Elements of Team-Based Care in a Patient-Centered Medical Home Are Associated with Lower Burnout Among VA Primary Care Employees

Abstract

BACKGROUND: A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed. OBJECTIVE: To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT). DESIGN: Web-based, cross-sectional survey and administrative data from May 2012. PARTICIPANTS: A total of 4,539 VA primary care personnel from 588 VA primary care clinics. MAIN MEASURES: The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity. KEY RESULTS: Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout. CONCLUSIONS: Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.KEY WORDS: patient-centered medical home; burnout; team-based care; organizational change.

Using a Single Item to Measure Burnout in Primary Care Staff: A Psychometric Evaluation

“…44 We assessed the performance of the two measures across four distinct occupational classes: providers, registered nurses (RNs), clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks.…”

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

“…The task questions were developed by clinicians and social scientists with experiencing practicing and studying primary care at the VA, and the questions have been used in several published studies. 11,31,32 Composite Task Delegation/Reliance Score To generate a composite task delegation/reliance score, we calculated the mean of the scores for all respondents across all 15 tasks. We also calculated the mean task delegation/reliance score for each task and task grouping.…”

Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden

“…First, implementation of PACT builds upon prior VHA investments in infrastructure and health information technology necessary to meet PCMH goals. 8 Thus, interpretation of study findings should consider differences between PACT and implementation of other medical homes recognized by the National Committee for Quality Assurance. Second, our methodological approach applied ITS models, because PACT implementation occurred simultaneously in all VHA clinics and a natural control group of non-PACT clinics did not exist.…”

“…[5][6][7] PACT provisions to increase access and integrate team-based care could increase capacity and the frequency of primary care provider (PCP) visits for some patients, particularly those with a relatively high comorbidity burden and a greater need for face-to-face primary care. [8][9][10] Finally, PACT efforts to increase care coordination, including the shifting of some services from specialists to primary care, are likely to disproportionately affect high-comorbidity patients, particularly those with multiple providers or who are dually enrolled in Medicare. 11,12 In contrast, healthier primary care patients might have decreased use of face-to-face primary care if other options introduced by PACT, such as telephone or electronic visits, served as an appropriate substitute.…”