Evidence map›Paper›PMID 25724571›Full record

Trial reportJournal of general internal medicine2015

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study.

Mark Linzer, Sara Poplau, Ellie Grossman, Anita Varkey, Steven Yale, Eric Williams, Lanis Hicks, Roger L Brown, Jill Wallock, Diane Kohnhorst and 1 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 164 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
164citing papers in PubMed, 14 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

164 citing papers in PubMed, 14 syntheses or guidelines pooled it.

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104 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

Mark LinzerDivision of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA, Mark.linzer@hcmed.org.
Sara Poplau
Ellie Grossman
Anita Varkey
Steven Yale
Eric Williams
Lanis Hicks
Roger L Brown
Jill Wallock
Diane Kohnhorst
Michael Barbouche

Funding

Creating Healthy Workplaces: Improving Outcomes for Providers and PatientsR18HS018160 · AHRQ · HENNEPIN HEALTHCARE RESEARCH INSTITUTE · PI LINZER, MARK · 2009 to 2011
$834k
AHRQ HHS 5R18-HS018160-03AHRQ HHS R18 HS018160
6 · The paper itself

Abstract

backgroundWork conditions in primary care are associated with physician burnout and lower quality of care.

objectiveWe aimed to assess if improvements in work conditions improve clinician stress and burnout. SUBJECTS: Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study. STUDY

designThis was a cluster randomized controlled trial. MEASURES: Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12-18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites.

interventionsDiverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects. ANALYSIS: Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement.

resultsOf 166 clinicians, 135 (81.3%) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8% vs 7.1% less burned out, p = 0.01) and satisfaction (23.1% vs 10.0% more satisfied, p = 0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9, p = 0.02], and with targeted QI projects than in controls (OR 4.8, p = 0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1, p = 0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2, p = 0.06). LIMITATIONS: We used heterogeneous intervention types, and were uncertain how well interventions were instituted.

conclusionsOrganizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.

Indexed as

CommunicationPhysicians, Primary CareQuality ImprovementWorkflowAdultBurnout, ProfessionalCluster AnalysisFemaleHumansInterprofessional RelationsJob SatisfactionMaleMiddle AgedQuality of LifeStress, PsychologicalWorkplace

Identifiers

PMID25724571
PMCPMC4510236

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.