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Tables
Task Task Groupings Gathering patient preventive services history (eg, immunization history) In-person data collection Screening patients for diseases (eg, doing a depression screen) Assessing patient lifestyle factors (eg, diet, smoking cessation) Receiving messages from patients (other than requests for prescriptions) Messaging Resolving messages from patients (other than requests for prescriptions) Responding to prescription refill requests Encouraging lifestyle modifications (eg, diet, smoking cessation) Counseling/education Educating patients about disease-specific self-care activities (eg, foot care in diabetes) Educating patients about medications Evaluating patients and making treatment decisions Decision making Completing forms for patients (eg, disability documentation) Responding to requests for home health care orders Responding to patient diagnostic and treatment data (eg, laboratory tests, radiology studies) Tracking data Following up on referrals (eg, to specialists) - Table 2.
Perceived Task Delegation/Reliance and Prevalence of Burnout among Veterans Affairs Primary Care Providers and Nurse Care Managers
PCPs (n = 721) Nurses (n = 598) Difference P Value Composite task delegation/reliance (15 tasks) 2.97 (0.64) 3.26 (0.50) 0.91 (0.43) <.01 In-visit data collection 3.31 (0.71) 3.40 (0.66) 0.80 (0.63) <.01 Messages 3.47 (0.62) 3.66 (0.56) 0.62 (0.60) <.01 Counseling/education 3.05 (0.82) 3.60 (0.53) 0.85 (0.68) <.01 Decision making 2.53 (0.86) 2.76 (0.85) 1.14 (0.62) <.01 Tracking data 2.48 (1.01) 2.99 (0.91) 1.17 (0.79) <.01 Burnout Dichotomized 48.6 34.8 <.01 5-Level categorization 1 13.0 23.3 2 38.5 42.0 3 29.0 21.5 4 12.5 8.6 5 7.1 4.6 <.01 Appropriate staffing 64.3 66.4 .06 Turnover 54.4 54.9 .60 Minutes spent in huddles, mean (SD) 13.30 (10.90) 14.33 (11.61) .40 Presence of PACT coach 45.3 50.6 .06 Years of VA employment, mean (SD) 8.53 (6.37) 8.61 (6.90) .13 Data are mean (standard deviation) or percentages.
PACT, patient aligned care team; PCP, primary care provider; SD, Standard Deviation; VA, Veterans Affairs.
- Table 3.
Multivariable Regression Examining Association of Reported Staffing, Turnover, Huddle Time, Presence of Patient Aligned Care Team Coach, and Length of Veterans Affairs Employment, with a Composite Task Delegation/Reliance Score
PCPs Nurses β P Value β P Value Appropriate staffing 0.179 <.01 −0.119 .01 Staff turnover −0.123 .02 0.013 .77 Minutes in huddle 0.012 <.01 0.006 <.01 Presence of PACT coach −0.005 .92 −0.026 .55 Years at VA 0.004 .35 0.005 .13 PACT, patient aligned care team; PCP, primary care provider; VA, Veterans Affairs.
- Table 4.
Association of Composite Task Delegation/Reliance and Composite Task Discordance, Along with Staffing, Turnover, Huddle Time, Patient Aligned Care Team Coach, and Length of Veterans Affairs Employment, with Workplace Burnout
PCP Burnout Nurse Burnout OR 95% CI OR 95% CI Composite task delegation/reliance (15 tasks) 0.68 0.49–0.93 1.66 1.13–2.45 Appropriate staffing 0.68 0.46–0.99 0.68 0.46–1.00 Staff turnover 1.74 1.20–2.52 1.42 0.98–2.07 Minutes in huddle 0.98 0.96–1.00 1.00 0.98–1.02 Presence of PACT coach 0.68 0.47–0.98 0.83 0.57–1.19 Years at VA 1.05 1.02–1.08 1.00 0.97–1.03 Composite task discordance (15 tasks) 1.81 1.14–2.88 1.26 0.84–1.91 Appropriate staffing 0.68 0.46–0.99 0.65 0.44–0.95 Turnover 1.83 1.27–2.65 1.42 0.98–2.06 Huddle time 0.98 0.96–0.99 1.00 0.99–1.02 PACT coach present 0.68 0.47–0.98 0.83 0.58–1.19 Years at VA 1.05 1.02–1.08 1.00 0.98–1.03 CI, confidence interval; OR, odds ratio; PACT, patient aligned care team; PCP, primary care provider; VA, Veterans Affairs.
- Appendix Table 1.
Perceived Delegation and Reliance of Individual Tasks for Primary Care Physicians and Nurses
PCPs (n = 721) Nurses (n = 598) P Value Gathering patient preventive services utilization history (eg, immunization history) 3.33 (0.92) 3.30 (0.89) .73 Screening patients for diseases (eg, doing a depression screen) 3.35 (0.90) 3.30 (0.91) .85 Assessing patient lifestyle factors 3.25 (0.84) 3.60 (0.65) <.01 Receiving messages from patients 3.70 (0.60) 3.75 (0.58) .08 Resolving messages from patients (other than requests for prescriptions) 3.49 (0.73) 3.72 (0.62) <.01 Responding to prescription refill requests 3.06 (1.04) 3.51 (0.75) <.01 Encouraging lifestyle modifications 3.17 (0.88) 3.70 (0.56) <.01 Educating patients about disease-specific self-care activities (eg, foot care in diabetes) 3.11 (0.94) 3.63 (0.65) <.01 Educating patients about medications 2.87 (0.97) 3.47 (0.76) <.01 Evaluating patients and making treatment decisions 2.64 (1.02) 2.91 (1.10) <.01 Completing forms for patients 2.20 (1.11) 2.41 (1.11) <.01 Responding to requests for home health care orders 2.67 (1.12) 2.69 (1.14) 0.40 Responding to patient diagnostic and treatment data (eg, laboratory tests, radiology studies) 2.58 (1.10) 3.00 (1.03) <.01 Following-up on referrals (eg, to specialists) 2.49 (1.09) 2.95 (1.02) <.01 PCPs, primary care providers.
- Appendix Table 2.
Association of Task Delegation/Reliance with Burnout, by Task Groupings and Individual Tasks, Adjusting for Other Covariates*
PCP Burnout Nurse Burnout In-visit data collection 0.90 (0.66–1.21) 1.09 (0.83–1.44) Gathering patient preventive services utilization history (eg, immunization history) 1.02 (0.81–1.28) 0.88 (0.72–1.08) Screening patients for diseases (eg, doing a depression screen) 1.04 (0.83–1.31) 0.92 (0.75–1.12) Assessing patient lifestyle factors 0.76 (0.59–0.96) 1.02 (0.77–1.35) Messages 0.75 (0.54–1.04) 0.95 (0.68–1.32) Responding to prescription refill requests 0.75 (0.62–0.91) 1.39 (1.07–1.80) Receiving messages from patients 0.93 (0.67–1.29) 1.46 (1.00–2.13) Resolving messages from patients (other than requests for prescriptions) 1.05 (0.79–1.39) 1.38 (0.99–1.93) Counseling/education 0.70 (0.55–0.90) 0.94 (0.66–1.33) Encouraging lifestyle modifications 0.77 (0.61–0.97) 1.04 (0.76–1.43) Educating patients about disease-specific self-care activities (eg, foot care in diabetes) 0.82 (0.67–1.02) 0.82 (0.62–1.09) Educating patients about medications 0.73 (0.60–0.90) 1.34 (1.03–1.75) Decision making 0.77 (0.61–0.96) 0.91 (0.73–1.13) Evaluating patients and making treatment decisions 0.81 (0.68–0.97) 1.27 (1.06–1.51) Completing forms for patients 0.86 (0.73–1.01) 1.21 (1.03–1.43) Responding to requests for home health care orders 0.94 (0.79–1.11) 1.24 (1.05–1.47) Responding to patient diagnostic and treatment data (eg, laboratory tests, radiology studies) 0.81 (0.68–0.96) 1.20 (1.00–1.44) Tracking data 0.88 (0.73–1.06) 0.94 (0.76–1.15) Tracking patient diagnostic data 0.87 (0.73–1.03) 1.14 (0.95–1.37) Following up on referrals (eg, to specialists) 0.95 (0.80–1.13) 1.45 (1.20–1.76) Data are adjusted odds ratios (95% confidence intervals).
↵* Model also includes appropriate staffing, recent turnover, presence of Patient Aligned Care Team coach, and duration of Veterans Affairs employment.
PCPs, primary care providers.
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