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2015 HSR&D/QUERI National Conference Abstract

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3172 — Patient-Centered Medical Home Implementation and Burnout among VA Primary Care Employees

Simonetti JA, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington; Sylling PW, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington; Nelson K, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington; Taylor L, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington; Harvey HB, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington; Mohr DC, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Curtis I, Office of Analytics and Business Intelligence, Veterans Health Administration; Schectman G, Office of Patient Care Services, US Department of Veterans Affairs; Fihn SD, Office of Analytics and Business Intelligence, Veterans Health Administration; Helfrich CD, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington

Objectives:
The aims of this study were to estimate the change in burnout prevalence among VA primary care employees from 2012-2013, assess whether extent of clinic-level PACT implementation was associated with clinic-level burnout prevalence, and assess whether clinic-level progress in PACT implementation from 2012-2013 was associated with change in clinic-level burnout.

Methods:
We studied 8,135 and 7,510 primary care respondents to the 2012 and 2013 VA All Employee Surveys, respectively, which included a validated, single-item burnout measure. To assess change in VA primary care burnout from 2012-2013, we aggregated respondent burnout to the clinic level and used linear regression with change in overall clinic-level burnout prevalence from 2012-2013 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 (range -8 to 8; higher scores indicating more extensive implementation). We used linear regression to model 2013 clinic-level burnout prevalence as a function of 2012 Pi2 scores and to model change in clinic-level burnout prevalence (2012-2013) as a function of change in clinic-level PACT implementation between years. Each model adjusted for differences in respondent and clinic characteristics.

Results:
Thirty-three percent of 2012 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 respondent and clinic characteristics between years, we estimated that burnout among VA primary care employees increased 5% from 2012-2013 (p < 0.01). In unadjusted and adjusted models, there was no association between extent of clinic-level PACT implementation and clinic-level burnout prevalence, or between change in clinic-level PACT implementation and change in clinic-level burnout between years.

Implications:
Burnout among VA primary care employees is high and increased from 2012-2013. The extent to which clinics had implemented the PACT model in 2012 and their implementation progress from 2012-2013 were not associated with clinic-level burnout prevalence.

Impacts:
The effect of PACT on workforce burnout remains unclear. Additional work is needed to identify specific elements of the PACT model that most influence burnout and to follow long-term trends in VA primary care burnout.