Reducing Burnout among VA PCPs Using Evidence-Based Quality Improvement

利用基于证据的质量改进减少 VA PCP 的倦怠

基本信息

批准号：
10642587
负责人：
Eric Andrew Apaydin
金额：
--
依托单位：
VA GREATER LOS ANGELES HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-10-01 至 2028-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10642587
关键词：
Acceleration Address Affect Ambulatory Care Facilities Anxiety Burn injury Caring Chronic Chronic Disease Clinic Clinical Communities Complex Data Depersonalization Disease Management Effectiveness Emotional Employee Evaluation Evidence based practice Feedback Foundations Gender Goals Guidelines Health Health Care Rationing Health Personnel Healthcare Systems Hour Impairment Individual Integrated Delivery Systems Intention Intervention Interview Knowledge Leadership Life Link Los Angeles Magic Measures Medical Care Team Medical Errors Medical center Mental Depression Mentorship Methodology Methods Modeling Morale Nurses Occupations Organizational Change Patients Personal Satisfaction Physicians Prevalence Primary Care Process Productivity Provider Qualitative Evaluations Qualitative Methods Qualitative Research Quality of Care Randomized, Controlled Trials Reporting Research Research Methodology Research Priority Risk Risk Factors Safety Schedule Scientist Service delivery model Signal Transduction Site Stress Surveys Time Training Veterans Woman Women&apos s Health Work Workload Workplace acceptability and feasibility barrier to care burnout care delivery collaborative approach collaborative care design effective intervention effectiveness evaluation empowerment evidence base exhaustion experience flexibility future implementation health care settings impaired productivity implementation science implementation strategy improved innovation member mindfulness-based stress reduction multidisciplinary pilot test post intervention preservation primary care clinic primary care practice primary care provider primary care setting primary care team professional atmosphere psychologic response smoking cessation stressor systematic review therapy design therapy development welfare

项目摘要

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.

背景：倦怠，对慢性工作场所压力的长期心理反应，非常普遍在VA初级保健的提供者和员工中。医疗保健工作者（HCW）倦怠不仅有害受影响的人，也对他们工作的组织。医疗错误增加，护理质量较差以及患者的经历较差。烧毁的HCW也有效小时更少，更有可能离开他们的组织。减少倦怠的组织干预措施是比个人干预更有效，但没有任何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输入以开发和试点测试减少倦怠干预措施，并由证据和由专家促进的，它是根据参与初级保健诊所的特定需求量身定制的。来自这项工作将为在其他VA设施中实施倦怠干预措施的策略提供信息，并适用于当地组织环境。意义/影响：在VA中，31-55％的提供者，护士，临床协会和患者一致的护理团队（PACT）团队中的行政员工始终报告倦怠。强的初级保健模型对于VA的集成交付系统至关重要。高倦怠，随后营业额，可以通过减少初级保健人员，团队功能和协议保真度来侵蚀这种力量，从而损害了退伍军人的访问权限，并将更多的照顾转移到社区。解决初级倦怠在导致更大的下游效果之前，要保持更大 VA医疗保健系统。此外，针对初级保健的倦怠遇到了HSR＆D和ORD 研究初级保健实践和复杂慢性疾病管理的优先事项以及增加 VA研究的实质性实际影响。创新：EBQI是一种有效且良好的策略有助于实施协议，妇女健康协议，抑郁协作和吸烟停止指南。该策略还减少了协议实施期间的提供商和员工倦怠，但从来没有与倦怠干预措施一起使用以优化影响。这个CDA是第一个努力将EBQI与基于证据的倦怠干预措施相结合，以适应本地组织环境。通过EBQI，一种多层次的协作方法，赋予了前线HCW的能力，我们可能会增加减少倦怠干预措施的可行性和影响。具体目的：在此CDA中，我目的是：目标1：了解VA初级保健中倦怠的设施和诊所级别的驱动因素；目标2：发展使用EBQI方法减少干预措施；目标3：评估可行性，可接受性和试点EBQI-核能减少干预措施的有效性。方法论：对于目标1，我会使用调查和访谈来衡量倦怠并识别倦怠驾驶员，这将作为基础用于利益相关者参与的优先设置流程，使用EBQI设计本地批准的循证减少倦怠干预措施。 AIM 2将涉及整合倦怠和干预的关键动力在AIM 1中确定的活动，并开发EBQI-FACIT的倦怠干预措施（使用利益相关者小组，质量改进培训，形成性反馈和实践设施）。 AIM 3将需要评估 EBQI-核能倦怠干预措施的可行性，可接受性和有效性 VIS 22的五个VA医疗中心和基于社区的门诊诊所的楔形设计。在AIM期间 3，我还将使用访谈来确定干预障碍和促进者。下一步 /实施：在本CDA的第3年和第5年中，我将准备并提交IIR进行国家组织调查以识别和研究倦怠驱动程序在VA初级保健中的影响，以及较大的多站点群集随机对照试验，以充分评估EBQI-FACITAIT倦怠的有效性和影响减少。调查结果还将与国家和地方利益相关者共享，以告知未来的实施。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Telework Arrangements and Physician Burnout in the Veterans Health Administration.

DOI：
10.1001/jamanetworkopen.2023.40144
发表时间：
2023-10-02
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Leung, Lucinda B.;Yoo, Caroline K.;Rose, Danielle E.;Jackson, Nicholas J.;Stockdale, Susan E.;Apaydin, Eric A.
通讯作者：
Apaydin, Eric A.