title: Association between implementation of a medical team training program and surgical morbidity.
abstract: OBJECTIVE
  To determine whether there is an association between the Veterans Health Administration Medical Team Training (MTT) program and surgical morbidity.
  
  
  METHODS
  A retrospective health services study was conducted with a contemporaneous control group. Outcome data were obtained from the Veterans Health Administration Surgical Quality Improvement Program. The analysis included aggregated measures representing 119,383 sampled procedures from 74 Veterans Health Administration facilities that provide care to veterans.
  
  
  METHODS
  The primary outcome measure was the rate of change in annual surgical morbidity rate 1 year after facilities enrolled in the MTT program as compared with 1 year before and compared with the non-MTT program sites.
  
  
  RESULTS
  Facilities in the MTT program (n = 42) had a significant decrease of 17% in observed annual surgical morbidity rate (rate ratio, 0.83; 95% CI, 0.79-0.88; P = .01). Facilities not trained (n = 32) had an insignificant decrease of 6% in observed morbidity (rate ratio, 0.94; 95% CI, 0.86-1.05; P = .11). After adjusting for surgical risk, we found a decrease of 15% in morbidity rate for facilities in the MTT program and a decrease of 10% for those not yet in the program. The risk-adjusted annual surgical morbidity rate declined in both groups, and the decline was 20% steeper in the MTT program group (P = .001) after propensity-score matching. The steeper decline in annual surgical morbidity rates was also observed in specific morbidity outcomes, such as surgical infection.
  
  
  CONCLUSIONS
  The Veterans Health Administration MTT program is associated with decreased surgical morbidity.
authors.affiliation: National Center for Patient Safety, Department of Veterans Affairs, 215 N Main St, White River Junction, VT 05009, USA. yinong.young-xu@va.gov
authors.forename: Yinong
authors.initials: Y
authors.lastname: Young-Xu
authors.forename: Julia
authors.initials: J
authors.lastname: Neily
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
authors.forename: Brian T
authors.initials: BT
authors.lastname: Carney
authors.forename: Priscilla
authors.initials: P
authors.lastname: West
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mazzia
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Paull
authors.forename: James P
authors.initials: JP
authors.lastname: Bagian
mesh_terms: D002423:Cause of Death; D057189:Checklist; D015331:Cohort Studies; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006284:Health Plan Implementation / Q000458:organization & administration*; D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D015233:Models, Statistical; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*; D014481:United States; D020246:Venous Thrombosis / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control