While it makes sense that teams with enhanced clinical expertise or improved coordination demonstrated some improvements, it is interesting that those improvements did not entirely translate to patient outcomes. Also, it seems counterintuitive that the combination of enhanced clinical expertise and improved coordination only had a limited effect on patient outcomes. I am surprised that no one had previously considered the effects of team characteristics on patient outcomes. I think it would make sense to, in a future study, to compare the effectiveness of patient care teams against standard patient treatment, consider why patient teams varied in effectiveness across care settings, and to consider whether certain patients in certain specialties benefitted from patient care teams over patients in others.
First of all, after reading “Why Most Published Research Are False” I feel that I can’t really trust the article that reviewing published literature. Plus, there are so many different settings that use team approaches (hospital, out-patient, rehabilitation etc.), there are so many nosology groups for which you would need different types of teams, that it is really hard to make any conclusions based on combining everything together. I think the main point is: it is really unclear what is going on with the team approaches in health care. On the other hand, if reviewing outcomes of teams with enhanced clinical expertise and improved coordination showed mixed results it means something was not done right in a way of teams. Because logically thinking it should work. If you had a myocardial infarction and there is a trained nurse in the hospital that spends 2 hours explaining you what actually happened to your heart and teaching on nutrition and exercise, there is the same doctor that was taking care of you in the hospital following you in a cardiology office and the rehabilitation team has an opportunity to communicate with your cardiologist – it should eventually make a difference in the outcome. So, I agree – important field that needs to be addressed.
Patient outcomes are very hard to measure in studies like these do to the multiple factors that play into the outcomes. It is easy to get caught up in process measures, did the pt get his annual test x? In a study I am currently involved in we are trying to determine whether increasing autonomy of Pediatric resident physicians leads to better outcomes. There are reasons to believe that there might be an improvement. What do we measure? I'm open for ideas....
While it makes sense that teams with enhanced clinical expertise or improved coordination demonstrated some improvements, it is interesting that those improvements did not entirely translate to patient outcomes. Also, it seems counterintuitive that the combination of enhanced clinical expertise and improved coordination only had a limited effect on patient outcomes. I am surprised that no one had previously considered the effects of team characteristics on patient outcomes. I think it would make sense to, in a future study, to compare the effectiveness of patient care teams against standard patient treatment, consider why patient teams varied in effectiveness across care settings, and to consider whether certain patients in certain specialties benefitted from patient care teams over patients in others.
ReplyDeleteFirst of all, after reading “Why Most Published Research Are False” I feel that I can’t really trust the article that reviewing published literature.
ReplyDeletePlus, there are so many different settings that use team approaches (hospital, out-patient, rehabilitation etc.), there are so many nosology groups for which you would need different types of teams, that it is really hard to make any conclusions based on combining everything together. I think the main point is: it is really unclear what is going on with the team approaches in health care.
On the other hand, if reviewing outcomes of teams with enhanced clinical expertise and improved coordination showed mixed results it means something was not done right in a way of teams. Because logically thinking it should work. If you had a myocardial infarction and there is a trained nurse in the hospital that spends 2 hours explaining you what actually happened to your heart and teaching on nutrition and exercise, there is the same doctor that was taking care of you in the hospital following you in a cardiology office and the rehabilitation team has an opportunity to communicate with your cardiologist – it should eventually make a difference in the outcome.
So, I agree – important field that needs to be addressed.
Patient outcomes are very hard to measure in studies like these do to the multiple factors that play into the outcomes. It is easy to get caught up in process measures, did the pt get his annual test x? In a study I am currently involved in we are trying to determine whether increasing autonomy of Pediatric resident physicians leads to better outcomes. There are reasons to believe that there might be an improvement. What do we measure? I'm open for ideas....
ReplyDelete