Patterns of coordination and clinical outcomes: A study of surgical services

Objective. To test the hypothesis that surgical services combining relative ly high levels of feedback and programming approaches to the coordination o f surgical staff would have better quality of care than surgical services u sing low levels of both coordination approaches as well as those surgical s ervice using low levels of either coordination approach. Study Setting A study sample of 44 academically affiliated surgical service s that are part of the Department of Veterans Affairs. Study Design. In a cross-sectional analysis, surgical services were assigne d 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 t he other; and low on both. Univariate and multivariate analyses were used t o assess differences among these groups with respect to three quality indic ators: risk-adjusted mortality, risk-adjusted morbidity, and staff percepti ons of quality. Data Collection/Extraction Methods. Risk-adjusted mortality and morbidity c ame from an outcomes reporting program within the Department of Veterans Af fairs that entails the prospective collection of clinical data from patient charts. Data on coordination practices and perceived quality came from a s urvey 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 lo west morbidity, but the difference was statistically significant with respe ct 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 qual ity of care. Study results also suggest that staff coordination is more imp ortant for improving morbidity than mortality in surgical services.