Interdisciplinary Teams and Home-Based Medical Care: Secondary Analysis of a National Survey

Objectives: The objective of this study was to describe the use of interdisciplinary teams (IDTs)in home-based medical care practices. Design: We performed a secondary data analysis using results from the 2013 National Home-Based Primary Care and Palliative Care Network survey of home-based medical care (HBMC)practices. Setting and Participants: Two hundred forty-six unique HBMC practices were included in this study. Methods: Descriptive statistics and frequency distributions were generated on the sample characteristics, practice IDT configurations, and routine use of IDT meetings. Associations between practice characteristics, IDT configuration, and routine use of IDT meetings were analyzed using bivariate analyses and logistic regression. Results: Sixty percent of practices held routinely scheduled IDT meetings. Most practices that used IDTs reported meeting weekly (42.2%)or monthly (26.5%). The most common practice team configurations included billing providers without teams (45.9%), billing providers with both a care coordinator and nurse (23.7%), then practices with either a billing provider and nurse (14.9%)or a billing provider with a care coordinator (14.2%). Practices that conducted regular IDT meetings were more likely to be a group practice rather than solo practice (59% vs 45%, P =.03), be owned or sponsored by a primary hospital or health system rather than an independent practice (23% vs 12%, P =.03), be financially subsidized by a hospital or health system rather than be independently financed (17% vs 6%, P =.01), be affiliated with an academic institution rather than not (30% vs 16%, P =.01), and be a not-for-profit vs for-profit entity (30% vs 17% P =.03). Conclusions and Implications: There is substantial diversity in IDT integration in HBMC practices. Routine IDT care in HBMC will improve care quality but will require clear standards and accountability for it to be fully integrated into HBMC practice.