title: Association between medical home characteristics and staff professional experiences in pediatric practices.
abstract: 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.
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA.
authors.forename: Caprice
authors.initials: C
authors.lastname: Knapp
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA.
authors.forename: Shourjo
authors.initials: S
authors.lastname: Chakravorty
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Madden
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Baron-Lee
authors.affiliation: RSG Consulting, Cherry Hill, NJ USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Gubernick
authors.affiliation: School of Public Health, University of Medicine and Dentistry of New Jersey, Newark, NJ USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Kairys
authors.affiliation: Department of Pediatrics, University of South Florida, Tampa, FL USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Pelaez-Velez
authors.affiliation: Center for Health Policy, Stanford University, Stanford, CA USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA ; Department of Pediatrics, University of Florida, Gainesville, FL USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Thompson
keywords: CHIPRA; Medical home; Pediatrics; Staff; Survey