4033 — Investigating the impact of VA clinician burnout on patient-reported access to primary care

Lead/Presenter: Taona Haderlein,  COIN - Los Angeles
All Authors: Haderlein TP (Center for the Study of Healthcare Innovation, Implementation, and Science, Greater Los Angeles VA Healthcare System, Sepulveda CA), Rose, DE (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles VA Healthcare System, Sepulveda CA), Stockdale, SE (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles VA Healthcare System, Sepulveda CA)

Objectives:
While the Patient Centered Medical Home Model (PCMH) is associated with positive patient outcomes, the model requires the restructuring of primary clinic workflow and job roles. Past research indicates that organizational changes such as PCMH transformation heighten the risk for employee burnout. However, little is known about subsequent impacts of clinician burnout on patients' experiences. The present study examines Veterans Health Administration (VA) clinician-reported burnout as a predictor of patient-reported access to primary care.

Methods:
We merged primary care clinician (PCC) data from the Veterans Assessment and Improvement Laboratory baseline clinician survey, collected from November 2011 through March 2012, with data from the Survey of Healthcare Experiences of Patients (SHEP) administered by the VA Office of Reporting, Analytics, Performance, Improvement and Deployment. We included scores from three subscales of the Maslach Burnout Inventory - emotional exhaustion (EE), cynicism (CY), and professional efficacy (PE) - as our primary predictor variables. We used data from patients who were identified as members of the PCCs' patient panels. Our dependent variables were three SHEP items that assessed patient-reported access to primary care. Variable responses were dichotomized as 1 = always and 0 = sometimes, usually, or never.

Results:
We analyzed data from 161 primary care clinicians, and 4,171 Veteran patients. Patients of clinicians reporting high CY were less likely to report that they always obtained an urgent appointment (OR: .95, 95% CI: .95-.96) or routine appointment (OR: .96, 95% CI:.92-.99) when needed. Patients of clinicians reporting high EE were more likely to report always getting urgent (OR: 1.02, 95%CI: 1.01- 1.03) and routine appointments (OR: 1.01, 95% CI:1.00-1.02) when needed. Low PE was associated with reduced patient-reported access to routine appointments (OR: .96, 95% CI:.93-.99). No association was found for access to tests and treatments.

Implications:
CY and low PE negatively impacted patient-reported access to primary care appointments, while EE was positively associated with patient-reported access.

Impacts:
The VA may benefit from system-level initiatives to increase provider morale, as this study demonstrates the connectedness of provider burnout and patient experiences. The influence of burnout on perceived access varies among burnout dimensions; further study is needed to clarify potential mechanisms of these associations.