Reducing Burnout among VA PCPs Using Evidence-Based Quality Improvement

背景：职业倦怠是一种对慢性工作压力的长期心理反应，是非常普遍的 在VA初级保健的提供者和工作人员中。医疗工作者（HCW）倦怠不仅不利于 受影响的个人，以及他们工作的组织。高比例的HCW烧毁与以下因素有关： 医疗差错增加，护理质量下降，患者体验下降。烧毁的HCW也可以 更少的时间，更有可能离开他们的组织。组织干预，以减少倦怠是 比个人干预更有效，但没有一种组织干预适用于所有人。 设置.我们建议使用循证质量改进（EBQI），利用协作领导， PACT小团队的投入，以制定和试点测试减少倦怠的干预措施，通过证据和 在专家的协助下，根据参与的初级保健诊所的具体需求量身定制。的结果 这项工作将为在其他退伍军人管理局设施中实施倦怠干预措施的战略提供信息， 组织背景。意义/影响：在VA，31-55%的提供者，护士，临床助理， 在患者一致的护理团队（PACT）小团队的行政助理一致报告倦怠。强 初级保健模式是必不可少的VA的综合交付系统。高度倦怠，以及随后的 人员流动，可能会削弱这种力量，减少初级保健人员，团队功能和PACT的忠诚度， 从而削弱了退伍军人的准入，并将更多的照顾转移到社区。解决小学生职业倦怠问题 在它导致更大的下游影响之前进行护理对于保护退伍军人的健康和 VA医疗保健系统此外，解决初级保健中的倦怠问题符合HSR&D和ORD 初级保健实践和复杂的慢性病管理的研究优先事项， VA研究的实质性现实世界影响。创新：EBQI是一个有效且得到良好评价的战略 这有助于实施PACT，妇女健康PACT，抑郁症合作护理和吸烟 戒烟指南。该战略还减少了PACT实施过程中提供者和工作人员的倦怠， 从未与倦怠干预措施一起使用，以优化影响。这个CDA是第一次奋进 将联合收割机EBQI作为实施策略与基于证据的倦怠干预措施相结合， 组织背景。通过EBQI，一种多层次的协作方法，赋予一线医护人员权力， 我们可以增加减少倦怠干预的可行性和影响。具体目标：在本CDA中，我 目标：目标1：了解VA初级保健中的设施和临床层面的倦怠驱动因素;目标2：制定 使用EBQI方法的倦怠减少干预措施;目标3：评估可行性，可接受性， 试验EBQI促进倦怠减少干预措施的有效性。方法：对于目标1，我将 通过调查和访谈来衡量倦怠，并确定倦怠的驱动因素，这将作为基础 对于企业主参与的优先级设置过程，使用EBQI设计本地定制的循证 减少倦怠干预。目标2将涉及整合倦怠和干预的关键驱动因素 目标1中确定的活动，并制定EBQI促进的倦怠干预措施（使用利益相关者小组， 质量改进培训、形成性反馈和实践促进）。目标3将包括评价 可行性，可接受性，和有效性的EBQI促进倦怠干预在试点阶段 在VISN 22的五个VA医疗中心和社区门诊诊所中进行楔形设计。Aim期间 3、我还将使用访谈来识别干预障碍和促进者。后续步骤/实施： 在本CDA的第3年和第5年，我将分别准备和提交IIR，以进行国家组织 一项调查，以确定和研究退伍军人事务部初级保健中职业倦怠驱动因素的影响，以及一个更大的多地点集群 随机对照试验，以充分评估EBQI促进的倦怠的有效性和影响 还原还将与国家和地方利益攸关方分享调查结果，为今后的执行工作提供信息。

Background: Burnout, a long-term psychological response to chronic workplace stress, is highly prevalent among providers and staff in VA primary care. Healthcare worker (HCW) burnout is not only detrimental to affected individuals, but also to the organizations that they work in. High rates of HCW burnout are linked to increased medical errors, worse quality of care, and worse patient experience. Burned out HCWs also work fewer hours and are more likely to leave their organization. Organizational interventions to reduce burnout are more effective than individual interventions, but no single organizational intervention is applicable to all settings. We propose to use evidence-based quality improvement (EBQI) to utilize collaborative leadership and PACT teamlet input to develop and pilot test a burnout reduction intervention, informed by evidence and facilitated by experts, that is tailored to the specific needs of participating primary care clinics. Findings from this work will inform strategies for implementing burnout interventions in other VA facilities, adapted to local organizational contexts. Significance/Impact: In VA, 31-55% of providers, nurses, clinical associates, and administrative associates in patient-aligned care team (PACT) teamlets consistently report burnout. Strong primary care models are essential to the VA’s integrated delivery system. High burnout, and subsequent turnover, could erode that strength by decreasing primary care staffing, team function and PACT fidelity, thereby impairing Veteran access and shifting more care to the community. Addressing burnout in primary care before it leads to larger downstream effects is essential to preserving Veteran health and the integrity of the VA healthcare system. In addition, addressing burnout in primary care meets the HSR&D and ORD research priorities of primary care practice and complex chronic disease management, and of increasing substantial real-world impact of VA research. Innovation: EBQI is an effective and well-evaluated strategy that aided in the implementation of PACT, Women’s Health PACT, depression collaborative care, and smoking cessation guidelines. The strategy also reduced provider and staff burnout during PACT implementation, but has never been used in tandem with burnout interventions to optimize impacts. This CDA is the first endeavor to combine EBQI as an implementation strategy with evidence-based burnout interventions, adapted for local organizational contexts. Through EBQI, a multi-level, collaborative approach that empowers frontline HCWs, we may increase the feasibility and impact of burnout reduction interventions. Specific Aims: In this CDA, I aim to: Aim 1: Understand facility- and clinic-level drivers of burnout in VA primary care; Aim 2: Develop burnout reduction interventions using an EBQI approach; and Aim 3: Evaluate feasibility, acceptability, and effectiveness of the pilot EBQI-facilitated burnout reduction interventions. Methodology: For Aim 1, I will measure burnout and identify burnout drivers using surveys and interviews, which will serve as the foundation for stakeholder-engaged priority setting processes using EBQI to design locally-tailored evidence-based burnout reduction interventions. Aim 2 will involve integrating the key drivers of burnout and intervention activities identified in Aim 1, and developing EBQI-facilitated burnout interventions (using stakeholder panels, quality improvement training, formative feedback, and practice facilitation). Aim 3 will entail evaluation of the feasibility, acceptability, and effectiveness of the EBQI-facilitated burnout interventions in a pilot stepped wedge design among five VA medical centers and community-based outpatient clinics in VISN 22. During Aim 3, I will also use interviews to identify intervention barriers and facilitators. Next Steps / Implementation: In Years 3 and 5 of this CDA, respectively, I will prepare and submit IIRs to conduct a national organizational survey to identify and study the impact of burnout drivers in VA primary care, and a larger multi-site cluster randomized controlled trial to fully evaluate the effectiveness and impacts of EBQI-facilitated burnout reduction. Findings will also be shared with national and local stakeholders to inform future implementation.