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Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.

ABSTRACT: BACKGROUND:Primary care teams face daily time pressures both during patient encounters and outside of appointments. OBJECTIVES:We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure. RESEARCH DESIGN:Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients. SUBJECTS:Patients (n=1291 respondents, 73.5% response rate) with diabetes and/or coronary artery disease established with practice teams (n=353 respondents, 84% response rate) at 16 primary care sites, randomly selected from 2 Accountable Care Organizations. MEASURES AND ANALYSIS:We measured team member perceptions of 2 potentially distinct time pressure constructs: (1) encounter-level, from 7 questions about likelihood that time pressure results in missing patient management opportunities; and (2) practice-level, using practice atmosphere rating from calm to chaotic. The Patient Assessment of Chronic Illness Care (PACIC-11) instrument measured patient-reported experience. Multivariate logistic regression models examined organizational predictors of each time pressure type, and hierarchical models examined time pressure predictors of patient-reported experiences. RESULTS:Encounter-level and practice-level time pressure measures were not correlated, nor predicted by the same organizational variables, supporting the hypothesis of two distinct time pressure constructs. More encounter-level time pressure was most strongly associated with less health information technology capability (odds ratio, 0.33; P<0.01). Greater practice-level time pressure (chaos) was associated with lower PACIC-11 scores (odds ratio, 0.74; P<0.01). CONCLUSIONS:Different organizational factors are associated with each forms of time pressure. Potential consequences for patients are missed opportunities in patient care and inadequate chronic care support.

SUBMITTER: McDonald KM

PROVIDER: S-EPMC6402989 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.

McDonald Kathryn M KM Rodriguez Hector P HP Shortell Stephen M SM

Medical care 20181001 10

<h4>Background</h4>Primary care teams face daily time pressures both during patient encounters and outside of appointments.<h4>Objectives</h4>We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure.<h4>Research design</h4>Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients.<h4>Subjects</h4>Patients (n=1291 respondents, 73.5% response rate) with diabetes and/or ...[more]

PMID: 30130270

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Project description:ObjectiveTo examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures.Data sourcesThis study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices.Study designWe used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects.Principal findingsCompared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( p<.001) measures.ConclusionsPhysicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable.

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Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.

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Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.

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