Carson Matthew B, Scholtens Denise M, Frailey Conor N, Gravenor Stephanie J, Powell Emilie S, Wang Amy Y, Kricke Gayle Shier, Ahmad Faraz S, Mutharasan R Kannan, Soulakis Nicholas D
From the Departments of Preventive Medicine (M.B.C., D.M.S., C.N.F., A.Y.W., G.S.K., F.S.A., N.D.S.), Emergency Medicine (S.J.G., E.S.P.), Family and Community Medicine (A.Y.W.), and Medicine (F.S.A., R.K.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.
Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):670-678. doi: 10.1161/CIRCOUTCOMES.116.003041. Epub 2016 Nov 8.
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.
We extracted 4 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, a measure that assesses the strength of a patient-sharing relationship between 2 providers based on risk-adjusted encounter outcomes. We compared an observed collaboration network of 334 providers and 3453 relationships to 1000 networks with shared positive outcome ratio 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.
Satisfaction rates seem 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.
医疗保健领域的团队合作性质复杂且具有跨学科性，基于共同患者诊疗经历的医护人员协作对其成功至关重要。通过风险调整后的患者结局来描述工作关系的强度，有助于深入了解医院环境中医护人员之间的互动情况。
我们从西北大学医学院企业数据仓库中提取了4年内在心内科住院单元的患者、医护人员及诊疗活动数据。然后创建了一个医护人员-患者网络，以识别共同参与患者诊疗的医护人员，并计算医护人员对之间的满意度。我们展示了一个新参数——共享积极结局率的应用，该参数基于风险调整后的诊疗结局来评估两名医护人员之间患者共享关系的强度。我们将观察到的由334名医护人员和3453种关系组成的协作网络与1000个基于随机结局的具有共享积极结局率得分的网络进行比较，发现医护人员对之间有188种协作关系的患者满意度评分显著高于预期。一组22名医护人员在患者满意度方面表现格外出色。我们的结果表明，整个网络的协作得分存在很大差异，并突出了我们识别在一组共同患者诊疗中得分高于和低于预期的关系的能力。
不同医护团队的满意度似乎存在差异。团队协作可以通过对医护人员对之间协作的综合衡量来量化。在足够多的共同诊疗中跟踪医护人员对的结局，可能为质量改进策略提供信息，例如优化团队人员配置、识别高绩效团队的特征和做法、制定基于证据的团队指南以及重新设计住院护理流程。
