A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study
A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study
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DOI：
10.1007/s11606-015-3235-4
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发表时间：
2015-08-01
影响因子：
5.7
通讯作者：
Barbouche, Michael
中科院分区：
文献类型：
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作者：
Linzer, Mark;Poplau, Sara;Barbouche, Michael
初级保健的工作条件与医生的倦怠和较低的护理质量有关。我们的目的是评估工作条件的改善是否会改善临床医生的压力和倦怠。中西部和纽约市34家诊所的初级保健临床医生参加了这项研究。这是一项随机对照试验。工作条件，如时间压力，工作场所混乱和工作控制，以及临床医生的结果，在基线和12-18个月时进行测量。一个简短的工作生活和工作条件的总结措施提供给工作人员和临床医生在干预sites.Diverse干预分为三类：1）改善沟通; 2）工作流程的变化，和3）有针对性的质量改进（QI）projects.Multilevel回归评估工作生活数据和干预措施对临床结果的影响。一个多层次的分析，然后看看临床医生的结果评分改善，并确定类型的干预措施与改善。166名临床医生，135（81.3%）完成了这项研究。虽然基线数据对临床医生结局没有组治疗效应，但更多的干预临床医生显示出倦怠（21.8% vs 7.1%更少倦怠，p = 0.01）和满意度（23.1% vs 10.0%更满意，p = 0.04）的改善。与对照组相比，工作流干预更有可能改善倦怠[倦怠改善的比值比（OR）为5.9，p = 0.02]，并且有针对性的QI项目（OR 4.8，p = 0.02）。沟通或工作流程的干预导致临床医生满意度的更大改善（OR 3.1，p = 0.04），并显示出更大的改善趋势，打算离开（OR 4.2，p = 0.06）。我们使用了不同的干预类型，并且不确定干预措施的实施情况。组织可能能够改善倦怠，通过解决沟通和工作流程，以及针对临床医生关注的问题启动QI项目，解决不满意和保留问题。
Work conditions in primary care are associated with physician burnout and lower quality of care.We aimed to assess if improvements in work conditions improve clinician stress and burnout.Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study.This was a cluster randomized controlled trial.Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12-18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites.Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects.Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement.Of 166 clinicians, 135 (81.3 %) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8 % vs 7.1 % less burned out, p = 0.01) and satisfaction (23.1 % vs 10.0 % more satisfied, p = 0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9, p = 0.02], and with targeted QI projects than in controls (OR 4.8, p = 0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1, p = 0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2, p = 0.06).We used heterogeneous intervention types, and were uncertain how well interventions were instituted.Organizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.