Abstract：
To quantify the association between primary care team workload satisfaction and primary care physician (PCP) turnover and examine potential mediation of workplace climate factors using survey and administrative data.
Longitudinal observational study using data from 2008 to 2016.
The outcome variable was PCP turnover. The main explanatory variable was satisfaction with amount of workload. We included 7 additional workplace climate measures (eg, satisfaction with direct supervision) as mediators. We included characteristics of PCPs (eg, PCP years of experience, gender), salary, and clinic factors (eg, urban vs rural geography, community vs hospital based) as covariates.
US Department of Veterans Affairs (VA) PCPs working at 787 VA primary care clinics nationally were recruited for this study. Over the 9-year study period, 8362 unique PCPs were employed in the VA. The unadjusted mean quarterly turnover rate was 1.83%, and the mean (SD) workload satisfaction score was 3.58 ( 0.24) on a 5-point Likert scale over the study period. In adjusted analysis, a 1-point increase in workload satisfaction was associated with a decrease of 0.73 (95% CI, 0.36-1.10) percentage points in the probability of turnover in a calendar quarter. In the mediation analysis, we found that workload satisfaction impacted turnover through only 1 of the 7 workplace climate measures: satisfaction with direction by senior managers.
Our study findings highlight the key role that achieving primary care workload satisfaction can play in reducing PCP turnover. Identification of direction by senior managers as an underlying mechanism is an important finding for strategic planning to mitigate PCP turnover.
Longitudinal observational study using data from 2008 to 2016.
The outcome variable was PCP turnover. The main explanatory variable was satisfaction with amount of workload. We included 7 additional workplace climate measures (eg, satisfaction with direct supervision) as mediators. We included characteristics of PCPs (eg, PCP years of experience, gender), salary, and clinic factors (eg, urban vs rural geography, community vs hospital based) as covariates.
US Department of Veterans Affairs (VA) PCPs working at 787 VA primary care clinics nationally were recruited for this study. Over the 9-year study period, 8362 unique PCPs were employed in the VA. The unadjusted mean quarterly turnover rate was 1.83%, and the mean (SD) workload satisfaction score was 3.58 ( 0.24) on a 5-point Likert scale over the study period. In adjusted analysis, a 1-point increase in workload satisfaction was associated with a decrease of 0.73 (95% CI, 0.36-1.10) percentage points in the probability of turnover in a calendar quarter. In the mediation analysis, we found that workload satisfaction impacted turnover through only 1 of the 7 workplace climate measures: satisfaction with direction by senior managers.
Our study findings highlight the key role that achieving primary care workload satisfaction can play in reducing PCP turnover. Identification of direction by senior managers as an underlying mechanism is an important finding for strategic planning to mitigate PCP turnover.
摘要：
目的：量化初级护理团队工作量满意度与初级护理医师（PCP）更替之间的关联，并使用调查和管理数据检查工作场所气候因素的潜在中介作用。
方法：使用2008年至2016年的数据进行纵向观察研究。
方法：结果变量为PCP转换。主要解释变量是对工作量的满意度。我们包括了7项额外的工作场所气候措施(例如，对直接监督的满意度)作为调解人。我们包括PCP的特征(例如，PCP多年的经验，性别)，薪水,和临床因素(例如，城市与乡村地理，基于社区和医院)作为协变量。
结果：本研究招募了美国退伍军人事务部（VA）在全国787VA初级保健诊所工作的PCP。在9年的研究期间，在VA中采用8362种独特的PCP。未经调整的平均季度周转率为1.83%，在研究期间,5分Likert量表的平均(SD)工作量满意度得分为3.58(0.24).在调整后的分析中，工作负荷满意度增加1分,一个日历季度的离职概率下降0.73(95%CI,0.36~1.10)个百分点.在调解分析中，我们发现，工作量满意度仅通过7项工作场所氛围措施中的一项来影响离职率：高级管理人员对方向的满意度。
结论：我们的研究结果强调了实现初级护理工作量满意度在减少PCP更替方面的关键作用。确定高级管理人员的指导作为一种潜在机制是战略规划的重要发现，以减轻PCP的离职。
方法：使用2008年至2016年的数据进行纵向观察研究。
方法：结果变量为PCP转换。主要解释变量是对工作量的满意度。我们包括了7项额外的工作场所气候措施(例如，对直接监督的满意度)作为调解人。我们包括PCP的特征(例如，PCP多年的经验，性别)，薪水,和临床因素(例如，城市与乡村地理，基于社区和医院)作为协变量。
结果：本研究招募了美国退伍军人事务部（VA）在全国787VA初级保健诊所工作的PCP。在9年的研究期间，在VA中采用8362种独特的PCP。未经调整的平均季度周转率为1.83%，在研究期间,5分Likert量表的平均(SD)工作量满意度得分为3.58(0.24).在调整后的分析中，工作负荷满意度增加1分,一个日历季度的离职概率下降0.73(95%CI,0.36~1.10)个百分点.在调解分析中，我们发现，工作量满意度仅通过7项工作场所氛围措施中的一项来影响离职率：高级管理人员对方向的满意度。
结论：我们的研究结果强调了实现初级护理工作量满意度在减少PCP更替方面的关键作用。确定高级管理人员的指导作为一种潜在机制是战略规划的重要发现，以减轻PCP的离职。
