title: Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.
abstract: Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG.
  
  
  
  Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality.
  
  
  
  Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care.
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.). kinks@med.umich.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.).
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Funk
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.).
authors.forename: Spencer A
authors.initials: SA
authors.lastname: Garrison
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.).
authors.forename: Jason
authors.initials: J
authors.lastname: Owen-Smith
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.).
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kaufman
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.).
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.affiliation: From the Department of Urology (J.M.H., S.A.K.), Department of Cardiac Surgery (F.D.P.), Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine (B.K.N.), University of Michigan Medical School, Ann Arbor; Department of Strategic Management and Entrepreneurship, University of Minnesota Carlson School of Management, Minneapolis (R.J.F.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Department of Sociology, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor (S.A.G, J.O.-S.).
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000368:Aged; D000072096:Cardiologists / Q000458:organization & administration; D016000:Cluster Analysis; D003299:Cooperative Behavior; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*; D010359:Patient Readmission; D010820:Physicians / Q000458:organization & administration*; D011183:Postoperative Complications / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D066231:Surgeons / Q000458:organization & administration; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Medicare; comorbidity; coronary artery bypass; health services research; surgeons