A group of hospital administrators at a tertiary care center is interested in optimizing quality-related outcomes, including length of hospitalization and patient functional status for high-risk patients undergoing neurosurgical procedures. Patients at highest risk for poor outcomes include those who are age 65 and have multiple medical comorbidities, including hypertension, diabetes, coronary artery disease, and heart failure. The administrators are considering methods to coordinate care between the attending surgeon and a hospitalist-led, multidisciplinary team. Hospital administrators decide to implement a team-based care model that involves comanagement of surgical patients by surgeons and a hospitalist-led, multidisciplinary team that includes physical therapists, a social worker, pharmacists, and a nurse case manager. A series of team meetings is held to define team goals, member roles, and methods for tracking desired quality and outcomes data. Which of the following approaches is recommended to improve team performance and clinical quality?

Question

A group of hospital administrators at a tertiary care center is interested in optimizing quality-related outcomes, including length of hospitalization and patient functional status for high-risk patients undergoing neurosurgical procedures.  Patients at highest risk for poor outcomes include those who are age >65 and have multiple medical comorbidities, including hypertension, diabetes, coronary artery disease, and heart failure.  The administrators are considering methods to coordinate care between the attending surgeon and a hospitalist-led, multidisciplinary team.  Hospital administrators decide to implement a team-based care model that involves comanagement of surgical patients by surgeons and a hospitalist-led, multidisciplinary team that includes physical therapists, a social worker, pharmacists, and a nurse case manager.  A series of team meetings is held to define team goals, member roles, and methods for tracking desired quality and outcomes data.  Which of the following approaches is recommended to improve team performance and clinical quality?

Quizplus · Accepted Answer

Explanation: Comanagement is a model in which a surgeon and a generalist physician-led multidisciplinary team share responsibility for patient care and is associated with improvement in quality indicators and certain health outcomes for high-risk patients. Because comanagement involves multiple team members and disciplines, the following best practices are recommended to optimize the effectiveness of this model: Define clear, specific roles for each team member. Unnecessary overlap of tasks among team members may lead to errors due to duplicated efforts (eg, multiple team members administering insulin in response to a patient's elevated glucose) (Choice B). Refine clinical processes through systematic review and continuous cycles of testing and assessment. Compared to a single comprehensive analysis, an ongoing, iterative approach is more effective in improving quality outcomes (Choice C). Track important clinical outcomes (eg, mortality, readmission rates) to assess overall effectiveness of the care model. (Choice A) Six sigma is a quality improvement approach that seeks to eliminate serious defects to a statistical standard (eg, error rate <99.997%). This method is appropriate to reduce catastrophic outcomes (eg, wrong-site surgery) but is less effective in addressing and improving the complex and multifaceted goals in a comanagement system. Educational objective: Comanagement is a care model in which a surgeon and a comanaging generalist physician (ie, hospitalist) share responsibility for patient care. An ideal comanagement model defines clear, specific roles for each team member, continuously refines clinical processes through quality improvement, and tracks important clinical outcomes. References: Evaluation of internal medicine physician or multidisciplinary team comanagement of surgical patients and clinical outcomes. (http://www.ncbi.nlm.nih.gov/pubmed/2765514) Surgical comanagement by hospitalists: continued improvement over 5 years. (http://www.ncbi.nlm.nih.gov/pubmed/217186)

A Group of Hospital Administrators at a Tertiary Care Center