Medical team interdependence as a determinant of use of clinical resources.
OBJECTIVE
Our objective, based on organization theory, is to examine whether interdependence among physicians leads to coordination problems that in turn may explain variations observed in the use of clinical resources.


METHODS
Secondary data about episodes of in-hospital care were collected over a 14-month period in two midsize acute care hospitals located in two suburbs of Montreal, Quebec.


METHODS
Hierarchical regression analysis was used to assess the marginal effect of medical team interdependence on clinical resource utilization after taking into account the effect attributable to the nature of several morbidities taken as specific and distinct tasks.


RESULTS
Medical team interdependence is found within medical specialties as well as between specialties. The largest portion of resource utilization was explained by morbidity characteristics, whereas team interdependence had a weaker, but systematic effect for all morbidities studied (15 regression models out of 18 performed). Task coordination was found to become more difficult as the number of physicians coming from different specialties increased in the context of teamwork.


CONCLUSIONS
Results suggest that team practice does not entirely overcome coordination problems inherent to task (morbidity) interdependence. In considering the individual (especially the attending) physician as the main factor responsible for resource utilization, other factors related to team practice may too readily be overlooked.
Sicotte
C
C
Department of Health Administration, Faculty of Medicine, University of Montreal, Quebec.
Pineault
R
R
Lambert
J
J
D003858:Dependency, Psychological; D003954:Diagnostic Services / Q000706:statistics & numerical data*; D017050:Episode of Care; D006302:Health Services Research / Q000379:methods; D006748:Hospital Departments; D006801:Humans; D007400:Interprofessional Relations; D007587:Job Description; D008505:Medical Staff, Hospital / Q000523:psychology*; D008511:Medicine; D009017:Morbidity; D010348:Patient Care Team / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011792:Quebec; D012044:Regression Analysis; D012189:Retrospective Studies; D012494:Sampling Studies; D013038:Specialization