N/A
N=661
The Impact of Burnout on Patient-Centered Care: A Comparative Effectiveness Trial in Mental Health
Burnout · Quality of Care
Bottom Line
View on ClinicalTrials.gov: NCT02146326 ↗Enrolled (actual)
661
Serious AEs
—
Results posted
Apr 2017
Primary outcome: Primary: Maslach Burnout Inventory (MBI): Emotional Exhaustion — 2.3; 2.7; 2.3; 2.7 units on a scale — p=0.80
Study Design & Population
- Study type
- Interventional
- Phase
- N/A
- Interventions
- Motivational Interviewing (MI) (Behavioral); Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE) (Behavioral)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- Indiana University
- Primary completion
- Apr 2016
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Maslach Burnout Inventory (MBI): Emotional Exhaustion |
2.3; 2.7; 2.3; 2.7; 2.5; 2.6 | 0.80 |
| PRIMARY Maslach Burnout Inventory (MBI): Depersonalization |
1.3; 1.5; 1.2; 1.4; 1.3; 1.5 | 0.80 |
| PRIMARY Maslach Burnout Inventory (MBI): Personal Accomplishment |
4.9; 4.9; 4.9; 4.9; 4.9; 4.9 | 0.54 |
| SECONDARY Job Satisfaction |
5.7; 5.2; 5.4; 5.1; 5.3; 4.9 | 0.94 |
| SECONDARY Turnover Intentions-Considered Leaving |
2.0; 2.6; 2.4; 2.6; 2.5; 2.8 | 0.96 |
| SECONDARY Turnover Intentions-Likely to Leave |
1.6; 1.9; 1.8; 2.0; 1.9; 2.2 | 0.17 |
| SECONDARY Work Interference With Home Life |
2.7; 2.9; 2.7; 2.9; 2.7; 2.9 | 0.47 |
| SECONDARY Home Life Interference With Work |
1.9; 1.9; 1.8; 1.9; 1.9; 1.8 | 0.60 |
| SECONDARY Emotional Labor Scale: Surface Acting |
2.1; 2.2; 2.2; 2.3; 2.1; 2.2 | 0.37 |
| SECONDARY Emotional Labor Scale: Deep Acting |
3.4; 3.2; 3.4; 3.1; 3.1; 3.2 | 0.83 |
| SECONDARY Emotional Labor Scale: Genuine Emotions |
4.0; 4.0; 4.1; 4.0; 3.9; 4.0 | 0.64 |
| SECONDARY Importance: Reduce Work-Related Stress |
6.5; 6.4; 6.4; 7.3; 6.5; 7.5 | 0.37 |
| SECONDARY Confidence: Reduce Work-Related Stress |
7.0; 6.0; 6.5; 6.3; 6.6; 5.7 | 0.13 |
| SECONDARY Importance: Client Interaction |
9.4; 9.5; 9.5; 9.3; 9.3; 9.2 | 0.93 |
| SECONDARY Confidence: Client Interaction |
8.5; 8.3; 8.5; 8.1; 8.5; 8.1 | 0.11 |
| SECONDARY Quality of Care: Person Centered Care |
3.7; 3.6; 3.8; 3.7; 3.8; 3.8 | 0.21 |
| SECONDARY Quality of Care: Discordant Care |
3.8; 3.8; 3.8; 3.8; 3.9; 3.8 | — |
| SECONDARY Quality of Care-Total |
3.8; 3.7; 3.8; 3.7; 3.8; 3.8 | 0.17 |
| SECONDARY Perceptions of Supervisory Support |
4.1; 3.9; 4.0; 3.9; 3.9; 3.8 | 0.24 |
| SECONDARY Staff Turnover |
23; 33; 66; 70 | 0.35 |
| SECONDARY Adult State Hope Scale |
5.78; 5.78; 5.75; 5.85; 5.77; 5.85 | 0.67 |
| SECONDARY Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item |
1.9; 2.0; 1.8; 2.0; 1.6; 1.9 | 0.04 sig |
| SECONDARY Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item |
3.0; 3.3; 2.9; 3.2; 2.8; 3.1 | 0.34 |
| SECONDARY Health-Care Climate Questionnaire |
6.0; 5.9; 5.8; 5.9; 6.0; 5.9 | 0.71 |
| SECONDARY Working Alliance Inventory (WAI) |
5.6; 5.5; 5.4; 5.6; 5.7; 5.6 | 0.22 |
| SECONDARY Working Alliance Inventory (WAI) - Tasks Subscale |
22.0; 21.5; 21.3; 22.2; 22.6; 22.4 | 0.11 |
| SECONDARY Working Alliance Inventory (WAI) - Goals Subscale |
21.8; 21.4; 21.0; 21.8; 22.4; 21.7 | 0.14 |
| SECONDARY Working Alliance Inventory (WAI) - Bonds Subscale |
23.2; 23.0; 22.6; 23.0; 23.3; 22.8 | 0.55 |
| SECONDARY Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale |
62.5; 61.3; 63.6; 62.1; 64.8; 65.2 | 0.91 |
| SECONDARY Short-Form Health Survey (SF-12)-Physical Health Functioning |
41.4; 41.9; 42.3; 41.8; 42.0; 41.7 | 0.48 |
| SECONDARY Short-Form Health Survey (SF-12)-Mental Health Functioning |
42.6; 42.0; 42.7; 43.0; 43.2; 43.4 | 0.67 |
| SECONDARY Patient Health Questionnaire 9-item (PHQ-9) |
9.6; 10.0; 8.8; 9.8; 9.1; 9.4 | 0.77 |
| SECONDARY Generalized Anxiety Disorder (GAD-7) |
9.4; 9.7; 8.5; 8.4; 8.5; 8.8 | 0.59 |
| SECONDARY Client Satisfaction Questionnaire |
3.4; 3.5; 3.4; 3.5; 3.5; 3.5 | 0.64 |
| SECONDARY Quality of Care-Person Centered Care |
3.8; 3.8; 3.7; 3.8; 3.6; 3.9 | 0.05 |
| SECONDARY Quality of Care-Negative Interactions |
4.3; 4.3; 4.8; 4.3; 4.3; 4.4 | 0.06 |
| SECONDARY Quality of Care-Inattentive Care |
4.2; 4.2; 4.3; 4.3; 4.2; 4.3 | 0.84 |
| SECONDARY Quality of Care Total |
4.0; 4.0; 4.0; 4.0; 3.9; 4.1 | 0.14 |
| SECONDARY Patient Engagement-Missed Appointments |
11.96; 11.02; 14.47; 12.20; 14.52; 11.50 | 0.45 |
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.
Data sourced from ClinicalTrials.gov (NCT02146326). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.