Teamwork among physicians may improve post-CABG outcomes in Medicare patients

After adjusting for regional- and hospital-level factors, health systems in which physicians collaborate during CABG episodes had lower 60-day rates of emergency department visits, readmissions and mortality among Medicare beneficiaries, according to a recent study.

The researchers mentioned there was significant variability in the level of teamwork for CABG across the more than 1,000 health systems that they analyzed.

Lead researcher John M. Hollingsworth, MD, MS, of the University of Michigan’s department of urology, and colleagues published their results online Nov. 8 in Circulation: Cardiovascular Quality and Outcomes. The Agency for Healthcare Research and Quality funded the study.

“Surgical care is complex, involving multiple providers dispersed across locations over time,” Hollingsworth said in a news release. “Our findings show that physician teamwork influences patient outcomes, even more than some measures of comorbid illness.”

This study included 251,630 Medicare beneficiaries who were at least 66 years old and underwent CABG between 2008 and 2011. The patients were required to have continuous enrollment in fee-for-service Medicare Parts A and B for six months before and 60 days after their admission for surgery. In all, 466,243 physicians from 1,186 health systems cared for the patients.

Health systems with low levels of teamwork for CABG served higher proportions of black and Hispanic residents. They also tended to have more primary care physicians and medical specialists and fewer acute care beds and surgeons per capita, according to the researchers.

Hospitals in health systems with low levels of teamwork for CABG were more likely to have an academic affiliation, larger physician staffs, treat more cardiac patients and receive more surgical referrals from outside their immediate geographic area.

After accounting for differences between health systems, the researchers found that higher levels of teamwork were associated with significantly improved CABG outcomes.

Health systems with physicians that worked together frequently had 24.6 percent fewer emergency department visits, 24.4 percent lower readmission rates and 28.4 percent lower mortality rates compared with health systems with low teamwork levels.

The researchers mentioned that teamwork initiatives at health systems with low to moderate levels of teamwork during CABG procedures at baseline could reduce the number of emergency department visits, readmissions and deaths after CABG by 71.4, 53.7 and 16.8 per 1,000 discharges each year, respectively.

They added that the study had a few limitations, including that they did not observe the interactions between physicians. Instead, they inferred the interactions based on medical claims. In addition, the trial could have been subject to residual confounding. Further, the observational design meant that the researchers could not determine causality with the data.

“Our findings suggest that the way in which surgeons and nonsurgeons collaborate in their patients’ care could be manipulated in an effort to improve surgical outcomes,” the researchers wrote. “Indeed, programs being rolled out by Centers for Medicare and Medicaid Services and other payers are already incorporating such social innovations. Thus, further research is needed synthesizing both quantitative analyses (such as our own) of referral patterns and qualitative analyses of physician information sharing to better understand the contexts that shape physician teams.”