Study: Physician Teamwork Improves CABG Outcomes

Physicians working together more closely correlates to better outcomes for patients who undergo coronary artery bypass grafting (CABG), according to a new observational study.

A team led by researchers from the University of Michigan Medical School collected Medicare data from 251,630 beneficiaries who underwent CABG between 2008 and 2011. The patients studied by the investigators received care from 466,243 physicians practicing in 1186 health systems.
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Lead author John M. Hollingsworth, MD, MS, an assistant professor of urology at the University of Michigan Medical School, and colleagues concluded that institutions displaying more teamwork in caring for CABG patients—determined by clustering of the same surgeons, primary care physicians, and other physicians on claims for patients during the surgical period the researchers evaluated—saw substantially better 60-day outcomes for CABG patients.  

For example, these centers boasted an emergency department visit rate that was 24.6% lower than that of "low-cooperation centers," a readmission rate that was lower by 24.4%, and a 28.4% lower death rate.

The researchers also found that hospitals displaying low levels of physician collaboration in treating CABG patients were more likely to have an academic affiliation, have larger physician staffs, treat more cardiac patients, and receive a larger number of surgical referrals extending beyond their geographic areas. These centers also tended to serve communities with larger black and Hispanic populations, serve a higher proportion of college-educated residents, operate in less-rural areas, include more primary care providers and medical specialists, and have fewer acute care beds and surgeons per capita.

The findings "suggest that teamwork matters, and [a successful CABG procedure] requires more than just an excellent surgeon," said study coauthor Brahmajee K. Nallamothu, MD, MPH, a professor of medicine in the Department of Internal Medicine at the University of Michigan.

"Optimal outcomes still depend upon the careful interaction and coordination of providers from across specialties," Dr Nallamothu said. "I think it should encourage all of us to figure out ways that primary care practitioners can help to better organize such groups or 'teams' for their patients."

“Those physician interactions in the preoperative and postdischarge period—which involve primary care physicians—are also critically important in terms of patient outcomes,” Dr Hollingsworth added.

—Mark McGraw

Reference:
Hollingsworth JM, Funk RJ, Garrison SA, et al. Association between physician teamwork and health system outcomes after coronary artery bypass grafting [published online November 8, 2016]. Circ Cardiovasc Qual Outcomes. doi: http://dx.doi.org/10.1161/CIRCOUTCOMES.116.002714.