Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach

Abstract

Background: The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk-adjusted patient outcomes supplies insight into provider interactions in a hospital environment.

Methods and results: We extracted 4 years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine's Enterprise Data Warehouse. We then created a provider-patient network to identify healthcare providers who jointly participated in patient encounters and calculated satisfaction rates for provider-provider pairs. We demonstrated the application of a novel parameter, the shared positive outcome ratio, a measure that assesses the strength of a patient-sharing relationship between 2 providers based on risk-adjusted encounter outcomes. We compared an observed collaboration network of 334 providers and 3453 relationships to 1000 networks with shared positive outcome ratio scores based on randomized outcomes and found 188 collaborative relationships between pairs of providers that showed significantly higher than expected patient satisfaction ratings. A group of 22 providers performed exceptionally in terms of patient satisfaction. Our results indicate high variability in collaboration scores across the network and highlight our ability to identify relationships with both higher and lower than expected scores across a set of shared patient encounters.

Conclusions: Satisfaction rates seem to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform quality improvement strategies such as optimizing team staffing, identifying characteristics and practices of high-performing teams, developing evidence-based team guidelines, and redesigning inpatient care processes.

Keywords: cardiology; data mining; inpatients; patient satisfaction; quality improvement; statistical model.

Figure 1

The data management pipeline used in this study.

Figure 2

The Shared Positive Outcome Ratio, or SPOR, weights relationships according to the relative success of a provider pair. The SPOR answers this question: ‘How many more positives outcomes do these providers attain when they collaborate versus when they collaborate with other providers?’ In this example, 30 patient encounters are shown. Some patients report a positive outcome (highly likely to recommend Northwestern Medicine to others, red), while others report a negative outcome (not highly likely to recommend, black). Provider 1 (P1) interacts with 20 of these patients and Provider 2 (P2) interacts with an overlapping 20 patients. Providers 1 and 2 share 10 patient encounters with 9/10 reporting a positive outcome. If the rate of satisfaction were the same inside the overlap as it is outside of the overlap, the SPOR would be 1, which is the expected value. In this example, however, both providers have greater success when working together (i.e., inside the overlap) and the SPOR value is greater than 1. This metric was calculated for each pair of providers in the network.

Figure 3

SPOR distribution densities. The effect of five shared patient threshold values on the density of the SPOR value distributions in the collaboration network is shown. The SPOR value is in log₂ form. The distribution narrows as the threshold is increased, revealing the trade off between the relative stability of an approximately normal distribution and the inclusion of potentially interesting relationships based on fewer shared encounters.

Figure 4

A subset of the provider collaboration network consisting of 22 providers and 30 collaborations. Relationships are labeled with the SPOR score for the collaboration. The properties of the highlighted relationship are displayed on the bottom left and include SPOR rank (the rank order of the SPOR coefficient), p-value (pval), SPOR coefficient (coef), and the total number of shared encounters on which the collaboration is based (num_collabs).