Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout
Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout
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DOI：
10.1001/jamanetworkopen.2019.9609
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发表时间：
2019-08-01
影响因子：
13.8
通讯作者：
Linzer, Mark
中科院分区：
文献类型：
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作者：
Kroth, Philip J.;Morioka-Douglas, Nancy;Linzer, Mark
重要性许多人认为临床医生职业倦怠流行的一个主要原因是设计不良的电子健康记录（EHRs）。为了确定哪些EHR设计和使用因素与临床医生的压力和职业倦怠有关，并确定导致这一问题的其他来源。设计，设置和参与者这项调查研究了来自3个机构的282名门诊初级保健和亚专科临床医生的压力和职业倦怠，对EHR设计和使用因素的意见，以及有用的应对策略。线性和逻辑回归被用来估计协会的工作条件与压力的连续规模和倦怠作为一个有序的分类规模的二元结果。该调查于2016年8月至2017年7月进行，数据分析时间为2019年1月至2019年5月。主要结果和指标临床医生的压力和职业倦怠，通过验证的问题，EHR设计和使用因素被临床医生确定为与压力和职业倦怠最相关，以及临床医生工作条件的指标进行测量。282人（44.1%）回答。其中，241人（85.5%）是医生，160人（56.7%）是妇女，193人（68.4%）从事初级保健工作。对EHR设计和使用最普遍的担忧是过多的数据输入要求（245 [86.9%]），长剪贴笔记（212 [75.2%]），无法从多个机构获得信息（206 [73.1%]），面向账单的票据（206 [73.1%]），干扰工作与生活平衡（178 [63.1%]），姿势问题（144 [51.1%]）和疼痛（134 [47.5%]）归因于使用EHR。总体而言，EHR的设计和使用因素占12.5%的方差的措施的压力和6.8%的方差的措施的倦怠。工作条件，包括EHR使用和设计因素，占压力方差的58.1%;关键工作条件是办公室气氛（（beta）超过上限= 1.26; P
IMPORTANCE Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs).OBJECTIVES To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem.DESIGN, SETTING, AND PARTICIPANTS This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019.MAIN OUTCOMES AND MEASURES Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions.RESULTS Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres ((beta) over cap = 1.26; P