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Original Article
Dec 2011

Association Between Implementation of a Medical Team Training Program and Surgical Morbidity

Author Affiliations

Author Affiliations: National Center for Patient Safety, Department of Veterans Affairs (VA), White River Junction, Vermont (Drs Young-Xu, Mills, Carney, Berger, Mazzia, Paull, and Bagian, and Mss Neily and West); Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire (Drs Young-Xu and Mills); Departments of Surgery, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas (Dr Berger); Departments of Biomedical Engineering, Medical School and College of Engineering, University of Michigan, and National Center for Patient Safety, Ann Arbor, Michigan (Dr Bagian).

Arch Surg. 2011;146(12):1368-1373. doi:10.1001/archsurg.2011.762

Objective To determine whether there is an association between the Veterans Health Administration Medical Team Training (MTT) program and surgical morbidity.

Design, Setting, and Participants 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.

Main Outcome Measures 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.

Conclusion The Veterans Health Administration MTT program is associated with decreased surgical morbidity.