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Team functioning and patient outcomes in stroke rehabilitation
Dale C Strasser1, Judith A Falconer, Jeph S Herrin
1Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA. dale_strasser@emory.org
Objective:
To evaluate the relationship between rehabilitation team functioning and stroke patient outcomes.
Design:
Prospective observational study.
Setting:
Veterans Administration (VA) inpatient and subacute rehabilitation units.
Participants:
Forty-six VA rehabilitation teams, including 530 rehabilitation team members from 6 disciplines (medicine, nursing, social work, physical therapy, occupational therapy, speech language pathology) and 1688 stroke patients treated by the teams.
Interventions:
Not applicable.
Main Outcome Measures:
Ten scales assessing team member perceptions of team functioning (communication, perceived effectiveness, physician involvement, physician support, teamness, utility of quality information, innovation, interprofessional relationships, order and organization, task orientation) and 3 primary patient outcome variables-functional improvement, discharge home, and length of rehabilitation stay (LOS).
Results:
Three of the 10 measures of team functioning were significantly associated with patient functional improvement ( P <.05): task orientation, order and organization, and utility of quality information. One measure of team functioning-effectiveness-was significantly associated with LOS ( P <.05). None of the team variables predicted discharge destination. Aspects of team functioning that were important to outcomes differed depending on the outcome of interests. Efforts directed toward improving team activities and relationships, including collaborative planning and problem solving and the use of feedback information, may enhance rehabilitation treatment effectiveness.
Conclusions:
Characteristics of team functioning predict selected rehabilitation outcomes.