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The Effect of Care Team Composition on the Quality of HIV CareUniversity of Washington, Seattle, hrod{at}u.washington.edu
Harvard University, Cambridge
Harvard Medical School, Boston
Tufts-New England Medical Center, Boston
Yale School of Public Health, New Haven Compared to single-clinician care, care provided by multiple clinicians might result in higher-quality care, especially if some of them have condition-specific expertise and complementary knowledge, skills, and roles. Individual physician continuity, which has been shown to be associated with care quality, necessarily decreases when care is provided by multiple clinicians. This study uses data from the HIV Cost and Services Utilization Study to assess the effect of care team composition on the quality of HIV care. In adjusted analyses, care teams composed of three or more clinicians were associated with more consistent prescribing of pneumocystis carinii pneumonia prophylaxis when medically indicated ( p < .01). Patients with multiple physicians generally reported worse care coordination, however, and had more inappropriate use of emergency services. These findings indicate both advantages and disadvantages to having multiple clinicians. More effort should be devoted to facilitating coordination when multiple clinicians provide care.
Key Words: team composition • continuity of care • organizational characteristics • chronic illness care • quality of care
Medical Care Research and Review, Vol. 65, No. 1,
88-113 (2008) |
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