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Health Serv Res. 1998 December; 33(5 Pt 1): 1211–1236.
PMCID: PMC1070314

Patterns of coordination and clinical outcomes: a study of surgical services.

Abstract

OBJECTIVE: To test the hypothesis that surgical services combining relatively high levels of feedback and programming approaches to the coordination of surgical staff would have better quality of care than surgical services using low levels of both coordination approaches as well as those surgical service using low levels of either coordination approach. STUDY SETTING: A study sample of 44 academically affiliated surgical services that are part of the Department of Veterans Affairs. STUDY DESIGN: In a cross-sectional analysis, surgical services were assigned to one of three groups based on their scores on feedback and programming coordination measures: high on both measures; high on one measure, low on the other; and low on both. Univariate and multivariate analyses were used to assess differences among these groups with respect to three quality indicators: risk-adjusted mortality, risk-adjusted morbidity, and staff perceptions of quality. DATA COLLECTION/EXTRACTION METHODS: Risk-adjusted mortality and morbidity came from an outcomes reporting program within the Department of Veterans Affairs that entails the prospective collection of clinical data from patient charts. Data on coordination practices and perceived quality came from a survey of surgical staff at each of the 44 participating surgical services. PRINCIPAL FINDINGS: The group of surgical services using high feedback and high programming had the best perceived quality. This group also had the lowest morbidity, but the difference was statistically significant with respect to only one of the two other groups: the group with low feedback and low programming. No significant group differences were found for mortality. CONCLUSIONS: Study results provide partial support for the hypothesis that high levels of feedback and programming should be combined for optimal quality of care. Study results also suggest that staff coordination is more important for improving morbidity than mortality in surgical services.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Alt-White AC, Charns M, Strayer R. Personal, organizational and managerial factors related to nurse - physician collaboration. Nurs Adm Q. 1983 Fall;8(1):8–18. [PubMed]
  • Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T, Siegler M. An alternative strategy for studying adverse events in medical care. Lancet. 1997 Feb 1;349(9048):309–313. [PubMed]
  • Argote L. Input uncertainty and organizational coordination in hospital emergency units. Adm Sci Q. 1982 Sep;27(3):420–434. [PubMed]
  • Becker SW, Shortell SM, Neuhauser D. Management practices and hospital length of stay. Inquiry. 1980 Winter;17(4):318–330. [PubMed]
  • Daley J, Forbes MG, Young GJ, Charns MP, Gibbs JO, Hur K, Henderson W, Khuri SF. Validating risk-adjusted surgical outcomes: site visit assessment of process and structure. National VA Surgical Risk Study. J Am Coll Surg. 1997 Oct;185(4):341–351. [PubMed]
  • Daley J, Khuri SF, Henderson W, Hur K, Gibbs JO, Barbour G, Demakis J, Irvin G, 3rd, Stremple JF, Grover F, et al. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg. 1997 Oct;185(4):328–340. [PubMed]
  • Flood AB. The impact of organizational and managerial factors on the quality of care in health care organizations. Med Care Rev. 1994 Winter;51(4):381–428. [PubMed]
  • Gillies RR, Shortell SM, Anderson DA, Mitchell JB, Morgan KL. Conceptualizing and measuring integration: findings from the health systems integration study. Hosp Health Serv Adm. 1993 Winter;38(4):467–489. [PubMed]
  • Grover FL, Hammermeister KE, Burchfiel C. Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. Ann Thorac Surg. 1990 Jul;50(1):12–28. [PubMed]
  • Hartz AJ, Krakauer H, Kuhn EM, Young M, Jacobsen SJ, Gay G, Muenz L, Katzoff M, Bailey RC, Rimm AA. Hospital characteristics and mortality rates. N Engl J Med. 1989 Dec 21;321(25):1720–1725. [PubMed]
  • Khuri SF, Daley J, Henderson W, Barbour G, Lowry P, Irvin G, Gibbs J, Grover F, Hammermeister K, Stremple JF, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995 May;180(5):519–531. [PubMed]
  • Khuri SF, Daley J, Henderson W, Hur K, Gibbs JO, Barbour G, Demakis J, Irvin G, 3rd, Stremple JF, Grover F, et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg. 1997 Oct;185(4):315–327. [PubMed]
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med. 1986 Mar;104(3):410–418. [PubMed]
  • Kapp MB. 'Cookbook' medicine. A legal perspective. Arch Intern Med. 1990 Mar;150(3):496–500. [PubMed]
  • Mitchell PH, Armstrong S, Simpson TF, Lentz M. American Association of Critical-Care Nurses Demonstration Project: profile of excellence in critical care nursing. Heart Lung. 1989 May;18(3):219–237. [PubMed]
  • Shortell SM, Rousseau DM, Gillies RR, Devers KJ, Simons TL. Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire. Med Care. 1991 Aug;29(8):709–726. [PubMed]
  • Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, Knaus WA, Duffy J. The performance of intensive care units: does good management make a difference? Med Care. 1994 May;32(5):508–525. [PubMed]
  • Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care. 1992 Jul;30(7):615–629. [PubMed]
  • Thomas JW. Does risk-adjusted readmission rate provide valid information on hospital quality? Inquiry. 1996 Fall;33(3):258–270. [PubMed]
  • Young GJ, Charns MP, Daley J, Forbes MG, Henderson W, Khuri SF. Best practices for managing surgical services: the role of coordination. Health Care Manage Rev. 1997 Fall;22(4):72–81. [PubMed]

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