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

Archives of Public Health

Caprice Knapp⁴  Shourjo Chakravorty⁴  Vanessa Madden⁴  Jacqueline Baron-Lee⁴  Ruth Gubernick⁶  Steven Kairys²  Cristina Pelaez-Velez⁵  Lee M Sanders³  Lindsay Thompson¹ 

[1] Department of Pediatrics, University of Florida, Gainesville, FL, USA

[2] School of Public Health, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

[3] Center for Health Policy, Stanford University, Stanford, CA, USA

[4] Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA

[5] Department of Pediatrics, University of South Florida, Tampa, FL, USA

[6] RSG Consulting, Cherry Hill, NJ, USA

关键词: Survey;    Staff;    CHIPRA;    Pediatrics;    Medical home;   

Others  :  1083893
DOI  :  10.1186/2049-3258-72-36

 received in 2014-01-24, accepted in 2014-07-01,  发布年份 2014

【 摘 要 】

Background

The 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.

Methods

Eligible 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%.

Results

Staff 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.

Conclusions

Staff 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.

【 授权许可】

   
2014 Knapp et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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