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- Title
Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study.
- Authors
Linzer, Mark; Poplau, Sara; Brown, Roger; Grossman, Ellie; Varkey, Anita; Yale, Steven; Williams, Eric; Hicks, Lanis; Wallock, Jill; Kohnhorst, Diane; Barbouche, Michael; Williams, Eric S
- Abstract
<bold>Background: </bold>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.<bold>Design: </bold>A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City.<bold>Participants: </bold>Primary care clinicians and their diabetic and hypertensive patients.<bold>Interventions: </bold>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.<bold>Main Measures: </bold>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.<bold>Key Results: </bold>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).<bold>Limitations: </bold>Few quality metrics, short time span, fewer clinicians recruited than anticipated.<bold>Conclusions: </bold>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.<bold>Clinical Trial Registration Number: </bold>ClinicalTrials.gov # NCT02542995.
- Subjects
PSYCHOLOGICAL burnout; PRIMARY care; JOB stress; JOB satisfaction; MEDICAL care; PSYCHOLOGICAL burnout prevention; PREVENTION of medical errors; CLUSTER analysis (Statistics); COMPARATIVE studies; RESEARCH methodology; MEDICAL quality control; MEDICAL cooperation; PRIMARY health care; QUALITY assurance; REGRESSION analysis; RESEARCH; WORK environment; EVALUATION research; RANDOMIZED controlled trials
- Publication
JGIM: Journal of General Internal Medicine, 2017, Vol 32, Issue 1, p56
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-016-3856-2