Shift-Level Team Familiarity Is Associated with Improved Outcomes in Mechanically Ventilated Adults.

Due to a typesetter error, this is a previous version of this article; It will be replaced shortly by the final accepted version. Rationale: Organizing ICU interprofessional teams-nurses, physicians, and respiratory therapists-is high priority because of workforce crises, but how often clinicians work together (i.e., interprofessional familiarity) remains unexplored. Objectives: Determine if mechanically ventilated patients cared for by teams with greater familiarity have lower mortality, shorter duration of mechanical ventilation, and greater spontaneous breathing trial (SBT) implementation. Methods: Using electronic health records from five ICUs (2018-2019), we identified the interprofessional team that cared for each mechanically ventilated patient each shift, calculated familiarity, and modeled familiarity exposures separately on ICU mortality, duration of mechanical ventilation, and SBT implementation using encounter-level generalized linear regression models with a log-link, unit-level fixed effects adjusting for cofounders, including severity of illness. Measurements and Main Results: Familiarity was defined as how often clinicians worked together for all patients in an ICU (i.e., coreness) and for each patient (i.e., mean team value). Among 4,292 patients (4,485 encounters, 72,210 shifts), unadjusted mortality was 12.9%, average duration of mechanical ventilation was 2.32 days, and SBT implementation was 89%. An increase in coreness and mean team value, by the SD of each, was associated with lower probability of dying (coreness: adjusted marginal effect, -0.038; 95% confidence interval [-0.07 to -0.004]; mean team value: adjusted marginal effect, -0.0034 [-0.054 to -0.014]); greater probability of receiving SBT when eligible (coreness: 0.45 [0.007 to 0.083]; mean team value: 0.012 [-0.017 to 0.042]), and shorter duration of mechanical ventilation (coreness: -0.23 [-0.321 to -0.139]). Conclusions: Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution.

Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients.

BACKGROUND: Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. OBJECTIVE: To examine how the association of nurse assessments of patients' readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. RESEARCH DESIGN: Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014-03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. SUBJECTS: All Medicare patients in the study's intervention arm (n=14,684). MEASURES: Patient's race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient's Readiness for Hospital Discharge Scale (RHDS) score (0-10 scale) assessed by the discharging nurse on the day of discharge. RESULTS: Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18-8.24), non-Hispanic Black (8.20; 95% CI: 8.12-8.28), Hispanic (7.92; 95% CI: 7.81-8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01-8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3-30.3; White: 32.6%, 95% CI: 31.1-34.1). CONCLUSIONS: Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.