Team structure and adverse events in home health care.
OBJECTIVE
To identify relationships between variations in team structure and risk-adjusted adverse events across 86 teams in a large US home health care organization.


METHODS
Patient episode data were collected for two 6-month periods, January-June 2002 (N = 54,732 episodes) and January-June 2003 (N = 51,560 episodes). An adverse event was defined as having 1 or more events defined by the Centers for Medicare and Medicaid Services for home health care episodes. Events were risk adjusted using 2 alternative approaches-a Z-score and a Fixed Effects (FE)-score, for each team in each period. These scores (1 for each team in each period) were then regressed against objective measures of team structure.


RESULTS
The regressions based on the FE-score as the measure of quality performed better than the traditional Z-score. Based on these regressions we find that volume (number of episodes) (P = 0.03), number of weekend visits (P = 0.02), and workload distribution (P = 0.02) were negatively associated with the occurrence of adverse events, whereas higher weekend admissions (P = 0.01) were positively associated with adverse events.


CONCLUSIONS
Our analysis identifies a number of key team-level organizational variables that influence adverse events in home health care services. We also have demonstrated that the FE-score is a more accurate measure of team quality, as opposed to the Z-score, given that it focuses only on "team attributable" adverse events by isolating and excluding random variation from the quality score.
Feldman
Penny Hollander
PH
Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York 10021, USA. pfeldman@vnsny.org
Bridges
John
J
Peng
Timothy
T
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D017146:Models, Organizational; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*; D011787:Quality of Health Care; D012044:Regression Analysis; D020379:Risk Adjustment; D012308:Risk Management / Q000458:organization & administration*; D014481:United States