Connecting the Quadruple Aims in Primary Care: Workforce Experience, Clinical Quality, and Patient Experience in Two Learning Health Systems

University Of California, San Francisco, San Francisco CA

Investigators

Linked publications, trials & patents

Abstract

Project Summary/Abstract Primary care clinician burnout is of epidemic proportions in the US. Primary care physicians have among the highest rates of burnout among medical specialties, with more than 60% reporting high levels of burnout. In response to these alarming findings, national health care goals have expanded to include the concept of the ?quadruple aim,? with a proposed fourth aim being sustainability of practice for clinicians and staff. Burnout is a problem in its own right for reasons of concern about the well-being of healthcare workers, but there is also concern that it may adversely impact quality of care and patient experience. Burnout may also destabilize the workforce by causing high rates of job turnover, which is costly to health care organizations. Surprisingly little research has been performed in primary care settings testing these hypotheses, and the research that has been conducted does not provide strong evidence in support of an association between burnout and the other quadruple aim elements. We will use a Learning Health System model of research capitalizing on our longstanding partnership with 2 large health systems to investigate the association between primary care clinician and staff burnout and 1) care quality, 2) patient experience, and 3) workforce turnover. With 5 years of data from annual surveys of primary care clinicians and staff measuring burnout that we will link to administrative data on clinical quality, patient experience, and employee turnover, our data set represents the largest sample of primary care workers (N=997 from most recent survey wave) included in a US study investigating the association of burnout with these outcomes. The specific aims are: 1) To determine whether clinician and staff burnout is associated with quality of preventive and chronic care and patient experience at the individual clinician and clinic level, 2) To determine whether clinician and staff perceptions of teamwork moderate any association between burnout and quality and patient experience, respectively, and 3) To determine whether burnout predicts clinician and staff attrition over a 2-3 year period. To investigate the association between burnout and quality and patient experience, we will use cross-sectional analyses at the clinic level and individual clinician level. To investigate burnout as a predictor of attrition, we will use a longitudinal design at the level of individual clinicians and staff. The study is responsive to AHRQ's SEN NOT- HS-16-011 on innovative primary care research in its focus on ?team-ness,? provider and patient satisfaction, and health outcomes. The study findings will provide a much more rigorous scientific basis for understanding the implications of primary care workforce burnout for national goals of better quality of care, better patient experience, and lower cost. If we do not find an association, this will challenge assumptions that lowering burnout will result in better quality and patient experience and workforce retention. If we do find an association, this will provide some of the strongest observational research evidence to date supporting these relationships.