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Patient-Centered Medical Home Implementation and Burnout among VA Primary Care Employees

Mohr DC, Simonetti T, Sylling PW, Nelson K, Joos S, Curtis I, Taylor L, Harvey HB, Schectman G, Fihn SD, Helfrich CD. Patient-Centered Medical Home Implementation and Burnout among VA Primary Care Employees. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.


Research Objective: Patient-centered medical home (PCMH) models entail changes in primary care delivery, such as improvements in team functioning, that have been shown to be associated with lower burnout among primary care staff. In 2010, the VA began implementing a PCMH model, called the Patient-Aligned Care Team (PACT), at more than 900 primary care clinics. The aims of this study were to estimate the change in burnout prevalence among VA primary care staff from 2012 to 2013, determine whether extent of clinic-level PACT implementation was associated with clinic burnout prevalence, and determine whether clinic-level progress in PACT implementation from 2012 to 2013 was associated with change in clinic-level burnout. Study Design: We assessed burnout among VA primary care staff (providers, nurse care managers, licensed practical nurses, administrative clerks) using a validated, single-item measure that asked respondents to rate their level of burnout using a 5-level ordinal scale. Consistent with previous studies, we dichotomized burnout as absent (1-2) or present (3-5). To assess change in VA primary care burnout from 2012 to 2013, we aggregated respondent burnout to the clinic level and used linear regression with change in overall clinic-level burnout prevalence from 2012 to 2013 as the outcome. To assess the association between clinic-level PACT implementation and burnout, we used the PACT Implementation Progress Index (Pi2), a validated metric measuring implementation among VA clinics. Clinic Pi2 scores range from -8 to 8; higher scores indicating more extensive PACT implementation. We used linear regression to model clinic-level burnout prevalence in 2013 as a function of 2012 clinic Pi2 scores and to model change in clinic-level burnout prevalence from 2012 to 2013 as a function of change in clinic-level PACT implementation between years. Each model adjusted for differences in respondent and clinic characteristics. Population Studied: We studied 8,135 and 7,510 primary care respondents to the 2012 and 2013 VA All Employee Surveys, respectively (response rates 62.3% and 56.3%, respectively). Principal Findings: Thirty-three percent of 2012 respondents and 36.5% of 2013 respondents working in 421 VA clinics screened positive for burnout. After aggregating to the clinic-level and adjusting for differences in clinic and respondent characteristics between years, we estimated that the change in burnout among VA primary care staff from 2012 to 2013 was +5.0% (p < 0.01). In unadjusted and adjusted models, there was no association between extent of PACT implementation as measured by Pi2 and clinic-level burnout prevalence, or between change in clinic-level PACT implementation and change in clinic-level burnout between years. Conclusions: Burnout among VA primary care employees is high, and increased from 2012 to 2013. The extent to which clinics had implemented the PACT model in 2012 and their implementation progress from 2012 to 2013 were not associated with clinic-level burnout. Implications for Policy, Delivery or Practice: While medical home models, including PACT, may prove to lower burnout among the primary care workforce, their effectiveness in doing so in the short term remains unclear. Additional work is needed to identify specific elements of the PACT model that most strongly influence burnout and to follow long-term trends in burnout among VA primary care staff.

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