Care coordination and provider stress in primary care management of high-risk patients

• Published in: Journal of general internal medicine : JGIM Vol. 33; no. 1; pp. 65 - 71
• Main Authors: Okunogbe, Adeyemi, Meredith, Lisa S., Chang, Evelyn T., Simon, Alissa, Stockdale, Susan E., Rubenstein, Lisa V.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-01-2018; Springer Nature B.V
• Subjects: Adult; Attitude of Health Personnel; Continuity of care; Cost control; Critical components; Expenditures; Female; Health care; Health care facilities; Health Personnel - psychology; Hospitals, Veterans; Humans; Independent variables; Internal Medicine; Intersectoral Collaboration; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Nurses; Occupational Stress - diagnosis; Occupational Stress - epidemiology; Occupational Stress - psychology; Original Research; Patient-Centered Care - methods; Patients; Physicians; Pilot Projects; Primary care; Primary Health Care - methods; Regression analysis; Risk groups; Risk management; Stress; Stresses; Surveys and Questionnaires; High-risk patients; Provider stress; Patient-centered medical home model; Primary care; Care coordination
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-017-4186-8

Background
Care coordination is a critical component of managing high-risk patients, who tend to have complex and multiple medical and psychosocial problems and are typically at high risk for increased hospitalization and incur high health care expenditures. Primary care models such as the patient-centered medical homes (PCMHs) are designed to improve care coordination and reduce care fragmentation. However, little is known about how the burden of care coordination for high-risk patients influences PCMH team members’ stress.
Objective
To evaluate the relationship between provider stress and care coordination time in high-risk patient care and whether availability of help is associated with reduced stress.
Study design
Multivariable regression analysis of a cross-sectional survey of PCMH primary care providers (PCPs) and nurses.
Participants
A total of 164 PCPs and 272 nurses in primary care practices at five geographically diverse Veteran Health Administration (VA) medical center health systems.
Main measures
The main outcome variable was provider stress due to high-risk patient care. Independent variables were the reported proportion of high-risk patients in PCP/nurse patient panels, time spent coordinating care for these patients, and provider satisfaction with help received in caring for them.
Key results
The response rate was 44%. Spending more than 8 h per week coordinating care was significantly associated with a 0.21-point increase in reported provider stress compared to spending 8 h or less per week (95% CI: 0.04–0.39;
p
 = 0.015). The magnitude of the association between stress and care coordination time was diminished when provider satisfaction with help received was included in the model.
Conclusions
Perceived provider stress from care of high-risk patients may arise from challenges related to coordinating their care. Our findings suggest that the perception of receiving help for high-risk patient care may be valuable in reducing provider stress.