Association between medical home characteristics and staffprofessional experiences in pediatric practices

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 staffare key in implementing and maintaining the necessary changes. A paucity of information on staffexperiences 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 staffworking 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 staffmembers completed the survey and the response rate was 42.6%. Results: Staffmembers 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 staffburnout (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 staffburnout. Conclusions: Staffexperiences in the transition to becoming a PCMH are important. Although our study is cross-sectional, it provides some insight about how medical home, staffand practice characteristics are associated with job satisfaction and burnout. Many PCMH initiatives include facilitation and it should assist staffon how to adapt to change. Unless staffneeds are addressed a PCMH may be threatened by fatigue, burnout, and low morale.