From the Section of General Internal Medicine and the Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR (STE, EH); the Division of General Internal Medicine and Geriatrics and the Department of Family Medicine (STE), Oregon Health & Science University, Portland; the Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, WA (CDH, WLC, GBW); the Department of Health Services, University of Washington School of Public Health, Seattle (CDH, DG); the VA HSR&D Center for Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles Health Care System, Los Angeles, CA (LK, DER); the VISN 23 Patient Aligned Care Team Demonstration Laboratory, Iowa City VA Health Care System, Iowa City, IA (GS); and the Department of Management, University of Iowa, Iowa City (GS).
J Am Board Fam Med. 2018 Jan-Feb;31(1):83-93. doi: 10.3122/jabfm.2018.01.170083.
Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown.
We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout.
Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5).
Task delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses.
将初级保健提供者（PCP）的临床任务适当委托给其他团队成员，可能会减轻初级保健中的员工倦怠。但是，（1）在多学科团队中委托的程度，（2）与更大程度的委托相关的因素，以及（3）委托是否与倦怠相关，这些都尚不清楚。
我们对退伍军人事务部（VA）初级保健诊所中的 VA PCP-护士对进行了一项全国性的横断面调查，这是 VA 以患者为中心的医疗之家倡议的第四年。PCP 报告了他们在多大程度上依赖其他团队成员来完成 15 项常见的初级保健任务；配对护士报告了他们在多大程度上被依赖来完成相同的任务。通过对 15 个问题的回答取平均值，制定了任务委托/依赖的综合评分。我们进行了多变量回归分析，以探讨任务委托和倦怠的预测因素。
在 777 对 PCP-护士对中，PCP 报告的任务委托少于护士报告的被依赖程度（PCP 平均±标准偏差综合委托评分，2.97±0.64[范围，1-4]；护士综合依赖评分，3.26 ± 0.50[范围，1-4]）。大约 48%的 PCP 和 35%的护士报告倦怠。报告任务委托较多的 PCP 报告倦怠程度较低（比值比[OR]，每单位委托降低 0.62；95%置信区间[CI]，0.49-0.78），而报告被依赖程度较高的护士报告倦怠程度较高（OR，每单位依赖增加 1.83；95%CI，1.33-2.5）。
任务委托与 PCP 的倦怠程度降低有关，而任务依赖与护士的倦怠程度增加有关。通过增加 PCP 任务委托来改善初级保健工作生活的策略，必须考虑对护士的影响。
