Evaluation of Team Outcomes

The delivery of health care has been quantified with the model,

structure + process = outcome

Structure in health care delivery can refer to the physical plant or to such organizational structure as which disciplines are present on a team and what members’ credentials are.

Processes are specific patient interventions performed by health care professionals that result in an outcome. Some examples of processes are influenza immunization, geriatric assessment, mammography, and length of stay in a rehabilitation unit.

Outcomes are the result of the patient’s interaction with health care professionals. Examples of clinical outcome measures include mortality or length of stay associated with medical diagnosis or surgical procedures, readmission rates, morbidity measures, such as functional status after stroke rehabilitation, and unplanned return to the emergency room.

A key component of evaluation of teamwork is establishing the outcomes framework as well as the audiences for the outcomes of interest. Four distinct audiences are identified for the outcomes of interest in modern health care delivery:TEAMS00000004.gif

Team outcomes will be measured for effective and efficient practice. Evaluation and accountability will occur within the larger organization, and the team goals decided upon earlier will be the basis for this evaluation.

Perhaps the most telling measure of financial success of Medicare managed care is to look at the impact of the program on the profitability of the practice. Baseline measures should be established prior to the implementation of the program or activity to determine whether the system of care is successful in reducing health care costs. Commonly used measures include bed days per 1,000 patients, frequency and cost of emergency room visits, rates of and reasons for hospital readmission, and inpatient lengths of stay by DRG. With geriatric patients, assessing the long term costs is important. Studies assessing costs for 6-12 months have been done, but longer studies may be needed. When physicians and medical groups accept risk for Medicare managed care patients, the bottom line will determine whether they will continue to care for this group of patients.

As part of continuous quality improvement in health care, teams also need to evaluate their process including a review of communication patterns, effectiveness in resolving conflicts, and member participation.