Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study.
J Gen Intern Med
; 32(1): 56-61, 2017 01.
Article
em En
| MEDLINE
| ID: mdl-27612486
ABSTRACT
BACKGROUND:
While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety.DESIGN:
A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City.PARTICIPANTS:
Primary care clinicians and their diabetic and hypertensive patients.INTERVENTIONS:
Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline. MAINMEASURES:
We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category. KEYRESULTS:
There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09).LIMITATIONS:
Few quality metrics, short time span, fewer clinicians recruited than anticipated.CONCLUSIONS:
Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov # NCT02542995.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Qualidade da Assistência à Saúde
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Local de Trabalho
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Erros Médicos
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Melhoria de Qualidade
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Estados Unidos