RAND Corporation, Santa Monica, CA, USA.
Pardee RAND Graduate School, Santa Monica, CA, USA.
J Gen Intern Med. 2018 Jan;33(1):65-71. doi: 10.1007/s11606-017-4186-8. Epub 2017 Oct 2.
Care coordination is a critical component of managing high-risk patients, who tend to have complex and multiple medical and psychosocial problems and are typically at high risk for increased hospitalization and incur high health care expenditures. Primary care models such as the patient-centered medical homes (PCMHs) are designed to improve care coordination and reduce care fragmentation. However, little is known about how the burden of care coordination for high-risk patients influences PCMH team members' stress.
To evaluate the relationship between provider stress and care coordination time in high-risk patient care and whether availability of help is associated with reduced stress.
Multivariable regression analysis of a cross-sectional survey of PCMH primary care providers (PCPs) and nurses.
A total of 164 PCPs and 272 nurses in primary care practices at five geographically diverse Veteran Health Administration (VA) medical center health systems.
The main outcome variable was provider stress due to high-risk patient care. Independent variables were the reported proportion of high-risk patients in PCP/nurse patient panels, time spent coordinating care for these patients, and provider satisfaction with help received in caring for them.
The response rate was 44%. Spending more than 8 h per week coordinating care was significantly associated with a 0.21-point increase in reported provider stress compared to spending 8 h or less per week (95% CI: 0.04-0.39; p = 0.015). The magnitude of the association between stress and care coordination time was diminished when provider satisfaction with help received was included in the model.
Perceived provider stress from care of high-risk patients may arise from challenges related to coordinating their care. Our findings suggest that the perception of receiving help for high-risk patient care may be valuable in reducing provider stress.
患者护理协调是管理高危患者的重要组成部分，这些患者往往存在复杂且多样的医疗和心理社会问题，通常具有增加住院和医疗保健支出的高风险。以患者为中心的医疗之家（PCMH）等初级保健模式旨在改善护理协调并减少护理碎片化。然而，对于高危患者护理协调的负担如何影响 PCMH 团队成员的压力，我们知之甚少。
评估高危患者护理中提供者压力与护理协调时间之间的关系，以及帮助的可获得性是否与降低压力有关。
对五个地理上不同的退伍军人事务部（VA）医疗中心医疗系统的 PCMH 初级保健提供者（PCP）和护士进行横断面调查的多变量回归分析。
共有 164 名 PCP 和 272 名护士在五个地理上不同的退伍军人事务部（VA）医疗中心医疗系统的初级保健诊所。
主要结果变量是由于高危患者护理而导致的提供者压力。自变量为 PCP/护士患者组中高危患者的比例、为这些患者协调护理的时间以及提供者在照顾他们时获得帮助的满意度。
回复率为 44%。与每周花费 8 小时或更少时间协调护理相比，每周花费超过 8 小时协调护理与报告的提供者压力增加 0.21 分显著相关（95% CI：0.04-0.39；p=0.015）。当将提供者对获得的帮助的满意度纳入模型时，压力与护理协调时间之间的关联强度会降低。
从高危患者的护理中感知到的提供者压力可能源于协调其护理的挑战。我们的研究结果表明，对于高危患者护理获得帮助的感知可能有助于降低提供者的压力。
