Meredith Lisa S, Schmidt Hackbarth Nicole, Darling Jill, Rodriguez Hector P, Stockdale Susan E, Cordasco Kristina M, Yano Elizabeth M, Rubenstein Lisa V
*RAND Corporation, Santa Monica †VA HSR&D Center for the Study of Healthcare Implementation, Innovation, and Policy, Sepulveda ‡Pardee RAND Graduate School, Santa Monica §School of Health Policy and Management, University of California, Berkeley ∥Department of Health Policy and Management, UCLA, Fielding School of Public Health ¶UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.
Med Care. 2015 Mar;53(3):253-60. doi: 10.1097/MLR.0000000000000303.
Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration.
Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse.
515 veterans administration employees (191 PCCs and 324 other primary care staff).
Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization.
The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race.
Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.
将初级保健转变为以患者为中心的新模式需要医疗保健组织做出重大变革，包括跨专业期望和组织政策。员工的情绪耗竭可能伴随重大组织变革出现，威胁变革的成功。然而，关于初级保健转型期间与情绪耗竭的关联程度，几乎没有相关指导。我们评估了退伍军人健康管理局全国初级保健转型初始阶段的情绪耗竭情况。
对一个退伍军人管理行政区域内5个医疗系统的23家初级保健诊所的初级保健临床医生（PCC）和工作人员进行横断面在线调查。我们使用了描述性、双变量和多变量分析，并对诊所成员资格进行了调整，对无应答情况进行了加权处理。
515名退伍军人管理局员工（191名PCC和324名其他初级保健工作人员）。
结果变量是马氏倦怠量表的情绪耗竭分量表。预测因素包括诊所特征（来自行政数据）以及自我报告的变革效能感、转型经历和对组织的看法。
总体应答率为64%（515/811）。总体而言,53%的PCC和43%的工作人员存在高度情绪耗竭。PCC（与其他初级保健工作人员相比）、女性（与男性相比）以及非拉丁裔（与拉丁裔相比）受访者报告的情绪耗竭程度更高。在对性别和种族进行调整后，报告变革效能感较高和参与式决策的受访者情绪耗竭得分较低。
医疗保健组织认识到初级保健转型期间临床医生和工作人员出现情绪耗竭的可能性至关重要。应考虑通过提高临床医生和工作人员的变革效能感以及参与决策的机会来降低情绪耗竭的方法，同时要关注PCC和女性群体。
