Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting

Abstract

Background-Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Methods and Results-Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Conclusions-Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. (Circ Cardiovasc Qual Outcomes. 2016;9:641-648.

Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery

“…As reported previously, implementation resulted in a significant reduction in length of stay, surgical site infections, and variable direct costs, as well as improvement in the patient experience. [9][10][11] Designation of operating room teams Before the implementation of the ERAS program, anesthesia providers (attending anesthesiologist and anesthesia resident or certified registered nurse anesthetist [CRNA]) were assigned ad hoc to colorectal surgical cases by a central anesthesiologist scheduler. Providers were selected from the entire pool of clinical providers assigned to a particular clinical day.…”

“…At least one group found that improved teamworkdas captured by a network measure of provider overlap with patientsdled to better outcomes after coronary artery bypass grafting. 9 In this light, our group sought to better understand the potential impact of ERAS programs on teamwork through the use of social network analysis on a recently implemented ERAS for colorectal surgery program. Our hypothesis was that creating OR teams through the identification of surgical, anesthesia, and nursing leadership coupled with recruitment of designated ERAS providers across the perioperative environment would lead to both improvements in metrics of teamwork, as well as surgical outcomes.…”

Association of Informal Clinical Integration of Physicians With Cardiac Surgery Payments

“…Within each health system, we recorded an interaction between physicians if they billed for services for the same beneficiary around that beneficiary's CABG episode. 21 We mapped networks separately for each year and health system. Patients undergoing surgery at the same health system but in different years, or in the same year but at different health systems, experience different networks.…”

The association between patient sharing network structure and healthcare costs

“…These relationships, analyzed using social network measures, are a product of formal and informal information sharing [13,14], organizational affiliations [15,16], and care coordination [2,8]. Physician shared patient network structurebased in part on their referral patterns-is impacted by insurance type [17,18], patient clinical characteristics [19], socioeconomic characteristics [17,[20][21][22], and organizations [4,15,23].…”