Assessing Association Between Team Structure and Health Outcome and Cost by Social Network Analysis

Yong Fang Kuo, Pooja Agrawal, Lin Na Chou, Daniel Jupiter, Mukaila A. Raji

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background/Objective: To assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. Design: Cross-sectional study. Setting: Data from 20% randomly selected primary care service areas in the 2015 Medicare claims was used to identified primary care practices. Participants: 449,460 patients with diabetes, heart failure, or chronic obstructive pulmonary disease cared for by the identified primary care practices. Measurements: SNA network measures, including edge density, degree centralization, and betweenness centralization for each practice. Results: When compared to practices with MDs and nurse practitioners (NPs) or/and physicians assistants (PAs), the practices with MDs only had lower degree of centralization and higher MD-to-MD connectedness. Within the primary care practices comprising MDs, NPs or/and PAs, the non-physician providers were more connected (measured as edge density) to all providers in the practice but with higher degree of centralization compared to 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 were similar in the rate of ER admissions, hospitalizations, or total spending. Conclusion: Our 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.

Original languageEnglish (US)
Pages (from-to)946-954
Number of pages9
JournalJournal of the American Geriatrics Society
Issue number4
StatePublished - Apr 2021


  • Medicare
  • nurse practitioners
  • primary care
  • social network analysis

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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