Evidence map›Paper›PMID 31590181›Full record

SynthesisAnnals of internal medicine2019

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis.

Daniel S Tawfik, Annette Scheid, Jochen Profit, Tait Shanafelt, Mickey Trockel, Kathryn C Adair, J Bryan Sexton, John P A Ioannidis

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 244 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
244citing papers in PubMed, 9 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

244 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Daniel S TawfikStanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.).
Annette ScheidBrigham and Women's Hospital and Harvard Medical School, llBoston, Massachusetts (A.S.).
Jochen ProfitStanford University School of Medicine, Stanford, California, and California Perinatal Quality Care Collaborative, Palo Alto, California (J.P.).
Tait ShanafeltStanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.).
Mickey TrockelStanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.).
Kathryn C AdairDuke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.).
J Bryan SextonDuke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.).
John P A IoannidisStanford University School of Medicine, Stanford University School of Humanities and Sciences, and Meta-Research Innovation Center at Stanford (METRICS), Stanford, California (J.P.I.).

Funding

The WISER StudyR01HD084679 · NICHD · STANFORD UNIVERSITY · PI PROFIT, JOCHEN, SEXTON, JOHN BRYAN · 2015 to 2018
$2.2M
NICHD NIH HHS R01 HD084679
6 · The paper itself

Abstract

Background: Whether health care provider burnout contributes to lower quality of patient care is unclear. Purpose: To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship. Data Sources: MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019. Study Selection: Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care. Data Extraction: 2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests. Data Synthesis: A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety. Limitation: Studies were primarily observational; neither causality nor directionality could be determined. Conclusion: Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates. Primary Funding Source: Stanford Maternal and Child Health Research Institute.

Indexed as

Quality of Health CareBurnout, ProfessionalHealth PersonnelHumans

Identifiers

PMID31590181
PMCPMC7138707

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.