48.4% for TBC vs 8.7% for TPM; OR, 5.59 [95% CI, 4.27 to 7.33]), lower proportion of patients with controlled hypertension (<140/90 mm Hg) (85.0% for TBC vs 97.7% for TPM; OR, 0.87 [95% CI, 0.80 to 0.95]), and no significant differences in documentation of advanced directives (9.6% for TBC vs 9.9% for TPM; OR, 0.97 [95% CI, 0.91 to 1.03]). Per 100 person-years, rates of health care utilization were lower for TBC patients compared with TPM patients for emergency department visits (18.1 for TBC vs 23.5 for TPM; incidence rate ratio [IRR], 0.77 [95% CI, 0.74 to 0.80]), hospital admissions (9.5 for TBC vs 10.6 for TPM; IRR, 0.89 [95% CI, 0.85 to 0.94]), ambulatory care sensitive visits and admissions (3.3 for TBC vs 4.3 for TPM; IRR, 0.77 [95% CI, 0.70 to 0.85]), and primary care physician encounters (232.8 for TBC vs 250.4 for TPM; IRR, 0.93 [95% CI, 0.92 to 0.94]), with no significant difference in visits to urgent care facilities (55.7 for TBC vs 56.2 for TPM; IRR, 0.99 [95% CI, 0.97 to 1.02]) and visits to specialty care physicians (213.5 for TBC vs 217.9 for TPM; IRR, 0.98 [95% CI, 0.97 to 0.99], P > .008). Payments to the delivery system were lower in the TBC group vs the TPM group ($3400.62 for TBC vs $3515.71 for TPM; β, -$115.09 [95% CI, -$199.64 to -$30.54]) and were less than investment costs of the TBC program. CONCLUSIONS AND RELEVANCE: Among adults enrolled in an integrated health care system, receipt of primary care at TBC practices compared with TPM practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system.

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  • Effective team-based care and higher quality teamwork are associated with improvements in care access and quality, patient safety, patient satisfaction, clinical outcomes, and costs.

    “Effective team-based care and higher quality teamwork are associated with improvements in care access and quality, patient safety, patient satisfaction, clinical outcomes, and costs [2, 4–9].”

    From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [2]

  • Healthcare and human service providers often work in team-based settings where professionals work collaboratively with one another and service recipients toward shared goals.

    “Healthcare and human service providers (e.g., clinicians, case managers) often work in team-based settings where professionals work collaboratively with one another and service recipients toward shared goals [1, 2].”

    From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [2]

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Research works printed but not linked: 4

  1. Reiss-Brennan B. Mental health integration. J Prim Care Community Health. 2014;5(1):55-60.
  2. James BC, Savitz LA. How Intermountain trimmed health care costs through robust quality improvement efforts. Health Aff (Millwood). 2011; 30(6):1185-1191.
  3. Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two. Health Aff (Millwood). 2010;29(5):835-843.
  4. Rosenthal MB, Friedberg MW, Singer SJ, Eastman D, Li Z, Schneider EC. Effect of a multipayer patient-centered medical home on health care utilization and quality. JAMA Intern Med. 2013;173(20):1907-1913.

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Authors
Reiss-Brennan, B., Brunisholz, K. D., Dredge, C., Briot, P., Grazier, K., Wilcox, A., Savitz, L., & James, B.
Affiliations
  • Intermountain Healthcare (US)
  • University of Michigan (US)
Corresponding author
Reiss-Brennan, Brenda
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2016-08-23
Volume
316
Issue
8
Pages
826
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2016.11232
OpenAlex
W2512393512
Cited by
303
References
26
Citations by year
2026: 20 · 2025: 17 · 2024: 35 · 2023: 32 · 2022: 33 · 2021: 26 · 2020: 40 · 2019: 26 · 2018: 40 · 2017: 30 · 2016: 4
FWCI
62.00
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Intermountain Healthcare
  • Uniformed Services University of the Health Sciences
  • National Academy of Medicine
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
primary care models, integrated care, mental health integration, depression screening, hypertension control, health care utilization, health care costs, quality of care, patient satisfaction, patient engagement, usual care comparison, Intermountain Healthcare, patient-centered care
MeSH terms
Adult, Aged, Aged, 80 and over, Depression, Diabetes Mellitus, Emergency Medical Services, Family Practice, Female, Health Services, Health Services for the Aged, Hospitalization, Humans, Hypertension, Internal Medicine, Longitudinal Studies, Male, Mental Health Services, Middle Aged, Primary Health Care, Retrospective Studies, Self Care, Advance Directives, Health Care Costs, Outcome Assessment, Health Care, Delivery of Health Care, Integrated

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