Patterns of Coordination and Clinical Outcomes: A Study of Surgical Services.

Young, Gary P.; Charns, Martin P.; Desai, Kamal R.; Daley, Jennifer; Henderson, William; Khuri, Shukri F.

doi:10.5465/ambpp.1997.4981034

Cited by 74 publications

(97 citation statements)

References 12 publications

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“…These findings are consistent with the previously reported findings in the literature that have found associations between coordination and patient outcomes (9,20,21,27). Specifically, they provide further support for the relationship be- There was one potential limitation to these analyses.…”

Section: Discussionsupporting

confidence: 83%

The Relationship Between Provider Coordination and Diabetes-Related Foot Outcomes

et al. 2003

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OBJECTIVE -To investigate the relationship between provider coordination and amputations in patients with diabetes.RESEARCH DESIGN AND METHODS -The study design was a cross-sectional, descriptive study of process and outcomes for diabetes-related foot care at 10 Department of Veterans Affairs (VA) medical centers representing different geographic regions, population densities, patient populations, and amputation rates. The subjects included all providers of diabetes foot care and a random sample of primary care providers at each medical center. The main outcome measures were the Foot Systems Assessment Tool (FootSAT), nontraumatic lower extremity amputation rates, and investigators' ordinal ranking of site effectiveness based on site visits.RESULTS -The survey response rate was 48%. Scale reliability, as measured by Cronbach's ␣, ranged from 0.73 to 0.93. The scale scores for programming coordination (i.e., electronic medical record, policies, reminders, protocols, and educational seminars) and feedback coordination (i.e., discharge planning, quality of care meetings, and curbside consultations) were negatively associated with amputation rates, suggesting centers with higher levels of coordination had lower amputation rates. Statistically significant associations were found for programming coordination with minor amputations (P ϭ 0.02) and total amputations (P ϭ 0.04).CONCLUSIONS -The FootSAT demonstrated a stronger association with amputation rates than site visit rankings. Among these 10 VA facilities, those with higher levels of programming and feedback coordination had significantly lower amputation rates.

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Section: Discussionsupporting

confidence: 83%

The Relationship Between Provider Coordination and Diabetes-Related Foot Outcomes

et al. 2003

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“…Research has shown that physician participation is positively associated with improvement in hospital patient safety indicators, but involvement by multiple hospital units in the improvement effort is associated with worse values on this and other quality measures (169). Efforts specifically focused on standardizing aspects of health care delivery also have been shown to reduce errors (177). In addition, studies have demonstrated potential benefits for patient safety from time management (3), risk management (13), and remediation, i.e., disclosure (40) and apology (60).…”

Section: Coordinating At Care Transitions and Across Interdependent Fmentioning

confidence: 99%

Reducing Hospital Errors: Interventions that Build Safety Culture

Singer¹,

Vogus

2013

Annu. Rev. Public Health

152

145

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Hospital errors are a seemingly intractable problem and continuing threat to public health. Errors resist intervention because too often the interventions deployed fail to address the fundamental source of errors: weak organizational safety culture. This review applies and extends a theoretical model of safety culture that suggests it is a function of interrelated processes of enabling, enacting, and elaborating that can reduce hospital errors over time. In this model, enabling activities help shape perceptions of safety climate, which promotes enactment of safety culture. We then classify a broad array of interventions as enabling, enacting, or elaborating a culture of safety. Our analysis, which is intended to guide future attempts to both study and more effectively create and sustain a safety culture, emphasizes that isolated interventions are unlikely to reduce the underlying causes of hospital errors. Instead, reducing errors requires systemic interventions that address the interrelated processes of safety culture in a balanced manner.

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“…For example, if an intervention requires coordination among providers, it would be wise to include measures of structures and processes that facilitate or hinder coordination [see (90,95)] as well as measures of the processes of coordination [see (94)]. As a further example, the organization literature argues that structuring an oncology practice by multidisciplinary service lines facilitates coordination across disciplines, but this does not ensure such coordination.…”

Section: Organization-level Measurement and Measuresmentioning

confidence: 99%

Multilevel Interventions: Measurement and Measures

et al. 2012

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Multilevel intervention research holds the promise of more accurately representing real-life situations than single-level intervention research and, thus, with the proper research design and measures, being more likely to facilitate the effective and efficient resolution of complex health-care systems problems (1-3). Taking a multilevel approach to cancer care interventions, however, creates measurement challenges and opportunities. Some measurement issues are similar to those arising in single-level interventions, whereas some are unique to multilevel interventions (4,5). The purpose of this article is to examine the state of measurement in multilevel cancer intervention research and to suggest how opportunities in the field may be addressed by drawing on the measurement literature in other fields.One of the unique aspects of measurement in multilevel intervention research is that consideration of within and between level effects is needed. For multilevel interventions, it is not sufficient to measure effects at the different levels of intervention (eg, patient and healthcare team), cross-level effects must also be taken into consideration (eg, the effect of patients on the team and the team on the patients). Furthermore, some measurement issues may be more complex when conducting multilevel intervention research, and some measurement rules of thumb may be uniquely associated with specific levels of analysis (eg, group or organization levels of analysis) (6,7). Because multilevel interventions are based on systems theory [whether general systems (8-10), social ecological systems (11,12), or complex adaptive systems (13) models], they require identification of key constructs and measures by level and consideration of interactions within and across levels (6). Thus, multilevel intervention research benefits from thoughtful planning and design, an interdisciplinary approach, mixed methods (eg, a combination of objective factors, surveys, interviews, observations) measurement and analysis, and careful attention to the congruence of theory, constructs, and measures.Through a systematic review of the literature, this article examines the state of measurement in multilevel cancer care intervention research, identifies measurement opportunities in the field, and draws upon other fields to provide direction about measures and measurement to multilevel cancer care intervention researchers. Literature ReviewWe conducted a systematic literature review focused on cancer care intervention research and measures published in the past 5 years. This contrasts with Stange et al. in this monograph (14), which focuses on the broad spectrum of health care and prevention research over a 10-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Thus, our review provides a comprehensive overview of a more recent set of cancerspecific intervention studies.

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Patterns of Coordination and Clinical Outcomes: A Study of Surgical Services.

Cited by 74 publications

References 12 publications

The Relationship Between Provider Coordination and Diabetes-Related Foot Outcomes

The Relationship Between Provider Coordination and Diabetes-Related Foot Outcomes

Reducing Hospital Errors: Interventions that Build Safety Culture

Multilevel Interventions: Measurement and Measures

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