Characterizing Teamwork in Cardiovascular Care Outcomes

Abstract

Background The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk adjusted patient outcomes supplies insight into provider interactions in a hospital environment. Methods and Results We extracted four years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine’s Enterprise Data Warehouse. We then created a provider-patient network to identify healthcare providers who jointly participated in patient encounters and calculated satisfaction rates for provider-provider pairs. We demonstrated the application of a novel parameter, the Shared Positive Outcome Ratio (SPOR), an objective composite measure that quantifies a given pair’s concentration of positive outcomes over a set of shared patients. We compared an observed collaboration network of 334 providers and 3,453 relationships to 1,000 networks with SPOR scores based on randomized outcomes and found 188 collaborative relationships between pairs of providers that showed significantly higher than expected patient satisfaction ratings. A group of 22 providers performed exceptionally in terms of patient satisfaction. Our results indicate high variability in collaboration scores across the network and highlight our ability to identify relationships with both higher and lower than expected scores across a set of shared patient encounters. Conclusions Satisfaction rates appear to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform quality improvement strategies, such as optimizing team staffing, identifying characteristics and practices of high-performing teams, developing evidence-based team guidelines, and redesigning inpatient care processes.

A scoping review of patient-sharing network studies using administrative data

“…We identified two approaches to defining how many shared patients "counted" as a connection between two providers. One approach used a fixed threshold of shared patients (e.g., 1, 2, 5 shared patients) [23][24][25][26][27]. A second approach used relative thresholds.…”

“…Nonpatient facing physicians such as anesthesiologists, emergency medicine, radiologists, and pathologists were excluded in 11 studies [14,[28][29][30][31][32][33][34][35][36][37]. Studies also varied in geographic scope, ranging from constructing networks by country [20,38,39], hospital referral region [26,28,30,34,40], state [16,21,31,41], city [42,43], or within a hospital or health system [24,25,29,[44][45][46][47][48][49]. The geographic boundaries of a network are important to consider because networks are subject to the boundary specification problem in which excluding certain patients and/or providers may alter the network structure [50].…”

Impact of care provider network characteristics on patient outcomes: Usage of social network analysis and a multi-scale community detection

“…A modified SNA approach with community detection algorithms [26–28] has been developed to assess physicians’ characteristics in the network and within smaller communities (i.e., sub-dividing a large care network into smaller groups of nodes more densely connected). Using this approach, they showed that patients whose physicians were connected with larger number of physicians had higher spending.…”

Risk Adjusting Health Care Provider Collaboration Networks

“…The SPOR measurement is a pairwise metric that quantifies the ratio of specific positive outcomes shared between two providers versus outcomes shared with other providers, which is defined in more detail in past studies. 17,18 We built a provider collaboration network and calculated the SPOR edge weight. Two providers were linked within the network if each logged activity into the EHR for the same patient encounter between February 1, 2015 and January 31, 2016.…”

“…A method for quantifying the connections or edges between providers in a network, through their shared encounters, has been previously developed: the Shared Positive Outcome Ratio (SPOR). 17,18 The SPOR is a pairwise metric that quantifies the ratio of positive patient outcomes shared between two providers, versus all the positive patient outcomes when each of those two providers works with others in the network. This measure could be used in quality improvement processes; however, to be reliable we need to understand the role risk adjustment plays in the measure.…”