Reducing Burnout among VA PCPs Using Evidence-Based Quality Improvement

背景：职业倦怠是对长期工作场所压力的一种长期心理反应，非常普遍。 在退伍军人初级保健的提供者和工作人员中。医护人员(HCW)职业倦怠不仅有害于 受影响的个人，也包括他们工作的组织。HCW工作倦怠的高比率与 更多的医疗差错、更差的护理质量和更差的患者体验。筋疲力尽的卫生工作者也是有效的 更少的工作时间，更有可能离开他们的组织。减少职业倦怠的组织干预措施有 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。我们建议使用基于证据的质量改进(EBQI)来利用协作领导和 Pact Teamlet投入以开发和试点减少工作倦怠干预措施，根据证据和 在专家的推动下，这是为参与的初级保健诊所的特定需求量身定做的。调查结果来自 这项工作将为在其他退伍军人管理局设施中实施工作倦怠干预提供参考，以适应当地情况 组织上下文。意义/影响：在退伍军人事务部，31%-55%的提供者、护士、临床助理和 以患者为中心的护理团队(PACT)团队中的行政助理一致地报告工作倦怠。强壮 初级保健模式对退伍军人管理局的综合服务系统至关重要。高度倦怠，以及随后的 更替，可能会减少初级保健人员配备、团队功能和契约忠诚度，从而削弱这种优势， 从而损害了退伍军人的接触，并将更多的护理转移到社区。解决初级教师的职业倦怠问题 在它导致更大的下游影响之前的护理对于保护退伍军人的健康和 退伍军人管理局的医疗系统。此外，解决初级保健中的职业倦怠问题符合HSR&D和ORD 初级保健实践和复杂慢性病管理的研究优先事项，并增加 退伍军人事务部研究对现实世界的重大影响。创新：EBQI是一种有效且受到广泛评价的战略 这有助于实施PACT、妇女健康公约、抑郁症合作护理和吸烟 戒烟指南。该战略还减少了在实施PACT期间的提供者和工作人员的倦怠，但 从未与倦怠干预措施一起使用，以优化影响。这一CDA是第一次努力 将EBQI作为一种实施战略与循证的职业倦怠干预相结合，适用于当地 组织上下文。通过EBQI，这是一种多层次的协作方法，为一线卫生工作者提供支持， 我们可能会增加减少职业倦怠干预的可行性和影响。具体目标：在这份CDA中，我 目标1：了解退伍军人初级保健机构和诊所层面的职业倦怠驱动因素；目标2：发展 使用EBQI方法减少工作倦怠的干预措施；目标3：评估可行性、可接受性和 EBQI促进的减少工作倦怠的试点干预的有效性。方法：对于目标1，我将 通过调查和访谈来测量工作倦怠和确定工作倦怠的驱动因素，这将作为基础 对于利益相关者参与的优先设置流程，使用EBQI来设计本地定制的基于证据的流程 减少工作倦怠的干预措施。目标2将涉及整合工作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促进的职业倦怠干预措施(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将需要评估 EBQI促进的职业倦怠干预在试点阶段的可行性、可接受性和有效性 VISN 22的五个退伍军人医疗中心和社区门诊之间的楔形设计。在AIM期间 3、我还将通过访谈来确定干预障碍和促进者。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，旨在确定和研究退伍军人事务部初级保健和更大的多站点集群中职业倦怠驱动因素的影响 全面评估EBQI促进的职业倦怠的有效性和影响的随机对照试验 还原。还将与国家和地方利益攸关方分享调查结果，以便为今后的执行提供信息。

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.