Long-term impact of evidence-based quality improvement for facilitating medical home implementation on primary care health professional morale

Lisa S Meredith,Benjamin Batorsky,Elizabeth M Yano,Matthew Cefalu,Jill E Darling,Susan E Stockdale,Lisa V Rubenstein

doi:10.1186/s12875-018-0824-4

Abstract

BackgroundPoor morale among primary care providers (PCPs) and staff can undermine the success of patient-centered care models such as the patient-centered medical home that rely on highly coordinated inter-professional care teams. Medical home literature hypothesizes that participation in quality improvement can ease medical home transformation. No studies, however, have assessed the impact of quality improvement participation on morale (e.g., burnout or dissatisfaction) during transformation. The objective of this study is to examine whether primary care practices participating in evidence-based quality improvement (EBQI) during medical home transformation reduced burnout and increased satisfaction over time compared to non-participating practices.MethodsWe used a longitudinal quasi-experimental design to examine the impact of EBQI (vs. no EBQI), a multi-level, interdisciplinary approach for engaging frontline primary care practices in developing evidence-based improvement innovations and tools for spread on PCP and staff morale following the 2010 national implementation of the medical home model in the Veterans Health Administration. The sample included 356 primary care employees (107 primary care providers and 249 staff) from 23 primary care practices (6 intervention and 17 comparison) within one Veterans Health Administration region. Three intervention practices began EBQI in 2011 (early) and three more began EBQI in 2012 (late). Three waves of surveys were administered across 42 months beginning in November 2011 and ending in January 2016 approximately 2 years 18 months apart. We used repeated measures analysis of the survey data on medical home teams. Main outcome measures were the emotional exhaustion subscale from the Maslach Burnout Inventory, and job satisfaction.ResultsSix of 26 approved EBQI innovations directly addressed provider and staff morale; all 26 addressed medical home implementation challenges. Survey rates were 63% for baseline and 48% for both follow-up waves. Age was associated with lower burnout among PCPs (p = .039) and male PCPs had higher satisfaction (p = .037). Controlling for practice and PCP/staff characteristics, burnout increased by 5 points for PCPs in comparison practices (p = .024) and decreased by 1.4 points for early and 6.8 points (p = .039) for the late EBQI practices.ConclusionsEngaging PCPs and staff in EBQI reduced burnout over time during medical home transformation.

Highlights

Poor morale among primary care providers (PCPs) and staff can undermine the success of patientcentered care models such as the patient-centered medical home that rely on highly coordinated inter-professional care teams
We assess evidence-based quality improvement (EBQI) outcomes based on PCP and staff Emotional exhaustion (EE) and job satisfaction; we refer to these two concepts as indicators of PCP and staff morale
We addressed two questions: (1) Was transformation to the patient-centered medical home model associated with improved primary care practice morale over time? (2) Did engagement in EBQI improve morale among primary care practice’s providers and staff?

Summary

Introduction

Poor morale among primary care providers (PCPs) and staff can undermine the success of patientcentered care models such as the patient-centered medical home that rely on highly coordinated inter-professional care teams. No studies have assessed the impact of quality improvement participation on morale (e.g., burnout or dissatisfaction) during transformation. The objective of this study is to examine whether primary care practices participating in evidence-based quality improvement (EBQI) during medical home transformation reduced burnout and increased satisfaction over time compared to non-participating practices. In the work presented here, we test an approach, termed evidence-based quality improvement (EBQI), for accelerating change and maintaining morale in six engaged primary care sites during large scale implementation of a new team-based, patient centered primary care model (the patient centered medical home). We assess EBQI outcomes based on PCP and staff EE and job satisfaction; we refer to these two concepts as indicators of PCP and staff morale

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