Commentaries on health services research

Abstract

A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. The literature on patient-centered medical home (PCMH) and burnout is limited, with most fi ndings based on small-scale demonstration projects among physicians. A study determined if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in the US Department of Veterans Affairs (VA) Patient Aligned Care Team (PACT). The study design included a web-based, cross-sectional survey of 4,539 VA primary care personnel. The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffi ng, delegation of clinical responsibilities, working to top of competency, and collective self-effi cacy. Overall, 39% of respondents reported burnout. Participatory decisionmaking and having a fully staffed PACT were associated with lower burnout; higher burnout was associated with being assigned to a PACT, spending time on work that someone with less training could do, and having a stressful, fast-moving work environment. Lower burnout may be achieved by PCMHs that are appropriately staffed, emphasize anticipatory decisionmaking, and increase the proportion of time team members spend working to the top of their competency level. 1 REFERENCE 1. Helfrich CD1, Dolan ED, Simonetti J, et al. Elements of teambased care in a patient-centered medical home are associated with lower burnout among VA primary care employees. ABSTRACTCohort data from the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system and an ICU-level survey included patients admitted to 29 adult medical and mixed medical-surgical ICUs in 22 US hospitals. The primary exposure was admission to an ICU where NPs and PAs participated in patient care; the outcome was patient level in-hospital mortality. We used multivariable relative ABSTRACT Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and the Joint Commission, recommend that patients receive