RESUMO
BACKGROUND: The Minnesota Hospital Association (MHA) recognized the impact that burnout and disengagement had on the clinician population. A clinician task force developed a conceptual framework, followed by annual surveys and a series of interventions. Features of the job demands-resources model were used as the conceptual underpinning to this analysis. PURPOSE: The aim of this study was to assess the applicability of a clinician-driven conceptual model in understanding burnout and work engagement in the state of Minnesota. METHODOLOGY: Four thousand nine hundred ninety clinicians from 94 MHA member hospitals/systems responded to a 2018 survey using a brief instrument adapted, in part, from previously validated measures. RESULTS: As hypothesized, job demands were strongly related to burnout, whereas resources were most related to work engagement. Variables from the MHA model explained 40% of variability in burnout and 24% of variability in work engagement. Variables related to burnout with the highest beta weights included having sufficient time for work (-0.266), values alignment with leaders (-0.176), and teamwork efficiency (-0.123), all ps < .001. Variables most associated with engagement included values alignment (0.196), feeling appreciated (0.163), and autonomy (0.093), ps < .001. CONCLUSION: Findings support the basic premises of the proposed conceptual model. Remediable work-life conditions, such as having sufficient time to do the job, values alignment with leadership, teamwork efficiency, feeling appreciated, and clinician autonomy, manifested the strongest associations with burnout and work engagement. PRACTICE IMPLICATIONS: Interventions reducing job demands and strengthening resources such as values alignment, teamwork efficiency, and clinician autonomy are seen as having the greatest potential efficacy.
Assuntos
Esgotamento Profissional , Engajamento no Trabalho , Esgotamento Profissional/prevenção & controle , Humanos , Satisfação no Emprego , Minnesota , Inquéritos e Questionários , Carga de TrabalhoRESUMO
BACKGROUND: Patients with serious chronic illnesses face increasingly complex care and are at risk of poor experience due to a fragmented health system. Most current patient experience tools are not designed to address the unique care aspects of this population and the few that exist are delivered too late in the disease trajectory and are not administered longitudinally which makes them less useful across settings. METHODS: We developed a new tool designed to address these gaps. The 25 item scale was tested and refined using randomly cross-validated exploratory and confirmatory factor analyses. Participants were not yet hospice eligible but sick enough to receive benefits of a supportive care approach in the last 2 to 3 years of life. Full information maximum likelihood models were run to confirm the factor structure developed in exploratory analyses. Goodness-of-fit was assessed with the Comparative Fit Index, the Tucker-Lewis Index, and the Root Mean Square Error of Approximation. Test-retest reliability was assessed with the intraclass correlation coefficient and internal consistency of the final scale was examined using Cronbach's alpha. RESULTS: Exploratory factor analysis revealed three domains - Care Team, Communication, and Care Goals - after removing weak loading and cross loading items. The initial three domain measurement model suggested in the development cohort was tested in the validation cohort and exhibited poor fit X 2 (206) = 565.37, p < 0.001; CFI = 0.879; TLI = 0.864; RMSEA = 0.076. After model respecification, including removing one additional item and allowing paths between theoretically plausible error terms, the final 21 item tool exhibited good fit X 2 (173) = 295.63, p < 0.001; CFI = 0.958; TLI = 0.949; RMSEA = 0.048. Cronbach's alpha revealed high reliability of each domain (Care Team = 0.92, Communication = 0.83, Care Goals = 0.77) and the entire scale (α = 0.91). ICC showed adequate test-retest validity (ICC = 0.58; 95% CI: 0.52-0.65) of the full scale. CONCLUSIONS: When administered earlier in the chronic illness trajectory, a new patient experience scale focused on care teams across settings, communication, and care goals, displayed strong reliability and performed well psychometrically. TRIAL REGISTRATIONS: This trial ( NCT01746446 ) was registered at ClinicalTrials.gov on November 27, 2012 (retrospectively registered).
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Demência/terapia , Insuficiência Cardíaca/terapia , Neoplasias/terapia , Satisfação do Paciente , Indicadores de Qualidade em Assistência à Saúde/normas , Idoso , Doença Crônica , Atenção à Saúde/normas , Demência/psicologia , Feminino , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Minnesota , Neoplasias/psicologia , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente/normas , Conforto do Paciente/normas , Relações Profissional-Paciente , Psicometria , Inquéritos e Questionários/normas , WisconsinRESUMO
BACKGROUND: Improving the quality and efficiency of chronic disease care is an important goal. OBJECTIVE: To test whether patients with chronic disease working with lay "care guides" would achieve more evidence-based goals than those receiving usual care. DESIGN: Parallel-group randomized trial, stratified by clinic and conducted from July 2010 to April 2012. Patients were assigned in a 2:1 ratio to a care guide or usual care. Patients, providers, and persons assessing outcomes were not blinded to treatment assignment. (ClinicalTrials.gov: NCT01156974). SETTING: 6 primary care clinics in Minnesota. PATIENTS: Adults with hypertension, diabetes, or heart failure. INTERVENTION: 2135 patients were given disease-specific information about standard care goals and asked to work toward goals for 1 year, with or without the help of a care guide. Care guides were 12 laypersons who received brief training about these diseases and behavior change. MEASUREMENTS: The primary end point for each patient was change in percentage of goals met 1 year after enrollment. RESULTS: The percentage of goals met increased in both the care guide and usual care groups (changes from baseline, 10.0% and 3.9%, respectively). Patients with care guides achieved more goals than usual care patients (82.6% vs. 79.1%; odds ratio, 1.31 [95% CI, 1.16 to 1.47]; P < 0.001); reduced unmet goals by 30.1% compared with 12.6% for usual care patients; and improved more than usual care patients in meeting several individual goals, including not using tobacco. Estimated cost was $286 per patient per year. LIMITATIONS: Providers' usual care may have been influenced by contact with care guides. Last available data in the electronic health record were used to assess end points. CONCLUSION: Adding care guides to the primary care team can improve care for some patients with chronic disease at low cost.
Assuntos
Pessoal Técnico de Saúde , Doença Crônica/terapia , Atenção à Saúde/métodos , Equipe de Assistência ao Paciente , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Idoso , Pessoal Técnico de Saúde/economia , Terapia Comportamental , Doença Crônica/economia , Atenção à Saúde/economia , Diabetes Mellitus/terapia , Feminino , Seguimentos , Objetivos , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Minnesota , Equipe de Assistência ao Paciente/economia , Atenção Primária à Saúde/economia , Adulto JovemRESUMO
While studies have been conducted to assess nurse perception of electronic health records, once electronic health record systems are up and running, there is little to guide the use of features within the electronic health record for nursing practice. Alerts are a promising tool for implementing best practice for patient care in inpatient settings. Yet the use of alerts for inpatient nursing is understudied. This study examined nurse attitudes and reactions to alerts in the inpatient setting. Focus groups were conducted at three hospitals with 50 nurses. Nurses were asked about five different alert features. For each alert, participants were asked about their feelings and reactions to the alert, how alerts help or hinder work, and suggestions for improvements. Findings include clear preferences for alert types and content. Nurses preferred a dashboard style alert with functions included to accomplish tasks directly in the alert. While nurses reported positive reactions to certain alert pages, they also reported low use of those features and occasional distrust of the data included in alerts. Findings provide guidance for future use of alerts and design of new alerts. Findings also identify the important challenge of designing and implementing alerts for integration with nursing workflow.
Assuntos
Atitude do Pessoal de Saúde , Alarmes Clínicos , Registros Eletrônicos de Saúde/instrumentação , Informática em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/psicologia , Adulto , Desenho de Equipamento , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Adulto JovemRESUMO
Quality of life (QOL) for patients with serious illness in late life is important for patients and policy makers and has implications for improved care delivery. This mixed-methods evaluation examined the effectiveness of a new whole-person approach to late life care-the LifeCourse-which provides patients with ongoing, across-setting assistance from lay health care workers, supported by a clinical team. We investigated whether participation in LifeCourse improves QOL for intervention patients, compared with usual care controls. QOL was assessed using baseline and 6 months Functional Assessment of Chronic Illness Therapy-Palliative version tool ( n = 181 patients and 126 controls). LifeCourse had a significant positive effect on overall QOL for patients when compared with controls. Interview data revealed that participants adjusted expectations when assessing QOL and actively sought out ways to maintain QOL with meaningful activities and needed services. LifeCourse offers a promising model for improving QOL for late life patients.
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Múltiplas Afecções Crônicas/terapia , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Minnesota , Satisfação do Paciente , Pesquisa QualitativaRESUMO
Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients' physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient- and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov .
Assuntos
Cuidadores/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Qualidade de Vida , Assistência Terminal/organização & administração , Planejamento Antecipado de Cuidados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Agentes Comunitários de Saúde/organização & administração , Feminino , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Cuidados Paliativos/organização & administração , Satisfação do Paciente , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVE: To examine the prevalence of disordered eating behaviors among sexually active adolescent males by gender and number of sex partners, and examine psychosocial well-being by sex partner factors among boys reporting disordered eating. METHOD: Data were collected from 10,095 9(th) and 12(th) grade Minnesota Student Survey participants who reported sexual intercourse in the past year. RESULTS: The use of any disordered eating behaviors was reported by 39.4% of the sexually active males reporting only female sex partners, 53.4% reporting only male sex partners, and 56.4% reporting both female and male sex partners. Rates of specific disordered eating behaviors were associated with higher numbers of sex partners (male and/or female) and same gender of sex partner, and were highest among those males who reported 3 or more of both genders of sex partners. Among sexually active males reporting disordered eating, poorer emotional well-being and less family connectedness were associated with greater number of partners and with same-sex partners. CONCLUSIONS: Sexually active males, especially those with multiple and/or same-sex partners, may benefit from interventions targeted at reducing disordered eating behaviors. Among sexually active males engaging in disordered eating behaviors, enhancing emotional health and improving family connectedness may be beneficial, especially among those with sex partners of the same gender and/or with multiple sex partners. The identification of specific psychosocial characteristics that are commonly associated with sexually active adolescent males and who exhibit disordered eating behaviors may provide direction toward the development of appropriate early identification, prevention, and treatment efforts.
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Adaptação Psicológica , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Comportamento Sexual , Adolescente , Adulto , Análise de Variância , Estudos Transversais , Relações Familiares , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Minnesota/epidemiologia , Prevalência , Autoimagem , Parceiros SexuaisRESUMO
INTRODUCTION: Family and friends of seriously ill patients are key partners in providing support and health care at home, managing relationships with clinicians, and navigating complex health care systems. Becoming a knowledgeable, confident, and effective caregiver is a developmental process we term 'caregiver activation' and could be facilitated by clinicians equipped with suitable tools. Managing Your Loved One's Health (MYLOH) is a new tool to identify gaps in caregivers' knowledge, skills, and access to clinical and personal support. Created in partnership with caregivers and clinicians, MYLOH items reflect the essential dimensions of caregiving and can be used to tailor caregiver coaching to domains of greatest need. In this study, we extend MYLOH's initial focus on dementia care to caregivers of patients with other chronic life-limiting illnesses. METHODS: MYLOH was completed by primary caregivers (n = 190) of people with a range of advanced chronic illnesses enrolled in the LifeCourse study, an innovative, whole-person approach to health management. Item relevance and responses were compared by group across MYLOH items and domains using z-tests for equality of proportions. RESULTS: All MYLOH items were relevant to caregiving for all types of chronic illness; only 13% of caregivers answered "not my responsibility" to any question. MYLOH identified caregiving struggles across patient diagnosis groups with a few, disease-specific 'hotspots'. Overall, 64% of caregivers scored low in activation on at least one healthcare management task, especially getting enough help with caregiving, managing everyday caregiving tasks, understanding/managing medications, and knowing how to respond to rapid changes in care recipients' health status. No difficulty was unique to a specific type of care recipient illness. CONCLUSIONS: MYLOH has potential as a tool for identifying caregiver coaching and support needs in managing a range of serious chronic illnesses. Caregiving difficulties endorsed by over 20% of caregivers should be core components of chronic illness management programs regardless of disease focus, with disease-specific tailoring as required. MYLOH may be useful in evaluating caregiver interventions and health systems' performance in integrating caregivers into the care management of patients with complex life-limiting illness.
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Cuidadores , Doença Crônica , Tutoria , Avaliação das Necessidades , Idoso , Cuidadores/psicologia , Doença Crônica/terapia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no PacienteRESUMO
BACKGROUND: Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited. OBJECTIVE: To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months. DESIGN: This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations. Robust change-score regression models adjusted for baseline differences and confounding. SETTING/PARTICIPANTS: Patients (113 intervention, 99 comparison in analyses) were individuals with heart failure or other serious chronic illness, cancer, or dementia who had visits to hospitals at a large multipractice health system in the United States Midwest. MEASUREMENTS: Primary outcome was 6-month change in patient experience measured via a novel, validated 21-item patient experience tool developed specifically for this intervention. Covariates included demographics, comorbidity score, and primary diagnosis. RESULTS: At 6 months, LifeCourse was associated with a moderate improvement in overall patient experience versus usual care. Individual domain subscales for care team, communication, and patient goals were not individually significant but trended positively in the direction of effect. CONCLUSION: Person-focused, team-based interventions can improve patient experience with care at a stage fraught with overmedicalization and many care needs. Improvement in patient experience in LifeCourse represents the sum effect of small improvements across different domains/aspects of care such as relationships with and work by the care team.
Assuntos
Múltiplas Afecções Crônicas/terapia , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Satisfação do Paciente , Assistência Centrada no Paciente/organização & administração , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores SocioeconômicosRESUMO
BACKGROUND AND OBJECTIVES: The increased demand on providers from health care systems combined with the complex and difficult practice of medicine contributes to provider stress and burnout. In order to develop effective, sustainable interventions for provider burnout, it is important to understand the lived experiences of providers and their perceptions of its causative factors. We describe focus group findings that explore provider perceptions and offer suggestions for future actions. METHODS: We convened six focus groups in five clinics involving 44 participants and used a common set of questions for each group. Real-time follow-up questions varied as needed to clarify or explore specific themes. We asked for descriptions of providers' daily work, their ability to complete that work, and the frustrations associated with accomplishing their tasks. In addition, providers were asked about transparency of decision making and their perceptions of control in the workplace. RESULTS: Three major themes evolved from these focus groups: the perceived impact of the work environment, work tasks, and "e-stress." CONCLUSIONS: Our findings suggest three competing tensions contribute to provider burnout, none of which were attributable to patient volume or complexity. These tensions were described as originating from clinician experience of management practices and new requirements in the work environment, tension between direct patient care and non-direct patient care work tasks, and "e-stress" caused by the digital presence in providers' work lives.
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Assistência Ambulatorial/psicologia , Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , Médicos/psicologia , Local de Trabalho/organização & administração , Adulto , Registros Eletrônicos de Saúde , Feminino , Grupos Focais , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Percepção , Relações Médico-Paciente , Autonomia Profissional , Profissionalismo , Fatores de Tempo , Carga de Trabalho/psicologia , Local de Trabalho/psicologiaRESUMO
Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout.
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Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Pessoal de Saúde/psicologia , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários/normas , Adulto , Esgotamento Profissional/diagnóstico , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Tempo , Equilíbrio Trabalho-VidaRESUMO
Lay persons ("care guides") without previous clinical experience were hired by a primary care clinic, trained for 2 weeks, and assigned to help 332 patients and their providers manage their diabetes, hypertension, and congestive heart failure. One year later, failure by these patients to meet nationally recommended guidelines was reduced by 28%, P < .001. Improvement was seen in tobacco usage, blood pressure control, pneumonia vaccination, low-density lipoprotein cholesterol levels, annual eye examinations, aspirin use, and microalbuminuria testing. Care guides served an average of 111 patients at an annual per patient cost of $392. Further testing of this model is warranted.
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Doença Crônica/terapia , Agentes Comunitários de Saúde , Comportamento Cooperativo , Equipe de Assistência ao Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Gerenciamento Clínico , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Minnesota , Projetos Piloto , Atenção Primária à Saúde , Papel ProfissionalRESUMO
Awareness of cardiovascular disease and diabetes risk factors can improve the health of individuals and populations. Community-based risk factor screening programs may be particularly useful for quantifying the burden of cardiometabolic risk in a given population, particularly in underserved areas. This study provided a description of a screening platform and how it has been used to monitor the cardiometabolic risk profile within the broader Heart of New Ulm Project, which is based in a rural Minnesota community. A cross-sectional, descriptive examination of baseline screening data indicated that 45% of the target population participated in the program over 8 months. Overall, 13% of the sample reported a personal history of diabetes or cardiovascular disease. Among the subset without active cardiometabolic disease, 35% were found to be at high risk for developing cardiovascular disease or type 2 diabetes over the next 8-10 years. A high prevalence of metabolic syndrome, high low-density lipoprotein cholesterol, obesity, and low fruit/vegetable consumption were of particular concern in this community. This article describes the use of screening results to inform the design of intervention programs that target these risk factors at both the community and individual levels. In addition, design considerations for future community-based cardiometabolic risk factor screening programs are discussed, with a focus on balancing program objectives related to health surveillance, research, and the delivery of preventive health care services.
Assuntos
Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Promoção da Saúde/métodos , Programas de Rastreamento/métodos , Desenvolvimento de Programas/métodos , Medição de Risco/métodos , População Rural/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Serviços de Saúde Comunitária , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Estilo de Vida , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde , Marketing Social , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: The impact of stress in conjunction with lifestyle factors on workplace productivity is understudied, thus the relationship between these variables was examined. METHODS: Negative binomial regression was used to test the cross-sectional association between stress and productivity loss in a sample of 2823 adults. RESULTS: After body mass index adjustment, there was an interaction between stress and physical activity (ß ± SE = 0.002 ± 0.001, P = 0.033). Active participants with low stress had 2% estimated productivity loss, whereas active participants with high stress had more than 11% productivity loss. Other lifestyle factors were not significant. CONCLUSIONS: Higher stress generally predicted greater productivity loss, but this association varied. At low stress, more activity was associated with less productivity loss. At high stress, more activity was associated with more productivity loss, perhaps indicating that individuals cope by exercising more and working less.