Communication in Primary Care Teams and Diabetes Outcomes: A Social Network Analysis

OBJECTIVE To examine how communication patterns within primary care teams are associated with diabetes outcomes, using social network analysis. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study in 23 primary care practices affiliated with institutions in New York and Pennsylvania. All providers and staff were invited to complete a survey measuring communication frequency and modality. We constructed egocentric communication networks for 96 primary care providers (PCPs), linking survey data to data from electronic health records for 2,617 patients with diabetes. Key network measures included density (proportion of actual to possible connections) and PCP betweenness centrality (extent to which communication was routed through the PCP). Multilevel logistic regression models assessed the association between network measures and composite measure of diabetes control, defined as achieving recommended targets for blood pressure, LDL cholesterol, and HbA1c. RESULTS Patients cared for by teams with denser communication networks were more likely to achieve composite diabetes control (odds ratio 1.28; 95% CI 1.04, 1.57) in unadjusted models. This association remained significant when controlling for patient and provider covariates but was attenuated after adjusting for institutional context and patient race and ethnicity. PCP betweenness centrality was not significantly associated with diabetes outcomes. CONCLUSIONS Denser primary care team communication was associated with improved diabetes control, but these effects were attenuated by institution and patient racial composition. Findings suggest team communication may contribute to better outcomes, yet its impact is shaped by practice context and patient population. Larger, multisite studies are warranted to clarify mechanisms and inform strategies for optimizing team-based diabetes care.