Clinical trial NCT02146326: The Impact of Burnout on Patient-Centered Care: A Comparative Effectiveness Trial in Mental Health
Official title: The Impact of Burnout on Patient-Centered Care: A Comparative Effectiveness Trial in Mental Health
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Burnout
Quality of Care
Lead sponsor: Indiana University
Sponsor class: OTHER
Collaborators: name: Four County Counseling Center
name: Places for People
name: Patient-Centered Outcomes Research Institute
First posted: 2014-05-23
Enrollment: 679
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Healthcare providers play an important role in helping patients be actively involved in treatment and recover from mental illness. But mental health clinicians, like other healthcare providers, are at risk for experiencing burnout-feeling emotionally drained from their work, having cynical thoughts toward patients and others, and feeling little accomplishment in their work. Burnout can lead to problems for the clinician including poor overall health, depression, and lower job satisfaction. Burnout also can impact how clinicians perform on the job; for example, people with high levels of burnout take more time off, show lower commitment to their job, and are more likely to quit or be fired. There is some evidence that burnout can affect the quality of care for patients, but very little rigorous research has tested this assumption. The purpose of our study is threefold. First, we will investigate how patients perceive burnout in clinicians and whether (and/or how) burnout impacts the care they receive. Next, we will test an intervention to reduce clinician burnout called Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE). BREATHE brings together tools that mental health clinicians are already familiar with, including relaxation and mindfulness exercises, setting boundaries, using social supports, and changing negative thought patterns and replacing them with more helpful ways of thinking. We have found this intervention effective in reducing burnout in other organizations, but have yet to study whether it also can improve patient outcomes. Clinicians (approximately 200) who participate will receive either the BREATHE intervention or training in motivational interviewing, which could also improve patient involvement in treatment and patient outcomes, but is unlikely to significantly reduce clinician burnout. We will also recruit up to 600 adult patients served by participating clinicians. We will survey clinicians and interview patients over a 12-month period after the intervention to determine how the intervention impacts clinician burnout and patient perceptions of care (relationship with the clinician, degree of autonomy in decision making), patient involvement in care, and outcomes (confidence in managing mental health, symptoms, functioning, and hope). Finally, this study will use a statistical procedure called Structural Equation Modeling to test a theoretical model of the relationship between burnout and patient outcomes. Findings from this study will show whether reducing clinician burnout can improve patient outcomes and the quality of care that patients receive. Our intervention will have the potential to be easily implemented in a variety of settings where burnout is a problem. Knowing how clinician burnout impacts patient outcomes, and whether improving burnout can improve patient care, can help improve the healthcare system.


Eligibility criteria: Inclusion Criteria:

* A staff member with client contact at either Four County Counseling or Places for People.
* Randomly chosen client from the participating staff lists. Must be 18 years old or older.

Exclusion Criteria:

* Clients younger than 18 years old.

Primary outcomes:
measure: Maslach Burnout Inventory (MBI): Emotional Exhaustion
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Maslach Burnout Inventory (MBI): Depersonalization
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Maslach Burnout Inventory (MBI): Personal Accomplishment
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Secondary outcomes:
measure: Job Satisfaction
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Turnover Intentions-Considered Leaving
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Turnover Intentions-Likely to Leave
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Work Interference With Home Life
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Home Life Interference With Work
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Emotional Labor Scale: Surface Acting
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Emotional Labor Scale: Deep Acting
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Emotional Labor Scale: Genuine Emotions
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Importance: Reduce Work-Related Stress
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Confidence: Reduce Work-Related Stress
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Importance: Client Interaction
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Confidence: Client Interaction
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Quality of Care: Person Centered Care
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Quality of Care: Discordant Care
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Quality of Care-Total
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Perceptions of Supervisory Support
timeFrame: Measured with staff at baseline, 3 months, 6 months, and 12 months
measure: Staff Turnover
timeFrame: Measured with staff at 12 months
measure: Adult State Hope Scale
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Health-Care Climate Questionnaire
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Working Alliance Inventory (WAI)
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Working Alliance Inventory (WAI) - Tasks Subscale
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Working Alliance Inventory (WAI) - Goals Subscale
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Working Alliance Inventory (WAI) - Bonds Subscale
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Short-Form Health Survey (SF-12)-Physical Health Functioning
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Short-Form Health Survey (SF-12)-Mental Health Functioning
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Patient Health Questionnaire 9-item (PHQ-9)
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Generalized Anxiety Disorder (GAD-7)
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Client Satisfaction Questionnaire
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Quality of Care-Person Centered Care
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Quality of Care-Negative Interactions
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Quality of Care-Inattentive Care
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Quality of Care Total
timeFrame: Measured with clients at baseline, 6 months, and 12 months
measure: Patient Engagement-Missed Appointments
timeFrame: Measured with clients at baseline, 6 months, and 12 months
Other outcomes:
Locations:
city: Logansport
country: United States
facility: Four County Counseling Center
state: Indiana
city: St. Louis
country: United States
facility: Places for People
state: Missouri
Study officials:
affiliation: Indiana University School of Medicine
name: Michelle P Salyers, PhD
role: PRINCIPAL_INVESTIGATOR
References: