New data suggests that the link between provider burnout and poor patient experience and care quality may be exaggerated.
It may be well documented that provider burnout has negative consequences for patient experience and care quality, but has the medical industry been overstating those issues? Perhaps so, according to new data from Stanford University School of Medicine.
Physician burnout runs rampant throughout the medical industry.
Data published in 2019 by the American Academy of Family Physicians (AAFP) revealed that although rates of physician burnout are going down, about 44 percent of family doctors are still reporting at least one symptom of burnout.
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And conventional wisdom has stated that high levels of provider burnout can be bad news for patients. Clinicians who are “checked out,” distracted, stressed, or overburdened cannot make meaningful connections with patients and run the risk of making medical mistakes, experts have long stated.
Data has confirmed these theories, with numerous studies tying physician burnout to lower care quality scores, said the Stanford researchers, led by Daniel S. Tawfik, MD, MS.
“Recent attention has been focused on the relation between health care provider burnout and reduced quality of care, with a growing body of primary literature and systematic reviews reporting associations between burnout and adherence to practice guidelines, communication, medical errors, patient outcomes, and safety metrics,” Tawfik and colleagues wrote.
But this latest data from Stanford calls those studies into question, looking specifically at study methodology and how it may have led to exaggerated connections between physician burnout and patient care quality.
The researchers looked at 145 studies related to physician burnout and patient care quality, segmenting care quality into five key categories including adherence to best practices, provider communication, occurrence of medical errors, patient outcomes, and quality and safety scores.
The researchers observed a total of 114 burnout and quality combinations, with 58 of them tying burnout to poor quality outcomes. Six of the combinations revealed a connection between physician burnout and high-quality care, while 50 of them were neutral, the team found.
However, the researchers also observed a high level of excess significance, meaning the studies yielded results that were shown to be more significant than they actually were.
In total, 73 percent of studies observed had excess significance compared to the 62 percent of studies the researchers predicted would have significant results. In other words, many of the study’s results were exaggerated because of study design, the team said.
“Although the effect sizes in the published literature are modestly strong, our finding of excess significance implies that the true magnitude may be smaller than reported, and the studies that attempted to lower the risk of bias demonstrate fewer significant associations than the full evidence base,” the researchers wrote.
Specifically, the researchers found excess significance in the best practices guidelines and quality and safety assessments.
“Investigations of burnout in relation to these outcomes are typically retrospective studies of routinely collected outcome metrics in existing data sets, without preregistered protocols,” the team explained. “The relative ease of defining and evaluating many outcomes in many ways with these data sets increases the risk for selective outcome and selective analysis reporting, which may have contributed to excess significance.”
Study methodology is the likely culprit for these overstated results.
In a separate editorial about the study, a group of researchers led by Carolyn S. Dewa, MPH, PhD from the University of California Davis outlined the reasons why physician burnout studies may yield excess significance. Specifically, studies used variable burnout measures, clinical quality measures, and study methods, the team said.
Additionally, studies may be confounding work environment factors that may lead to poor quality outcomes. For example, a study may indicate that physician burnout in the emergency department (ED) leads to patient safety errors. However, the study may not account for the high risk for medical errors in the ED that arise separately of physician burnout.
“If providers who were experiencing burnout practiced in high-risk environments and were more likely to answer the questionnaire, the relationship between burnout and medical error would be confounded,” Dewa and her colleagues wrote. “Thus, it is important for future studies, when appropriate, to adjust for potential confounders.”
Compounding of provider groups – physicians versus nurses versus physician assistants, for example – may also skew results.
To be clear, none of these researchers are suggesting that physician burnout does not impact patient experiences and outcomes, nor are they denying that physician burnout is a current industry challenge. However, more data is needed to understand the extent to which burnout impacts patient care.
“Considering the limitations of the available literature, prior reviews, and Tawfik and colleagues’ current meta-analysis, we conclude that higher burnout is associated with lower quality, but we are left without clear answers about of the magnitude or clinical significance of the relationship,” Dewa wrote.
In gaining that understanding, future researchers can better design their studies to more accurately predict the impact of provider burnout on patient care.
Date: October 10, 2019
Source: Patient Engagement Hit