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估算美国医生倦怠的归因成本。

Estimating the Attributable Cost of Physician Burnout in the United States.

机构信息

National University of Singapore, Singapore (S.H.).

Stanford University School of Medicine, Palo Alto, California (T.D.S., M.T.).

出版信息

Ann Intern Med. 2019 Jun 4;170(11):784-790. doi: 10.7326/M18-1422. Epub 2019 May 28.

DOI:10.7326/M18-1422
PMID:31132791
Abstract

BACKGROUND

Although physician burnout is associated with negative clinical and organizational outcomes, its economic costs are poorly understood. As a result, leaders in health care cannot properly assess the financial benefits of initiatives to remediate physician burnout.

OBJECTIVE

To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels.

DESIGN

Cost-consequence analysis using a mathematical model.

SETTING

United States.

PARTICIPANTS

Simulated population of U.S. physicians.

MEASUREMENTS

Model inputs were estimated by using the results of contemporary published research findings and industry reports.

RESULTS

On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.

LIMITATIONS

Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated.

CONCLUSION

Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.

摘要

背景

尽管医生职业倦怠与负面的临床和组织结果相关,但人们对其经济成本的认识还很有限。因此,医疗保健领域的领导者无法正确评估补救医生职业倦怠的举措带来的经济效益。

目的

估计与医生离职和医生减少临床工作时间相关的职业倦怠相关成本,分别从国家(美国)和组织层面进行测算。

设计

使用数学模型进行成本-后果分析。

设置

美国。

参与者

美国医生的模拟人群。

测量

模型输入使用当代已发表的研究结果和行业报告的结果进行估算。

结果

在全国范围内,保守的基本案例模型估计,每年美国因职业倦怠导致医生离职和减少临床工作时间相关的成本约为 46 亿美元。在多变量概率敏感性分析中,该估计值在 26 亿至 63 亿美元之间。在组织层面,每年因与离职和减少临床工作时间相关的职业倦怠导致的经济成本约为每位受雇医生 7600 美元。

局限性

可能存在未回复的偏差和原始数据中混杂因素控制不完整。一些参数无法从数据中获得,必须进行推断。

结论

结合之前的证据表明,职业倦怠可以通过适度的投资得到有效缓解,这些发现表明,针对医生的职业倦怠缓解计划的政策和组织支出具有巨大的经济价值。

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