A comprehensive model of cooperation between caregivers related to quality of care

Suitability of three indicators measuring the quality of coordination within hospitals

Background

Coordination within hospitals is a major attribute of medical care and influences quality of care. This study tested the validity of 3 indicators covering two key aspects of coordination: the transfer of written information between professionals (medical record content, radiology exam order) and the holding of multidisciplinary team meetings during treatment planning.

Methods

The study was supervised by the French health authorities (COMPAQH project). Data for the three indicators were collected in a panel of 30 to 60 volunteer hospitals by 6 Clinical Research Assistants. The metrological qualities of the indicators were assessed: (i) Feasibility was assessed using a grid of 19 potential problems, (ii) Inter-observer reliability was given by the kappa coefficient () and internal consistency by Cronbach's alpha test, (iii) Discriminatory power was given by an analysis of inter-hospital variability using the Gini coefficient as a measure of dispersion.

Results

Overall, 19281 data items were collected and analyzed. All three indicators presented acceptable feasibility and reliability (, 0.59 to 0.97) and showed wide differences among hospitals (Gini, 0.08 to 0.11), indicating that they are suitable for making comparisons among hospitals.

Conclusion

This set of 3 indicators provides a proxy measurement of coordination. Further research on the indicators is needed to find out how they can generate a learning process. The medical record indicator has been included in the French national accreditation procedure for healthcare organisations. The two other indicators are currently being assessed for inclusion.

Collaborative working relationships between pharmacists and physicians: an exploratory study

OBJECTIVES

To determine the degree of collaboration in a limited number of pharmacist-physician professional relationships and identify variables important in establishing collaboration between pharmacists and physicians.

DESIGN

A multicase design, using a personal interview and a mailed survey.

SETTING

Iowa.

PARTICIPANTS

Pharmacists in 10 community pharmacies and physicians with whom they collaborated.

INTERVENTION

Two researchers independently judged the stage of collaboration for each case and the level of effect each influence variable had on the development of pharmacist-physician collaboration.

MAIN OUTCOME MEASURES

Using the Collaborative Working Relationship Model, nine indicators of collaboration were assessed. In addition, influence variables were studied, which included individual, context, and exchange characteristics believed to affect the development of collaborative working relationships between pharmacists and physicians.

RESULTS

A Perrealt-Leigh reliability index of 0.89 was calculated as an estimate of interrater reliability of the judgments of nine indicators of collaboration. Four pharmacies were rated as having achieved early-stage collaboration, while six pharmacies were at late-stage collaboration. A high level of joint care activities, care communication, and increased accessibility to the physician and to patient information characterized late-stage collaboration. Six variables, labeled as discriminating, helped distinguish between early-stage collaboration and late-stage collaboration: the development of bidirectional communication, caring for mutual patients, the ability to identify a win-win opportunity, adding value to the medical practice, physician convenience, and movement toward balanced dependence between the pharmacist and physician.

CONCLUSION

The development of collaboration between pharmacists and physicians is influenced by characteristics of exchanges occurring between them. Continued study of collaborative working relationships between physicians and pharmacists can assist health care practitioners in developing a team-based approach to patient care, improving the ability of pharmacists and physicians to work together to coordinate patient care.