From the Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore (NK and EK); Discern Consulting, Baltimore, Maryland (RM).
J Am Board Fam Med. 2020 May-Jun;33(3):357-367. doi: 10.3122/jabfm.2020.03.190458.
The CMS Transforming Clinical Practice Initiative (TCPI) provided during transition to new models of value-based care. Maryland ambulatory practices participated in the Garden Practice Transformation Network (GPTN) as a part of the TCPI. During practices assessment, we measured prevalence of burnout and identified its remediable predictors among GPTN-Maryland practices.
A modified Mini Z tool survey was distributed among clinicians and staff in November 2018 - July 2019. Association between presence of burnout and burnout drivers was assessed using a Generalized Estimating Equation regression model for ordinal outcome.
Data from 166 responses were analyzed. Prevalence of burnout symptoms was 22%, with 35% enjoying their work. A 100-point Time Constraints/Teamwork (T/T) score was constructed using factors significantly associated with burnout symptoms. T/T score increase by 1 unit was associated with 10% increase in the odds of moving from the group experiencing burnout or stress to the group who found 'joy in work' (OR = 1.1, 95% CI 1.07, 1.13, p < 0.0001).
The Mini Z-derived T/T score could be useful for quick assessment of the degree of burnout and identifying burnout drivers related to effective organizational structure and supportive teamwork in .
CMS 转化临床实践计划（TCPI）在向新的基于价值的护理模式过渡期间提供了支持。马里兰州的门诊实践作为 TCPI 的一部分参与了花园实践转型网络（GPTN）。在对实践进行评估时，我们测量了 GPTN-马里兰州实践中 burnout 的流行率，并确定了其可纠正的预测因素。
在 2018 年 11 月至 2019 年 7 月期间，向临床医生和工作人员分发了经过修改的 Mini Z 工具调查。使用广义估计方程回归模型评估 burnout 及其驱动因素与存在之间的关联。
对 166 份回复的数据进行了分析。出现 burnout 症状的比例为 22%，其中 35%的人喜欢自己的工作。使用与 burnout 症状显著相关的因素构建了 100 分的时间限制/团队合作（T/T）评分。T/T 评分增加 1 分，与从经历 burnout 或压力的组转移到发现“工作乐趣”的组的几率增加 10%相关（OR=1.1，95%CI 1.07，1.13，p<0.0001）。
Mini Z 衍生的 T/T 评分可用于快速评估 burnout 的程度，并确定与有效的组织结构和支持性团队合作相关的 burnout 驱动因素。
