Association between medical home characteristics and staff professional experiences in pediatric practices

Abstract

BackgroundThe patient-centered medical home (PCMH) model has been touted as a potential way to improve primary care. As more PCMH projects are undertaken it is critical to understand professional experiences as staff are key in implementing and maintaining the necessary changes. A paucity of information on staff experiences is available, and our study aims to fill that critical gap in the literature.MethodsEligible pediatric practices were invited to participate in the Florida Pediatric Medical Home Demonstration Project out which 20 practices were selected. Eligibility criteria included a minimum of 100 children with special health care needs and participation in Medicaid, a Medicaid health plan, or Florida KidCare. Survey data were collected from staff working in these 20 pediatric practices across Florida. Ware’s seven-point scale assessed satisfaction and burnout was measured using the six-point Maslach scale. The Medical Home Index measured the practice’s medical home characteristics. Descriptive and multivariate analyses were conducted. In total, 170 staff members completed the survey and the response rate was 42.6%.ResultsStaff members reported high job satisfaction (mean 5.54; SD 1.26) and average burnout. Multivariate analyses suggest that care coordination is positively associated (b = 0.75) and community outreach is negatively associated (b = -0.18) with job satisfaction. Quality improvement and organizational capacity are positively associated with increased staff burnout (OR = 1.37, 5.89, respectively). Chronic condition and data management are associated with lower burnout (OR = 0.05 and 0.20, respectively). Across all models adaptive reserve, or the ability to make and sustain change, is associated with higher job satisfaction and lower staff burnout.ConclusionsStaff experiences in the transition to becoming a PCMH are important. Although our study is cross-sectional, it provides some insight about how medical home, staff and practice characteristics are associated with job satisfaction and burnout. Many PCMH initiatives include facilitation and it should assist staff on how to adapt to change. Unless staff needs are addressed a PCMH may be threatened by fatigue, burnout, and low morale.Electronic supplementary materialThe online version of this article (doi:10.1186/2049-3258-72-36) contains supplementary material, which is available to authorized users.

Development and Testing of the Provider and Staff Perceptions of Integrated Care (PSPIC) Survey

“…Several studies have documented the demands and challenges that providers and staff encounter while working in new models of primary care, which pursue ambitious goals to deliver timely, high-quality, well-coordinated, patient-centered care. However, these transitions in primary care have also illustrated the importance of addressing provider and staff needs given that care delivery changes can result in burnout, low job satisfaction, and low morale (Knapp et al, 2014; Lewis et al, 2012; Quinn et al, 2013). Interventions to change workflow and to implement targeted quality improvement projects that address clinicians’ concerns have shown promise for decreasing burnout, while interventions to improve communication among clinicians and staff have shown promise in improving clinician satisfaction (Linzer et al, 2015).…”