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2023 HSR&D/QUERI National Conference Abstract

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1112 — VA primary care healthcare worker engagement, burnout, and turnover intent during the COVID-19 pandemic

Lead/Presenter: Eric Apaydin,  COIN - Los Angeles
All Authors: Apaydin EA (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA), Rose DR (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA) McClean MR (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA) Mohr DC (Center for Healthcare Organization & Implementation Research, Boston, MA) Yano EM (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA) Shekelle PG (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA) Guo R (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA) Stockdale SE (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA)

Objectives:
The COVID-19 pandemic drove burnout and turnover among healthcare workers (HCWs), but working environments may have differentially buffered or exacerbated the pandemic’s effects. Primary care HCWs faced pandemic-related challenges, including assignments to COVID wards to accommodate surges, changes in staffing and space requirements to accommodate COVID testing and ICU surges, and a rapid shift to virtual care. HCWs who were engaged at their workplace may have experienced less burnout and turnover, despite these challenges. Our aims were (1) to measure the prevalence of burnout and turnover intent among HCWs in VA primary care during the COVID-19 pandemic and; (2) to understand the association between individual-level burnout and turnover intent outcomes and individual-level (employee engagement) and facility-level (COVID-19 burden, prior year burnout, and virtual care) predictors of those outcomes.

Methods:
We obtained individual-level data on burnout, turnover intent, employee engagement, and demographics from the 2020 VA All Employee Survey (AES) for 19,909 primary care HCWs (providers; registered nurses; clinical associates; administrative associates) in 141 facilities. We linked these data at the facility-level to burnout from the 2019 AES, COVID test and death rates from March to September 2020 from the 2020 VA COVID Shared Data Resource, the proportion of virtual primary care visits from March to September 2020 from the 2020 Corporate Data Warehouse, and facility complexity levels from the 2020 VHA Support Service Center. We modeled the relationships between individual-level burnout, turnover intent, employee engagement, demographics, and facility-level characteristics using logistic regressions with standard errors clustered by facility.

Results:
Thirty-seven percent of primary care HCWs reported burnout, and 31% reported their intent to leave their job within two years. From March to September 2020, facility average COVID tests were 56.5 per 1000 unique patients, average COVID deaths were 0.46 per 1000 unique patients, and approximately 29% of primary care visits were conducted by phone, video, or other virtual medium. Highly engaged employees were less likely to be burned out (odds ratio [OR] 0.29; 95% confidence interval [CI] 0.28-0.33) and had a lower intention to leave their job (OR 0.35; 95% CI 0.32-0.38). Greater than average facility-level burnout in 2019 was related to higher HCW burnout in 2020 (OR 8.19, 95% CI 2.11-31.82), but 2019 and 2020 turnover intent were not significantly associated. High COVID tests and deaths, and virtual care measures were not associated with burnout or turnover intent.

Implications:
Employee engagement, but not COVID-19 burden and virtual care use, was associated with less primary care HCW burnout and turnover intent during the pandemic.

Impacts:
Burnout and turnover intent were high, but similar to pre-pandemic levels, indicating the persistent influence of non-COVID drivers of these outcomes. Future research should focus on understanding elements of the working environment that contribute to burnout and turnover, and interventions to improve HCW well-being should be directed at improving primary care working environments.