title: The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members.
abstract: BACKGROUND
  Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.
  
  
  OBJECTIVE
  To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.
  
  
  METHODS
  We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.
  
  
  METHODS
  Primary care personnel at VA clinics responding to a national survey.
  
  
  METHODS
  Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).
  
  
  RESULTS
  There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.
  
  
  CONCLUSIONS
  Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.
authors.affiliation: Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA. christian.helfrich@va.gov.|Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA. christian.helfrich@va.gov.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Helfrich
authors.affiliation: Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Simonetti
authors.affiliation: Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA, USA.
authors.forename: Walter L
authors.initials: WL
authors.lastname: Clinton
authors.affiliation: Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA, USA.
authors.forename: Gordon B
authors.initials: GB
authors.lastname: Wood
authors.affiliation: Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Taylor
authors.affiliation: VA Office of Patient Care Services, Washington, DC, USA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Schectman
authors.affiliation: VA Office of Clinical Operations, Washington, DC, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Stark
authors.affiliation: Center for the Study of Healthcare Innovation, Implementation, & Policy, Greater Los Angeles VA, Sepulveda, CA, USA.|UCLA School of Medicine, Los Angeles, CA, USA.|RAND Corp, Santa Monica, CA, USA.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.|Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA, USA.
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.affiliation: Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.|Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA, USA.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
mesh_terms: D002055:Burnout, Professional / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000523:psychology* / Q000639:trends; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000639:trends*; D010561:Personnel Staffing and Scheduling / Q000639:trends; D058007:Physicians, Primary Care / Q000639:trends; D011320:Primary Health Care / Q000639:trends; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends; D016526:Workload / Q000523:psychology*
keywords: burnout; patient-centered medical home; primary care staffing; primary care workload; team-based care