Outcome Measures for Effective Teamwork in Inpatient Care

Outcome Measures for Effective Teamwork in Inpatient Care: Final Report

Melony E. Sorbero
Donna O. Farley
Soeren Mattke
Susan Lovejoy
Copyright Date: 2008
Edition: 1
Published by: RAND Corporation
Pages: 146
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  • Book Info
    Outcome Measures for Effective Teamwork in Inpatient Care
    Book Description:

    Addresses one step in the process of moving from teamwork training to teamwork practices that improve outcomes of care: identifying outcomes that are most likely to be affected as teamwork practices improve in an implementing organization. Discusses a literature search, methods for selecting and testing candidate measures, measures highly rated by clinical experts, and results of measure testing on administrative data of the DoD health system.

    eISBN: 978-0-8330-4602-4
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-vi)
  4. Figures
    (pp. vii-viii)
  5. Tables
    (pp. ix-x)
  6. Summary
    (pp. xi-xx)
  7. Acknowledgments
    (pp. xxi-xxii)
  8. Acronyms
    (pp. xxiii-xxiv)
  9. Chapter 1. Introduction
    (pp. 1-8)

    The Department of Defense (DoD) has been one of the leaders in actions to improve teamwork, which it has pursued with the goal of achieving safer care and reducing adverse events for patients served by its military hospitals. DoD and the Agency for Healthcare Research and Quality (AHRQ) have worked together to develop tools that can be used to evaluate how improved teamwork in delivering care is achieving safer outcomes for its patients. In 2004, AHRQ modified its Patient Safety Evaluation Center contract with RAND to add an analytic study to identify and test measures that have the potential to...

  10. Chapter 2. Review of the Literature on Teamwork and Patient Safety
    (pp. 9-18)

    Our literature review had three main purposes: to document the current state of knowledge regarding teamwork practices and their effects; to inform our selection of the three clinical areas for which measures would be identified and tested in this study; and to provide a foundation for identification of candidate teamwork-relevant outcome measures for this study. This chapter summarizes our review of the health care literature on teamwork-training and -improvement activities.

    Studies examining the relationship between teamwork, processes of care, and patient outcomes or evaluating the effects of teamwork training in medicine were identified through electronic and hand searches of the...

  11. Chapter 3. Selection of Clinical Areas
    (pp. 19-24)

    Three clinical areas for the work with measures were selected as the focus of this project. This chapter describes the process used to select the three clinical areas. It also discusses the results of the selection process.

    We used a multistep approach to select the clinical areas for which we would assess process and outcome measures. First, the project team, in conjunction with the project officers, created a list of candidate clinical areas for inclusion in the study, based on the following: (1) existence of process or outcome measures, (2) patient safety or quality-of-care issues based on the team’s knowledge...

  12. Chapter 4. Measure Identification and Rating on Relationship to Teamwork
    (pp. 25-30)

    Process and outcome measures were rated by the clinical advisory panel on their relationship to teamwork and on the soundness of the measure in a two-stage process. Between the two rounds of ratings, the panel met to review the results of the first round of ratings and discuss measures with intermediate ratings. Measures could be eliminated from further consideration after each round of ratings. This chapter details the steps used to identify and rate measures for each of the three clinical areas included in the process. It also presents the results of measure ratings by the clinical advisory panel.


  13. Chapter 5. Empirical Testing of Selected Measures
    (pp. 31-42)

    Measures rated by the clinical advisory panel as highly related to teamwork were empirically tested using DoD administrative health care services data. This chapter describes the methods used for this testing, presents the results of the analyses, and provides recommendations for the use of these measures.

    As a preliminary step, we assessed the data sources necessary to construct each of the highly rated measures. The data sources included administrative data, lab results, test results, nursing notes, physician notes, observation of the delivery of health care, Joint Commission data elements, and NSQIP data for surgery. The results of this assessment were...

  14. Chapter 6. Discussion
    (pp. 43-52)

    The scope of work defined for this study was to identify process-of-care and outcome measures that are sensitive to teamwork for three clinical areas that the DoD, health care organizations, or other entities could use to assess the effects of teamwork-training and -improvement interventions on patient care and outcomes. The clinical areas selected were labor and delivery, surgery, and treatment for AMI. In this project, we worked with the clinical advisory panel using a modified-Delphi process, as well as published evidence, to identify teamwork-related measures based on their clinical judgment. To our knowledge, this is the first study to use...

  15. Appendix A. Articles Included in Literature Review
    (pp. 53-74)
  16. Appendix B. Members of the Clinical Advisory Panel
    (pp. 75-76)
  17. Appendix C. Highly Rated Measures for Each Clinical Area
    (pp. 77-84)
  18. Appendix D. Descriptions of Highly Rated Measures for Each Clinical Area
    (pp. 85-104)
  19. Appendix E. Concepts Suggested by Clinical Advisory Panel
    (pp. 105-106)
  20. Appendix F. Empirical Results for Labor and Delivery Measures
    (pp. 107-108)
  21. Appendix G. Empirical Results for Surgery Measures
    (pp. 109-110)
  22. References
    (pp. 111-121)