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Abstract

The Department of Defense (DoD) has been one of the leaders in actions to improve teamwork, which it has pursued with the goal of achieving safer care and reducing adverse events for patients served by its military hospitals. DoD and the Agency for Healthcare Research and Quality (AHRQ) have worked together to develop tools to improve teamwork in delivering care in order to achieve safer outcomes for patients. In 2004, AHRQ modified its Patient Safety Evaluation Center contract with RAND to add an analytic study to identify and test measures that have the potential to capture improvements in teamwork practices.

This report presents the final results from the teamwork outcome measures study. Study components discussed in the report include the methods used for selecting and testing candidate measures, findings from a literature search that informed the measure-selection process, the measures identified by clinical experts as representing teamwork-sensitive outcomes, and results of the testing of a subset of these measures on the administrative data of the DoD health system. The three clinical areas for which measures were identified are labor and delivery, surgery, and treatment for acute myocardial infarction. Many of the outcome measures identified in this study and all of the process measures require information that is not available in administrative data but that is available in medical charts.

The contents of this report will be of interest to national and state policymakers, health care organizations and clinical practitioners, and health researchers who are engaged in activities to improve the quality and safety of health care and assess the effects of those improvements on care process and patient outcomes.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Review of the Literature on Teamwork and Patient Safety

  • Chapter Three

    Selection of Clinical Areas

  • Chapter Four

    Measure Identification and Rating on Relationship to Teamwork

  • Chapter Five

    Empirical Testing of Selected Measures

  • Chapter Six

    Discussion

  • Appendix A

    Articles Included in Literature Review

  • Appendix B

    Members of the Clinical Advisory Panel

  • Appendix C

    Highly Rated Measures for Each Clinical Area

  • Appendix D

    Descriptions of Highly Rated Measures for Each Clinical Area

  • Appendix E

    Concepts Suggested by Clinical Advisory Panel

  • Appendix F

    Empirical Results for Labor and Delivery Measures

  • Appendix G

    Empirical Results for Surgery Measures

Research conducted by

This work was sponsored by the Agency for Healthcare Research and Quality (AHRQ). The funding for this study was provided by DoD through an Interagency Agreement with AHRQ. The research was conducted in RAND Health, a division of the RAND Corporation.

This report is part of the RAND Corporation technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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