Team Work Experience and Doctor Quality of Care Performance

Background: What drives variation in the quality of care delivered by doctors is a question with important policy implications. However, although teamwork between doctors is common in health care, most existing policies and research attributes doctor quality performance to the quality and efforts of individual doctors. Little attention has been paid to the role of teams in shaping doctor performance. In this paper, I study whether team work experience--the amount of experience doctors working as a team have worked together the past--influences doctor performance.

Data and Method: I study whether team work experience between doctors that perform procedures (“proceduralists”) and doctors that care for the patient around procedures (“physicians”) influence patient health outcomes and medical resource use. My sample is Medicare patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) that are admitted through the emergency department (ED).

The data come from 2008-2014 20% Medicare claims files. I measure team work experience as the average of number of past collaborations between the proceduralist and each of the physicians that care for the patient during her current hospital stay, weighted by the share of care for that patient provided by each physician. For each patient, I measure 30-day mortality and length of hospital stay.

My estimation exploits pseudo-random variation in the pool of physicians on duty across days. Due to changes in physicians on duty, a proceduralist ends up working with different physicians for patients admitted on different days. Physicians' work schedules are generally set far ahead of a patient's admission date, typically in January or July of each year. However, when a patient is admitted is unanticipated since I restrict sample to patients admitted through the ED. The pre-fixed physician work schedules and randomness of patient arrivals lead to a limited possibility for patients to select which physicians to care for them or for proceduralists to select which physicians to work with. As a result, variation in team work experience for patients treated by the same proceduralist could be considered plausibly exogenous, and a comparison of outcomes for similar patients treated by the same proceduralist can shed light on the returns to team work experience. My baseline model is a proceduralist fixed effects model that focuses identification on variation in team work experience across patients within proceduralists. In the full model, I also control for hospital-year fixed effects, and a rich set of physician characteristics and patient characteristics.

Results: My main estimates suggest that a one standard deviation increase in team work experience reduces 30-day mortality rate of patients undergoing PTCA and CABG by 0.7 and 0.11 percentage points, or equivalently, 11 and 12 percent, respectively. For medical resource use, a one standard deviation increase in team work experience reduces length of stay for PTCA and CABG patients by 0.21 and 0.45 days, or equivalently, 5 and 3 percent, respectively.

Conclusion: Team work experience improves doctor performance and continued collaborations between doctors may be an important component of the health care production function.