番茄社区

SAN DIEGO -- Practicing in a team-based delivery model did not improve burnout rates for physicians after a year, a small study found.

Doctors who meet the criteria of "burned out" were higher (35%) for physicians a year after practicing in a team model compared with those practicing a more traditional model (30%, P=0.331), William Spinelli, MD, MPA, and colleagues reported here at the American Academy of Family Physicians Scientific Assembly.

Burnout rates were lower for clinical assistants and other office staff in a team model -- although those results weren't statistically significant, Spinelli, of Allina Health in Minneapolis, told 番茄社区 during a poster presentation.

Clinician and staff burnout is an increasing problem in medicine, the researchers said, yet few data exist about the impact of team-based delivery on burnout rates.

Researchers therefore examined eight community, primary care clinics that were part of a large Midwestern integrated delivery system. Of those eight clinics, four were implementing "Team Care", defined as moving from a 1-to-1 physician-to-clinical-assistant ratio to a 2-to-3 physician-to-assistant ratio.

Spinelli and colleagues surveyed the 96 providers, who were almost equally divided between the four clinics moving to team-based care and the four remaining the same. Surveys were given at 3, 6, and 12 months. Response rate was 42%.

Burnout was based on the Maslach Burnout Inventory, which measures emotional exhaustion, cynicism, and the amount of diminished sense of self-efficacy.

"We can't say that there's a [statistically significant difference] in the burnout rate between the two models we studied," Spinelli told 番茄社区.

The data show lower burnout rates for providers in the team-based model after 3 and 6 months, but that trend was reversed after 12 months. Spinelli was unsure why.

However, burnout rates were lower for clinical assistants and other office staff in the team model after 12 months.

Burnout prevalence was just over 20% for assistants in team care, compared with more than 30% for the control group. Prevalence for assistants in both arms was 24% at the start.

Office staff working in the team model showed a less than 20% burnout rate, compared with greater than 30% in the control group. Burnout prevalence was 28% for both arms at the start.

"Further research should focus on better implementation strategies for practice-based team design efforts with improved time-ordered measurement strategies," the poster said in its discussion section. "In addition, further efforts to clarify the most significant contributing factors to burnout in clinic physicians and staff [are] needed."

Spinelli acknowledged that the study was small, focusing on fewer than 100 physicians and eight clinics. However, the study's sponsor, Allina Health in Minneapolis, is expanding its team-based delivery pilot to 14 clinics, and researchers are collecting burnout data on those.

The researchers hope to publish the data in a medical journal later.

There have been some data collected on physicians working in team-based care. Group Health in Seattle published results in 2010 in Health Affairs and found compared with a control group.

The Dutch have also researched physician burnout extensively, Spinelli said. "What they have found is not too much different from what we expect to find," he said, which is that team-based care may not help physician burnout rates. Instead, burnout is based on how much and what kind of work is being done and how much control physicians have, Spinelli said.

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