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

• Published in: JAMA : the journal of the American Medical Association 2016-08, Vol.316 (8), p.826-834
• Main Authors: Reiss-Brennan, Brenda, Brunisholz, Kimberly D, Dredge, Carter, Briot, Pascal, Grazier, Kyle, Wilcox, Adam, Savitz, Lucy, James, Brent
• Format: Article
• Language: English
• Subjects: Adult; Advance Directives - statistics & numerical data; Aged; Aged, 80 and over; Clinical outcomes; Delivery of Health Care, Integrated - economics; Delivery of Health Care, Integrated - organization & administration; Delivery of Health Care, Integrated - statistics & numerical data; Depression - diagnosis; Depression - epidemiology; Diabetes Mellitus - therapy; Emergency Medical Services - statistics & numerical data; Family Practice; Female; Health Care Costs; Health care delivery; Health Services - economics; Health Services - utilization; Health Services for the Aged; Hospitalization - statistics & numerical data; Humans; Hypertension - epidemiology; Hypertension - therapy; Internal Medicine; Longitudinal Studies; Male; Mental Health Services - organization & administration; Mental Health Services - statistics & numerical data; Middle Aged; Outcome Assessment (Health Care); Primary Health Care - economics; Primary Health Care - methods; Primary Health Care - statistics & numerical data; Quality of care; Retrospective Studies; Self Care - statistics & numerical data
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2016.11232

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 (