Lewis Sarah E, Nocon Robert S, Tang Hui, Park Seo Young, Vable Anusha M, Casalino Lawrence P, Huang Elbert S, Quinn Michael T, Burnet Deborah L, Summerfelt Wm Thomas, Birnberg Jonathan M, Chin Marshall H
Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Arch Intern Med. 2012 Jan 9;172(1):23-31. doi: 10.1001/archinternmed.2011.580.
We sought to determine whether perceived patient-centered medical home (PCMH) characteristics are associated with staff morale, job satisfaction, and burnout in safety net clinics.
Self-administered survey among 391 providers and 382 clinical staff across 65 safety net clinics in 5 states in 2010. The following 5 subscales measured respondents' perceptions of PCMH characteristics on a scale of 0 to 100 (0 indicates worst and 100 indicates best): access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. The PCMH subscale scores were averaged to create a total PCMH score.
Six hundred three persons (78.0%) responded. In multivariate generalized estimating equation models, a 10% increase in the quality improvement subscale score was associated with higher morale (provider odds ratio [OR], 2.64; 95% CI, 1.47-4.75; staff OR, 3.62; 95% CI, 1.84-7.09), greater job satisfaction (provider OR, 2.45; 95% CI, 1.42-4.23; staff OR, 2.55; 95% CI 1.42-4.57), and freedom from burnout (staff OR, 2.32; 95% CI, 1.31-4.12). The total PCMH score was associated with higher staff morale (OR, 2.63; 95% CI, 1.47-4.71) and with lower provider freedom from burnout (OR, 0.48; 95% CI, 0.30-0.77). A separate work environment covariate correlated highly with the quality improvement subscale score and the total PCMH score, and PCMH characteristics had attenuated associations with morale and job satisfaction when included in models.
Providers and staff who perceived more PCMH characteristics in their clinics were more likely to have higher morale, but the providers had less freedom from burnout. Among the PCMH subscales, the quality improvement subscale score particularly correlated with higher morale, greater job satisfaction, and freedom from burnout.
我们试图确定感知到的以患者为中心的医疗之家（PCMH）特征是否与安全网诊所的员工士气、工作满意度和职业倦怠相关。
2010年对5个州65家安全网诊所的391名医疗服务提供者和382名临床工作人员进行了自我管理的调查。以下5个分量表用于衡量受访者对PCMH特征的感知，评分范围为0至100（0表示最差，100表示最佳）：获得医疗服务及与患者沟通、与其他医疗服务提供者沟通、跟踪数据、护理管理和质量改进。将PCMH分量表得分进行平均以得出PCMH总分。
603人（78.0%）做出了回应。在多变量广义估计方程模型中，质量改进分量表得分提高10%与更高的士气相关（医疗服务提供者优势比[OR]，2.64；95%置信区间[CI]，1.47 - 4.75；工作人员OR，3.62；CI，1.84 - 7.09）、更高的工作满意度（医疗服务提供者OR，2.45；CI，1.42 - 4.23；工作人员OR，2.55；CI 1.42 - 4.57）以及更少的职业倦怠（工作人员OR，2.32；CI，1.31 - 4.12）。PCMH总分与更高的员工士气相关（OR，2.63；CI，1.47 - 4.71），且与医疗服务提供者更少的职业倦怠相关（OR，0.48；CI，0.30 - 0.77）。一个单独的工作环境协变量与质量改进分量表得分和PCMH总分高度相关，当纳入模型时，PCMH特征与士气和工作满意度的关联减弱。
在诊所中感知到更多PCMH特征的医疗服务提供者和工作人员更有可能拥有更高的士气，但医疗服务提供者的职业倦怠程度较低。在PCMH分量表中，质量改进分量表得分尤其与更高的士气、更高的工作满意度和更少的职业倦怠相关。
