Lead/Presenter: Anna Zogas, COIN - Bedford/Boston
All Authors: Zogas A (Center for Healthcare Organization & Implementation Research), Charns, MP (Center for Healthcare Organization & Implementation Research; Boston University School of Public Health), Marchany, K (Center for Healthcare Organization & Implementation Research) Pogoda, TK (Center for Healthcare Organization & Implementation Research; Boston University School of Public Health)
We studied coordination of care in the VHA's Polytrauma/Traumatic Brain Injury (TBI) System of Care. The tiered system contains Polytrauma Network Sites (PNS) offering VISN-level post-acute rehabilitation, and Polytrauma Support Clinic Teams (PSCT), which provide evaluation and interdisciplinary treatment within their catchment areas. At both types of sites, "Core" teams are comprised of clinicians from different disciplines (e.g., Physiatry, Psychology, Occupational Therapy) who address the multiple health needs of Veterans with polytrauma/TBI. We examined the effect of Core team membership on coordination and how teams affected coordination.
This mixed-methods study used a web-based survey and semi-structured telephone interviews. Participants were either members of the Core team or clinicians to whom the Core team makes referrals (Non-Core). Employees (n = 1,594) from 16 VAMCs with PNS (n = 551) or PSCT (n = 1,043) responded to surveys. Respondents to the survey were asked about communication and coordination between clinicians in the past six months. A sample of employees surveyed (n = 68) also participated in semi-structured interviews. Interviews explored clinicians' perceptions of facilitators and barriers to coordination. Here, we present key facilitators.
Survey data showed that compared to Non-Core respondents, Core team members perceived better coordination with other Core team members on several measures of coordination (all p < 0.0001). There were no PNS vs. PSCT site differences (all p > 0.05). Interview data showed that the Core team perceived coordination to be facilitated by shared clinic space and participation in regular team meetings. Team meetings allow real-time, fluid communication and planning; a holistic picture of Veterans' physical, psychological, and psychosocial needs; and minimized discipline hierarchies.
Respondents' perceptions of coordination are driven by their status as members of the Core team. Regular clinician interactions and team meetings are key facilitators of coordination.
Well-coordinated teams have been shown to improve patient outcomes in many contexts. Our analysis of Polytrauma/TBI Core teams demonstrates that organizational factors are important for establishing structures that can facilitate coordination. Understanding the role of organizational factors is critical to fostering coordination and may improve the health care and health of Veterans.