Volume 49 | Number 1pt2 | February 2014

Abstract List

Ilana Graetz, Mary Reed, Stephen M. Shortell Ph.D., M.P.H., M.B.A., Thomas G. Rundall, Jim Bellows, John Hsu M.D., M.B.A.


To examine whether primary care team cohesion changes the association between using an integrated outpatient‐inpatient electronic health record () and clinician‐rated care coordination across delivery sites.

Study Design

Self‐administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 ( = 565), 2006 ( = 678), and 2008 ( = 626) during the staggered implementation of an integrated (2005–2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement.

Principal Findings

Among clinicians working in teams with higher cohesion, use was associated with significant improvements in reported access to timely and complete information (53.5 percent with vs. 37.6 percent without integrated‐), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all  < .05). We found no statistically significant association between use of the integrated‐ and reported care coordination in less cohesive teams.


The association between use and reported care coordination varied by level of team cohesion. s may not improve care coordination in less cohesive teams.