Amelia Compagni, PhD, is Associate Professor, Department of Policy Analysis and Public Management, Center for Research in Health and Social Care Management, Bocconi University, Milan, Italy. E-mail:
Health Care Manage Rev. 2019 Jan/Mar;44(1):67-78. doi: 10.1097/HMR.0000000000000158.
Primary care teams (hereafter referred to as primary care units [PCUs]) composed of general practitioners (GPs), nurses, and specialist doctors have recently been established in the Italian context, with the main aim of improving integrated care for chronic diseases.
The aim of the study was to assess whether the increased professional diversity of PCUs has resulted in an improvement in the integrated care of type II diabetes and to identify a potential mechanism mediating this effect.
METHODOLOGY/APPROACH: We analyzed 213 PCUs, comparing their performance in integrated type II diabetes care at two time points. Using social categorization theory and a fixed effects regression analysis, we tested a mediation model in which the frequency of communication among GPs in the PCUs, that is, within-subgroup communication, mediates the relationship between PCU professional diversity and team performance in diabetes care.
We show that when the professional diversity of the PCUs increases, integrated care of type II diabetes improves and better meets the standards of optimal care. Within-GP subgroup communication works as a mediating mechanism that translates the PCU professional diversity into better team performance. The mediation effect, however, is curvilinear. Beyond certain levels, within-subgroup communication can hamper PCUs' capacity to work collaboratively in integrated type II diabetes care.
The article suggests that, when creating interprofessional primary care teams, managers might be able to steer teams toward a better performance by encouraging communication among peers of the same profession.
由全科医生、护士和专科医生组成的基层医疗团队（以下简称基层医疗单位）最近在意大利建立，主要目的是改善慢性病的综合护理。
本研究旨在评估基层医疗单位专业人员多样性的增加是否导致了 2 型糖尿病综合护理的改善，并确定潜在的中介机制。
方法/途径：我们分析了 213 个基层医疗单位，在两个时间点比较了它们在 2 型糖尿病综合护理方面的表现。利用社会分类理论和固定效应回归分析，我们测试了一个中介模型，即基层医疗单位内全科医生之间的沟通频率（即亚组内沟通）中介了基层医疗单位专业多样性与糖尿病护理团队绩效之间的关系。
我们表明，当基层医疗单位的专业多样性增加时，2 型糖尿病的综合护理会得到改善，并且更符合最佳护理标准。亚组内的全科医生沟通是一种中介机制，它将基层医疗单位的专业多样性转化为更好的团队绩效。然而，这种中介效应是曲线的。超过一定水平后，亚组内的沟通可能会阻碍基层医疗单位在 2 型糖尿病综合护理方面的协作能力。
本文表明，在创建跨专业的基层医疗团队时，管理者可以通过鼓励同专业的同事之间进行沟通，使团队能够更好地发挥作用。
