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Managing Multimorbidity in Primary Care: Measuring Collaboration Efforts within and across Organizational Boundaries

Year: 2019
Type: dissertation
Study design: Observational Study
Abstract: In Ontario, there has been widespread investment and reform to enable collaboration between providers in interdisciplinary primary care teams (Family Health Teams [FHT] and Community Health Centres [CHC]), alongside partnerships to promote collaboration between primary care teams, hospitals, and community agencies. However our understanding of the factors associated with interprofessional collaboration within primary care teams, the association between interprofessional collaboration and patient outcomes, and the interplay between interprofessional and interorganizational collaboration as it relates to the primary care sector is still in its early stages. Study 1 examined which organizational characteristics are associated with interprofessional collaboration that was assessed via the Collaborative Practice Assessment Tool (CPAT) in CHCs and FHTs across Ontario. Study 2 involved analyzing linked administrative data to assess the association between interprofessional collaboration and emergency department (ED) visits, hospitalizations and 30-day readmissions for adults with multimorbidity. Study 3 adopted a network analysis lens to examine regular contact, level of integration, and four types of relationships (referrals, information sharing, joint care planning and shared resources) between organizations. Two care coordination initiatives (Health Links) were selected as case studies. One case was led by a lead agency with a low CPAT score and the second case was led by a lead agency with a high CPAT score. The use of formal and informal mechanisms of information sharing, a strong commitment to quality improvement and years since practice establishment were positively associated with interprofessional collaboration. Increasing team size, high levels of information exchange, a mixed governance board, and greater centralization of administrative processes had a negative association with CPAT score. The extent of interprofessional collaboration was not associated with the likelihood of having an ED visit, hospitalization or readmission. Results indicate no statistically significant association between interprofessional collaboration and healthcare utilization for patients with multimorbidity. The low-CPAT led case showed greater connectivity pertaining to regular contact and integration between organizations, compared to the high-CPAT led case. Mixed trends were observed for the four types of relationships examined. Network analysis findings offer key insight into how organizations in Health Links are interacting to better coordinate services for this unique patient population.
Language: English
Open Access status: green
OpenAlex ID: W3183349494
Cites: 284
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Related to: 10