Dana B. Mukamel, Ph D¹, Rachel Ritz, MS², Derick Peterson, PhD³, Stephen Kunitz, MD, PhD⁴, Alina Bajorska, MS⁵, Diane Gross, PhD⁴, T. Franklin Williams, MD⁶, and Helena Temkin-Greener, PhD⁵. (1) Department of Medicine, Division of General Internal Medicine & Primary Care, University of California, Irvine, Health Policy Research, 100 Theory, Suite 110, Irvine, CA 92697, 949 824 8873, dmukamel@uci.edu, (2) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (3) Department of Biostatistics, University of Rochester, 601 Elmwood Avenue, Box 630, Rochester, NY 14642, (4) Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (5) Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (6) Monroe Community Hospital, 435 East Henrietta Road, Rochester, NY 14620

One of the core tenets guiding the structure and operations of PACE, is that care is more effective if provided by a multidisciplinary team. PACE programs view all care givers, from physicians to aides, as members of the team. All disciplines participate in team meetings in which program participants are evaluated and care plans developed. In this study we test the hypothesis that participants’ health outcomes are better in sites that have better teams. We also examine which aspects of the team performance (i.e. leadership, communication, conflict resolution and coordination) are associated with better outcomes. We find that team performance is not significantly associated with risk adjusted mortality but is associated with risk adjusted decline in functional status (ADLs) at 3 and 12 months after enrollment and risk adjusted decline in urinary incontinence at 12 months post enrollment. These findings are based on data from DataPACE and an assessment of team performance based on a survey of all care givers in 26 PACE programs using a validated team performance tool. We estimated random effect models for mortality outcomes, random effect linear models for ADL outcomes and random effect ordered logistic models for urinary incontinence outcomes. Our findings suggest that teams are important in improving some but not all health outcomes. These findings offer insights to PACE and other programs providing acute and long term care to frail elders on the importance of teams and aspects of team performance that are most beneficial.

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