Practice Environments and Electronic Health Records Use in Primary Care: Reducing Nurse Practitioner Burnout

初级保健提供者倦怠是一种公共卫生危机，近48%的提供者报告倦怠。提供商 职业倦怠也是对美国的一个威胁。初级保健系统，因为它与穷人 患者、提供者和组织结果。目前，研究人员已经确定了组织（即， 实践环境）和结构预测器（即，电子健康记录（EHR）在基层医疗中的应用 导致医生倦怠的做法。然而，关于这种联系缺乏科学证据， 初级保健实践环境和EHR使用与执业护士（NP）倦怠之间的关系（即，一个 情绪衰竭、人格解体和低个人成就感的内在化感觉）。这是一 问题，因为NPs是美国最大的不断增长的初级保健提供者劳动力，他们增加了 获得医疗保健研究和质量机构（AHRQ）的优先人群，如低 收入和少数群体，包括妇女、儿童、老年人和残疾人以及生活在农村地区的人 和城市社区。此外，初级保健NP正在使用复杂的EHR，并在具有挑战性的环境中工作。 组织策略效率低下，支持和资源有限，无法提供高质量 病人护理由于使用复杂的电子病历和初级保健实践环境差是预测 医生职业倦怠，拟议的二次数据分析旨在确定这是否也是主要的情况 关注NPs本论文将使用2018年两个州1014个NP的横断面调查数据- 2019年初级保健NP研究，这是唯一包含有效和可靠措施的现有数据集， 初级保健NP实践环境，EHR使用和倦怠。提出了以下具体目标。目的 1是描述NP实践环境，EHR使用（即，病人护理的计算机化能力， 决策支持的电子提醒），以及初级保健实践中NP的倦怠。目标二是 调查初级保健NP实践环境（即，NP-医师关系，NP-管理 关系，独立的实践和支持，和专业的知名度）影响倦怠。目标3是检查是否 使用复杂的电子病历有助于在初级保健实践中的NP倦怠。我们假设，穷人中的NP 实践环境和复杂EHR的使用将与NP倦怠相关。主要研究者 将建立多层次的逻辑回归模型和集群NP在他们的做法，以检查是否EHR使用 和实践环境与倦怠有关。调查结果将产生初级保健知识 实践环境，EHR的使用，以及NP的倦怠，这可以为未来的干预措施提供信息，以改善NP， 患者和组织结果。这个R36学位论文奖将提供一个宝贵的机会，为前- 博士生，谁渴望成为一个独立的卫生服务研究人员，以产生证据 需要减少倦怠和改善初级保健服务。最后，本研究符合以下使命： AHRQ提供证据，促进更高质量，可获得，公平和负担得起的医疗保健。

Primary care provider burnout is a public health crisis with nearly 48% of providers reporting burnout. Provider burnout is also a threat to the United States (U.S.) primary care system because it is associated with poor patient, provider, and organizational outcomes. Currently, researchers have identified organizational (i.e., practice environment) and structural predictors (i.e., electronic health record [EHR] use) in primary care practices contributing to physician burnout. Yet, there is a dearth of scientific evidence on the association between primary care practice environment and EHR use with nurse practitioner (NP) burnout (i.e., an internalized feeling of emotional exhaustion, depersonalization, and low personal accomplishment). This is a problem because NPs are the largest growing primary care provider workforce in the U.S., and they increase access to care for Agency for Healthcare Research and Quality (AHRQ) priority populations such as low income and minorities including women, children, the elderly, and individuals with disabilities and living in rural and urban communities. Furthermore, primary care NPs are using complex EHRs and work in challenging environments with inefficient organizational policies and limited support and resources to deliver high quality patient care. Since use of complex EHRs and a poor primary care practice environment are predictors of physician burnout, the proposed secondary data analysis seeks to determine if this is also the case for primary care NPs. This dissertation will use cross-sectional survey data from 1014 NPs across two states in the 2018- 2019 Primary Care NP Study, which is the only existing dataset containing valid and reliable measures of primary care NP practice environment, EHR use, and burnout. The following specific aims are proposed. Aim 1 is to describe the NP practice environment, EHR use (i.e., computerized capabilities for patient care and electronic reminders for decision support), and burnout among NPs in primary care practices. Aim 2 is to investigate whether primary care NP practice environments (i.e., NP-physician relations, NP-administration relations, independent practice and support, and professional visibility) affect burnout. Aim 3 is to examine if use of complex EHRs contributes to NP burnout in primary care practices. We hypothesize that NPs in poor practice environments and use of complex EHRs will be associated with NP burnout. The Principal Investigator will build multi-level logistic regression models and cluster NPs within their practices to examine if EHR use and practice environments are associated with burnout. Findings will generate knowledge on primary care practice environment, EHR use, and burnout in NPs which can inform future interventions to improve NP, patient, and organizational outcomes. This R36 dissertation award will provide a valuable opportunity for a pre- doctoral student, who aspires to become an independent health services researcher, to generate evidence needed to reduce burnout and improve primary care delivery. Lastly, this study is aligned with the mission of the AHRQ to generate evidence that promotes higher quality, accessible, equitable, and affordable healthcare.