Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 7/2020

01-07-2020 | Care | Original Research

Association Between Difficulty with VA Patient-Centered Medical Home Model Components and Provider Emotional Exhaustion and Intent to Remain in Practice

Authors: Eric A. Apaydin, PhD, Danielle Rose, PhD, Lisa S. Meredith, PhD, Michael McClean, BA, Timothy Dresselhaus, MD, Susan Stockdale, PhD

Published in: Journal of General Internal Medicine | Issue 7/2020

Login to get access

Abstract

Background

The patient-centered medical home (PCMH) model is intended to improve primary care, but evidence of its effects on provider well-being is mixed. Investigating the relationships between specific PCMH components and provider burnout and potential attrition may help improve the efficacy of the care model.

Objective

We analyzed provider attitudes toward specific components of PCMH in the Veterans Health Administration (VA) and their relation to emotional exhaustion (EE)—a central component of burnout—and intent to remain in VA primary care.

Design

Logistic regression analysis of a cross-sectional survey.

Subjects

116 providers (physicians; nurse practitioners; physician assistants) in 21 practices between September 2015 and January 2016 in one VA region.

Main Measures

Outcomes: burnout as measured with the emotional exhaustion (EE) subscale of the Maslach Burnout Inventory and intent to remain in VA primary care for the next 2 years; predictors: difficulties with components of PCMH, demographic characteristics.

Key Results

Forty percent of providers reported high EE (≥ 27 points) and 63% reported an intent to remain in VA primary care for the next 2 years. Providers reporting high difficultly with PCMH elements were more likely to report high EE, for example, coordinating with specialists (odds ratio [OR] 8.32, 95% confidence interval [CI] 3.58–19.33), responding to EHR alerts (OR 6.88; 95% CI 1.93–24.43), and managing unscheduled visits (OR 7.53, 95% CI 2.01–28.23). Providers who reported high EE were also 87% less likely to intend to remain in VA primary care.

Conclusions

To reduce EE and turnover in PCMH, primary care providers may need additional support and training to address challenges with specific aspects of the model.
Appendix
Available only for authorised users
Literature
1.
Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. JAMA. 2018;320(11):1131–1150.
2.
Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103–111.CrossRef
3.
4.
Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(10):1317–1330.
5.
Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc. 2016;91(4):422–431.
6.
Spinelli WM. The phantom limb of the triple aim. Mayo Clin Proc. 2013;88(12):1356–1357.CrossRef
7.
Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.CrossRef
8.
9.
Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med. 2007;5(5):457–461.CrossRef
10.
Lewis SE, Nocon RS, Tang H, et al. Patient-centered medical home characteristics and staff morale in safety net clinics. Arch Intern Med. 2012;172(1):23–31.
11.
Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaén C. Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health Aff (Millwood). 2011;30(3):439–445.
12.
Nocon RS, Fairchild PC, Gao Y, et al. Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention. J Gen Intern Med. 2019;34(6):952–959.
13.
Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29(5):835–843.CrossRef
14.
Jackson GL, Powers BJ, Chatterjee R, et al. The patient-centered medical home: a systematic review. Ann Intern Med. 2013;158(3):169–178.
15.
Rosland AM, Nelson K, Sun H, et al. The patient-centered medical home in the Veterans Health Administration. Am J Manag Care. 2013;19(7):e263–272.
16.
Meredith LS, Schmidt Hackbarth N, Darling J, et al. Emotional exhaustion in primary care during early implementation of the VA’s medical home transformation: Patient-aligned Care Team (PACT). Med Care. 2015;53(3):253–260.CrossRef
17.
Meredith LS, Batorsky B, Cefalu M, et al. Long-term impact of evidence-based quality improvement for facilitating medical home implementation on primary care health professional morale. BMC Fam Pract. 2018;19(149):1–10.
18.
Helfrich CD, Dolan ED, Simonetti J, et al. Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees. J Gen Intern Med. 2014;29(Suppl 2):S659–666.
19.
Kim LY, Rose DE, Soban LM, et al. Primary care tasks associated with provider burnout: findings from a Veterans Health Administration survey. J Gen Intern Med. 2018;33(1):50–56.
20.
Edwards ST, Helfrich CD, Grembowski D, et al. Task delegation and burnout trade-offs among primary care providers and nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs). J Am Board Fam Med. 2018;31(1):83–93.
21.
Nelson KM, Helfrich C, Sun H, et al. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med. 2014;174(8):1350–1358.
22.
Chuang E, Brunner J, Mak S, et al. Challenges with implementing a patient-centered medical home model for women veterans. Womens Health Issues. 2017;27(2):214–220.
23.
Sylling PW, Wong ES, Liu CF, et al. Patient-centered medical home implementation and primary care provider turnover. Med Care. 2014;52(12):1017–1022.PubMed
24.
Maslach C, Leiter MP. Maslach Burnout Inventory Manual. Palo Alto, CA: Consulting Psychologists Press; 1996.
25.
Landon BE, Aseltine R, Shaul JA, Miller Y, Auerbach BA, Cleary PD. Evolving dissatisfaction among primary care physicians. Am J Manag Care. 2002;8(10):890–901.
26.
Ly DP, Glied SA. The impact of managed care contracting on physicians. J Gen Intern Med. 2014;29(1):237–242.CrossRef
27.
Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc. 2014;21(e1):e100–106.CrossRef
28.
Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Santa Monica, CA: RAND Corporation;2013.
29.
Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91(7):836–848.
30.
Love JS, Wright A, Simon SR, et al. Are physicians’ perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use? J Am Med Inform Assoc. 2012;19(4):610–614.CrossRef
31.
Deckard G, Meterko M, Field D. Physician burnout: an examination of personal, professional, and organizational relationships. Med Care. 1994;32(7):745–754.
32.
Gregory ST, Menser T. Burnout among primary care physicians: a test of the Areas of Worklife Model. J Health Manag. 2015;60(2):133–148.
33.
Linzer M, Manwell LB, Williams ES, et al. Working conditions in primary care: physician reactions and care quality. Annals of Internal Medicine. 2009;151(1):28–36.CrossRef
34.
Helfrich CD, Simonetti JA, Clinton WL, et al. The association of team-specific workload and staffing with odds of burnout among VA primary care team members. J Gen Intern Med. 2017;32(7):760–766.
35.
Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav. 2002;43(1):72–91.
36.
Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990–995.CrossRef
37.
Warde C, Ching WT, Sohmer R. Enhancing resilience to promote VA patient-centered medical home transformation and the untoward effects of the national access crisis. J Gen Intern Med. 2015;30(Suppl 2):516.
38.
Linzer M, Poplau S, Grossman E, et al. A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015;30(8):1105–1111.
39.
Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544–1552.
40.
Jackson GL, Williams JW. Does PCMH “work”?—the need to use implementation science to make sense of conflicting results. JAMA Intern Med. 2015;175(8):1369–1370.
41.
Tuepker A, Kansagara D, Skaperdas E, et al. “We’ve not gotten even close to what we want to do”: a qualitative study of early patient-centered medical home implementation. J Gen Intern Med. 2014;29(Suppl 2):614–622.
42.
Solimeo SL, Ono SS, Lampman MA, Paez MB, Stewart GL. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran’s health administration. J Interprof Care. 2015;29(1):26–33.CrossRef
Metadata
Title
Association Between Difficulty with VA Patient-Centered Medical Home Model Components and Provider Emotional Exhaustion and Intent to Remain in Practice
Authors
Eric A. Apaydin, PhD
Danielle Rose, PhD
Lisa S. Meredith, PhD
Michael McClean, BA
Timothy Dresselhaus, MD
Susan Stockdale, PhD
Publication date
01-07-2020
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine / Issue 7/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-020-05780-8

Other articles of this Issue 7/2020

Journal of General Internal Medicine 7/2020 Go to the issue

Concise Research Report

Chronic Conditions in Advanced Cardiac Disease: A Cluster Analysis of Transcatheter Aortic Valve Replacement (TAVR)-Treated Patients

Capsule Commentary

Capsule Commentary on Zheng et al., The Role of Spirituality in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Systematic Mixed Studies Review

Original Research

Instability in End-of-Life Care Preference Among Heart Failure Patients: Secondary Analysis of a Randomized Controlled Trial in Singapore

Original Research

Excess Weight Gain After Cure of Hepatitis C Infection with Direct-Acting Antivirals

Research and Reporting Methods

Reporting of Clinical Practice Guidelines: Practical Testing of AGREE and RIGHT Checklists

Review

Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments—a Systematic Review of Reviews

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits