Patient-Centered Medical Home Characteristics and Staff Morale in Safety Net Clinics
Patient-Centered Medical Home Characteristics and Staff Morale in Safety Net Clinics
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DOI：
10.1001/archinternmed.2011.580
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发表时间：
2012-01-09
影响因子：
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通讯作者：
Chin, Marshall H.
中科院分区：
文献类型：
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作者：
Lewis, Sarah E.;Nocon, Robert S.;Chin, Marshall H.
背景资料：我们试图确定是否认为以病人为中心的医疗之家（PCMH）的特点与工作人员的士气，工作满意度和倦怠在safety net clinics.Methods：自我管理的调查，391供应商和382名临床工作人员在65个安全网诊所在2010年在5个州。以下5个分量表测量受访者对PCMH特征的感知，范围为0至100（0表示最差，100表示最好）：获得护理和与患者沟通，与其他提供者沟通，跟踪数据，护理管理和质量改进。结果：603人（78.0%）回答。在多变量广义估计方程模型中，质量改进子量表得分增加10%与更高的士气相关（提供者比值比[OR]，2.64; 95% CI，1.47-4.75;工作人员OR，3.62; 95% CI，1.84-7.09），工作满意度更高（提供者OR，2.45; 95%CI，1.42-4.23;工作人员OR，2.55; 95%CI 1.42-4.57）和无倦怠（工作人员OR，2.32; 95%CI，1.31-4.12）。PCMH总分与较高的员工士气（OR，2.63; 95%CI，1.47-4.71）和较低的提供者免于倦怠（OR，0.48; 95%CI，0.30-0.77）相关。一个单独的工作环境协变量高度相关的质量改进子量表得分和总PCMH得分，和PCMH特性衰减关联的士气和工作满意度时，包括在models.Conclusions：供应商和工作人员谁认为更多的PCMH特性在他们的诊所更有可能有更高的士气，但供应商有更少的自由倦怠。在PCMH分量表中，质量改进分量表得分特别与更高的士气，更高的工作满意度和自由倦怠相关。
Background: We sought to determine whether perceived patient-centered medical home (PCMH) characteristics are associated with staff morale, job satisfaction, and burnout in safety net clinics.Methods: Self-administered survey among 391 providers and 382 clinical staff across 65 safety net clinics in 5 states in 2010. The following 5 subscales measured respondents' perceptions of PCMH characteristics on a scale of 0 to 100 (0 indicates worst and 100 indicates best): access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. The PCMH subscale scores were averaged to create a total PCMH score.Results: Six hundred three persons (78.0%) responded. In multivariate generalized estimating equation models, a 10% increase in the quality improvement subscale score was associated with higher morale (provider odds ratio [OR], 2.64; 95% CI, 1.47-4.75; staff OR, 3.62; 95% CI, 1.84-7.09), greater job satisfaction (provider OR, 2.45; 95% CI, 1.42-4.23; staff OR, 2.55; 95% CI 1.42-4.57), and freedom from burnout (staff OR, 2.32; 95% CI, 1.31-4.12). The total PCMH score was associated with higher staff morale (OR, 2.63; 95% CI, 1.47-4.71) and with lower provider freedom from burnout (OR, 0.48; 95% CI, 0.30-0.77). A separate work environment covariate correlated highly with the quality improvement subscale score and the total PCMH score, and PCMH characteristics had attenuated associations with morale and job satisfaction when included in models.Conclusions: Providers and staff who perceived more PCMH characteristics in their clinics were more likely to have higher morale, but the providers had less freedom from burnout. Among the PCMH subscales, the quality improvement subscale score particularly correlated with higher morale, greater job satisfaction, and freedom from burnout.