Article Figures & Data
Figures
- Figure 1.
Mean proportion of top box ratings for each engagement-burnout phenotype, unadjusted, (n = 151). *Statistically significant difference from other groups (P<.05). Abbreviations: PCP, primary care physician; Rec Clinic, Recommend Clinic.
Tables
Characteristic N (%) Mean ± SD Position Physician (non-resident) 153 (82.3) Nurse practitioner/physician assistant 33 (17.7) Tenure at time of survey Less than 2 years 38 (20.5) 3 to 10 years 78 (42.2) More than 10 years 69 (37.3) Complexity-adjusted panel per clinical FTE 1212 ± 460 Clinical FTE 0.48 ± 0.30 Health system University-based 84 (45.2) County-based 102 (54.8) Work in a residency-teaching clinic 90 (48.4) High burnout* 89 (51.2) Emotional exhaustion (score category)† Overall score 15.2 ± 7.4 Low exhaustion (0 to 10) 49 (26.3) Moderate exhaustion (11 to 15) 53 (28.5) High exhaustion (16 or more) 84 (45.2) Cynicism (score category)† Overall score 7.6 ± 7.1 Low cynicism (0 to 5) 94 (50.5) Moderate cynicism (6 to 10) 40 (21.5) High cynicism (11 or more) 52 (28.0) Engagement: Net Promoter Score (score category)‡ Overall score 7.3 ± 2.3 Detractor (0 to 6) 46 (24.7) Passively satisfied (7 to 8) 77 (41.4) Promoter (9 to 10) 63 (33.9) Burnout-engagement phenotypes Low burnout-low engagement 45 (24.6) Low burnout-high engagement 44 (24.0) High burnout-low engagement 78 (42.6) High burnout-high engagement 16 (8.7) HEDIS patient quality measures: Proportion of patients up-to-date or in control on HEDIS quality measures, mean (S.D.) Cancer screening up to date 71.9% (11.5%) Breast cancer screening up to date 72.4% (14.3%) Cervical cancer screening up to date 73.4% (11.0%) Colorectal cancer screening up to date 69.6% (14.5%) Diabetes under control 79.0% (13.0%) Hypertension under control 72.0% (10.2%) CG-CAPHS patient experience measures: Proportion of top box scores on CG-CAHPS measures, mean (S.D.) PCP communication 86.5% (12.8%) Rating of PCP 74.3% (17.1%) Recommend clinic‡ 80.1% (16.3%) CG-CAHPS, Clinician and Group Survey-Consumer Assessment of Healthcare Providers and Systems; FTE, full-time equivalent; HEDIS, Health care Effectiveness Data and Information Set; MBI, Maslach Burnout Inventory; PCP, primary care physician.
↵* The term “burnout” is defined as reporting either high exhaustion or high cynicism.
↵† The MBI emotional exhaustion and cynicism subscales have a possible range of 1–30, with 30 being the most severe emotional exhaustion or cynicism.
↵‡ The Net Promoter Score refers to the likelihood to recommend clinic as place to work. This score has a possible range of 0–10, with 10 being the most positive rating. Scores are classified as Detractor (0–6), Passively satisfied (7–8), or Promoters (9–10).
SD, standard deviation.
- Table 2.
Results of Multivariate Linear Regression Models for Composite Cancer Screening, Diabetes Control, and Hypertension Control, Adjusted for Covariates and Clustering by Clinic, (n = 171–180)*
Variable β Robust Standard Error 95% CI P value Dependent variable: Composite cancer screening Model 1: High burnout† −0.02 0.02 −0.05–0.02 .37 Model 2: High engagement‡ 0.02 0.02 −0.01–0.06 .21 Model 3: Burnout-engagement phenotypes High burnout-low engagement Reference High burnout-high engagement −0.02 0.02 −0.07–0.02 .27 Low burnout-low engagement −0.01 0.02 −0.06–0.03 .54 Low burnout-high engagement 0.03 0.03 −0.02–0.09 .20 Dependent variable: Diabetes control Model 1: High burnout −0.002 0.02 −0.05–0.05 .94 Model 2: High engagement −0.02 0.02 −0.06–0.02 .36 Model 3: Burnout-engagement phenotypes High burnout-low engagement Reference High burnout-high engagement −0.03 0.03 −0.09–0.03 .32 Low burnout-low engagement 0.004 0.03 −0.06–0.07 .90 Low burnout-high engagement −0.01 0.03 −0.07–0.04 .65 Dependent variable: Hypertension control Model 1: High burnout 0.003 0.01 −0.02–0.03 .85 Model 2: High engagement 0.003 0.02 −0.03–0.03 .86 Model 3: Burnout-engagement phenotypes High burnout-low engagement Reference High burnout-high engagement −0.04 0.02 −0.08–0.01 .13 Low burnout-low engagement −0.03 0.02 −0.08–0.02 .29 Low burnout-high engagement 0.004 0.01 −0.03–0.03 .80 ↵* This table illustrates the results of multivariate linear regression analysis. Three multivariate regression models are represented for each outcome in this table, with results adjusted for covariates and clustering by clinic. Burnout, engagement (likelihood to recommend the clinic), and the phenotypes were tested in separate regression models that included only 1 of these predictors at a time, along with the covariates. Covariates include complexity adjusted panel per clinical full-time equivalent, position (physician vs nurse practitioner), years in the health system, type of health system (county-based vs university-based), and whether working at a residency-teaching practice.
↵† The term “high burnout” is defined as reporting either high exhaustion or high cynicism.
↵‡ The term “high engagement” is defined as a score of 9–10 on the “the likelihood to recommend clinic as place to work.” This item has a possible range of 0–10, which 10 being the most positive rating. This definition is consistent with scoring for the “Net Promoter Score,” which defines a score of 9–10 as being a promoter.
CI, confidence interval.
- Table 3.
Results of Multivariate Linear Regression Models of Burnout and Engagement as Predictors of Patient Experience Scores, Adjusted for Covariates and Clustering by Clinic, (n = 151)*
Variable Adjusted β Robust Standard Error 95% CI P value Dependent variable: Proportion of patient ratings in top box for primary care provider communication Model 1: High burnout† 0.006 0.01 −0.02–0.03 .55 Model 2: High engagement‡ 0.008 0.01 −0.02–0.04 .54 Model 3: Burnout-engagement phenotypes High burnout-low engagement Reference High burnout-high engagement 0.04 0.02 0–0.08 .05 Low burnout-low engagement 0.001 0.02 −0.04–0.04 .95 Low burnout-high engagement −0.002 0.01 −0.03–0.03 .89 Dependent variable: Whether in top quartile of patient overall rating of primary care provider Model 1: High burnout 0.0005 0.01 −0.03–0.03 .97 Model 2: High engagement 0.007 0.03 −0.05–0.07 .81 Model 3: Burnout-engagement phenotypes High burnout-low engagement Reference High burnout-high engagement 0.04 0.02 0.009–0.08 .02 Low burnout-low engagement 0.01 0.03 −0.04–0.07 .62 Low burnout-high engagement −0.0004 0.03 −0.06–0.06 .99 Dependent variable: Proportion of patient ratings in top box for recommendation of clinic Model 1: High burnout −0.003 0.02 −0.04–0.03 .87 Model 2: High engagement 0.008 0.02 −0.03–0.04 .64 Model 3: Burnout-engagement phenotypes High burnout-low engagement Reference High burnout-high engagement 0.05 0.03 0.0002–0.10 .049 Low burnout-low engagement 0.02 0.03 −0.05–0.09 .55 Low burnout-high engagement 0.002 0.02 −0.04–0.04 .90 ↵* This table illustrates the results of multivariate logistic regression analysis. Three multivariate regression models are represented for each outcome in this table, with results adjusted for covariates and clustering by clinic. Burnout, engagement (likelihood to recommend the clinic), and the phenotypes were tested in separate regression models that included only 1 of these predictors at a time, along with the covariates. Covariates include complexity adjusted panel per clinical full-time equivalent, position (physician vs nurse practitioner), years in the health system, type of health system (county-based vs university-based), and whether working at a residency-teaching practice.
↵† The term “high burnout” is defined as reporting either high exhaustion or high cynicism.
↵‡ The term “high engagement” is defined as a score of 9–10 on the “the likelihood to recommend clinic as place to work.” This item has a possible range of 0–10, which 10 being the most positive rating. This definition is consistent with scoring for the “Net Promoter Score,” which defines a score of 9–10 as being a promoter.
CI, confidence interval.
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