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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 2/2014

01-07-2014 | Original Research

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

Authors: Christian D. Helfrich, MPH, PhD, Emily D. Dolan, MS, PhD, Joseph Simonetti, MD, Robert J. Reid, MD, PhD, Sandra Joos, PhD, Bonnie J. Wakefield, RN, PhD, Gordon Schectman, MD, Richard Stark, MD, Stephan D. Fihn, MD, MPH, Henry B. Harvey, MS, Karin Nelson, MD, MSHS

Published in: Journal of General Internal Medicine | Special Issue 2/2014

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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.
Appendix
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Metadata
Title
Elements of Team-Based Care in a Patient-Centered Medical Home Are Associated with Lower Burnout Among VA Primary Care Employees
Authors
Christian D. Helfrich, MPH, PhD
Emily D. Dolan, MS, PhD
Joseph Simonetti, MD
Robert J. Reid, MD, PhD
Sandra Joos, PhD
Bonnie J. Wakefield, RN, PhD
Gordon Schectman, MD
Richard Stark, MD
Stephan D. Fihn, MD, MPH
Henry B. Harvey, MS
Karin Nelson, MD, MSHS
Publication date
01-07-2014
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue Special Issue 2/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-013-2702-z

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