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Simonetti JA, Sylling PW, Nelson KM, Joos S, Mohr D, Curtis I, Taylor L, Harvey CB, Schectman G, Fihn SD, Helfrich CD. Patient-Centered Medical Home Implementation and Burnout among VA Primary Care Employees. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 24; Toronto, Canada.
Abstract: Patient-Centered Medical Home Implementation and Burnout among VA Primary Care Employees Character limit: 4210/5000 limit (including spaces). Background: Burnout is common among primary care staff and is associated not only with expressed intent to leave clinical practice but also less desirable patient and provider outcomes (e.g., depression). 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. In 2010, the VA began implementing a PCMH model, called the Patient-Aligned Care Team (PACT), at more than 900 primary care clinics. Previous studies of the PCMH's effect on burnout have produced mixed results, though a recent VA study reported lower staff burnout at sites with more effective PACT implementation. The aims of this study were to estimate the change in burnout prevalence among the 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. Methods: We performed a retrospective analysis using data from the 2012 and 2013 VA All Employee Survey (AES), a human resources survey fielded annually to all VA employees (response rates 62.3% and 56.3%, respectively). We included respondents who identified "primary care" as their main job role, responded to a question about burnout, worked in a clinic that had at least 1 respondent from each study year, and worked in one of four occupational categories that comprise the core PACT team: 1) primary care provider; 2) nurse care manager or registered nurse; 3) clinical associate (e.g., licensed practical nurse); or 4) administrative clerk. Primary outcomes were the change in overall VA primary care staff burnout prevalence from 2012 to 2013, clinic-level burnout prevalence, and change in clinic-level burnout prevalence from 2012 to 2013, which we assessed using a validated, single-item measure from the Physician Worklife Study 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, which we categorized by tertile. 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. Results: Among 8,135 and 7,510 primary care respondents working in 421 VA clinics included in the sample from the 2012 and 2013 AES surveys, 33.0% and 36.5% screened positive for burnout, respectively. 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. 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.

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