Team structure and adverse events in home health ccare

Penny Hollander Feldman, John Bridges, Timothy Peng

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: To identify relationships between variations in team structure and risk-adjusted adverse events across 86 teams in a large US home health care organization. METHODS:: Patient episode data were collected for two 6-month periods, Januaryĝ€"June 2002 (N ≤ 54,732 episodes) and Januaryĝ€"June 2003 (N ≤ 51,560 episodes). An adverse event was defined as having 1 or more events defined by the Centers for Medicare and Medicaid Services for home health care episodes. Events were risk adjusted using 2 alternative approachesĝ€"a Z-score and a Fixed Effects (FE)-score, for each team in each period. These scores (1 for each team in each period) were then regressed against objective measures of team structure. RESULTS:: The regressions based on the FE-score as the measure of quality performed better than the traditional Z-score. Based on these regressions we find that volume (number of episodes) (P ≤ 0.03), number of weekend visits (P ≤ 0.02), and workload distribution (P ≤ 0.02) were negatively associated with the occurrence of adverse events, whereas higher weekend admissions (P ≤ 0.01) were positively associated with adverse events. CONCLUSIONS:: Our analysis identifies a number of key team-level organizational variables that influence adverse events in home health care services. We also have demonstrated that the FE-score is a more accurate measure of team quality, as opposed to the Z-score, given that it focuses only on ĝ€ team attributableĝ € adverse events by isolating and excluding random variation from the quality score.

Original languageEnglish (US)
Pages (from-to)553-561
Number of pages9
JournalMedical Care
Volume45
Issue number6
DOIs
StatePublished - Jun 2007

Fingerprint

Home Care Services
Delivery of Health Care
event
Health
health
Centers for Medicare and Medicaid Services (U.S.)
Workload
Health Services
weekend
Organizations
health care
regression
health care services
workload
organization

Keywords

  • Adverse events
  • Home care
  • Patient safety
  • Quality of care
  • Teams

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Team structure and adverse events in home health ccare. / Feldman, Penny Hollander; Bridges, John; Peng, Timothy.

In: Medical Care, Vol. 45, No. 6, 06.2007, p. 553-561.

Research output: Contribution to journalArticle

Feldman, PH, Bridges, J & Peng, T 2007, 'Team structure and adverse events in home health ccare', Medical Care, vol. 45, no. 6, pp. 553-561. https://doi.org/10.1097/MLR.0b013e31803bb49c
Feldman, Penny Hollander ; Bridges, John ; Peng, Timothy. / Team structure and adverse events in home health ccare. In: Medical Care. 2007 ; Vol. 45, No. 6. pp. 553-561.
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