Patient outcomes were not improved in a pragmatic controlled study of redesigned interprofessional care of hospitalized patients, researchers report. The authors report “weak evidence of an association with higher ratings of teamwork climate but no association with adverse events, [length of stay (LOS)], 30-day readmissions, or patient experience. Efforts to improve patient safety and efficiency of care, spurred in large part by national campaigns, public reporting, and payment policies, may have resulted in limited opportunities for further improvement. Health care leaders should consider our findings in the context of their improvement priorities before implementing similar interventions.”
Health care professionals practicing on 1 unit at each of 4 U.S. hospitals underwent training regarding mentored implementation of unit-based physician teams, unit nurse–physician coleadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities. All nurses, nurse assistants, physicians, pharmacists, social workers, and case managers on the units were surveyed before the intervention and 6 to 9 months after implementation.
“Among 155 professionals who completed pre- and postintervention surveys, the median teamwork climate score was higher after than before the intervention only for nurses (n = 77) (median score, 88.0 [IQR, 77.0 to 91.0] vs. 80.0 [IQR, 70.0 to 89.0]; P = 0.022). Among 3,773 patients, a greater percentage had at least 1 adverse event after compared with before the intervention on control units (change, 1.61 percentage points [95% CI, 0.01 to 3.22 percentage points]). A similar percentage of patients had at least 1 adverse event after compared with before the intervention on intervention units (change, 0.43 percentage point [CI, −1.25 to 2.12 percentage points]). A difference-in-differences (DID) analysis of adverse events did not show a significant difference in change (adjusted DID, −0.92 percentage point [CI, −2.49 to 0.64 percentage point]; P = 0.25). Similarly, there were no differences in LOS, readmissions, or patient experience.”