Stress, Burnout, Compassion Fatigue, and Mental Health in Hospice Workers in Minnesota

Background: Working in hospice care is a highly challenging yet rewarding profession. However, the challenges of working with dying patients and their families can overwhelm even the most highly dedicated professional, leading to burnout, compassion fatigue, anxiety, and depression. Objective: The aim of this study was to better understand how stress affects the mental health of hospice workers in terms of burnout and compassion fatigue and how they cope with these issues. Methods: Data for this study are from Compassion Fatigue and You, a cross-sectional survey of hospice staff from across Minnesota. We surveyed 547 hospice workers throughout Minnesota to better understand the overall mental health of staff, including levels of stress, burnout, and compassion fatigue, and how they cope with these issues. The study was conducted in 2008 and 2009 through a private, not-for-profit research institute affiliated with a large Midwestern health plan. Results: Hospice staff reported high levels of stress, with a small but significant proportion reporting moderate-to-severe symptoms of depression, anxiety, compassion fatigue, and burnout. Staff reported managing their stress through physical activity and social support, and they suggested that more opportunities to connect with coworkers and to exercise could help decrease staff burnout. Conclusions: Poor mental health places staff at risk for burnout and likely contributes to staff leaving hospice care; this is a critical issue as the profession attempts to attract new staff to meet the expanding demands for hospice care

Barriers to Improving Primary Care of Depression: Perspectives of Medical Group Leaders

Using clinical trials, researchers have demonstrated effective methods for treating depression in primary care, but improvements based on these trials are not being implemented. This might be because these improvements require more systematic organizational changes than can be made by individual physicians. We interviewed 82 physicians and administrative leaders of 41 medical groups to learn what is preventing those organizational changes. The identified barriers to improving care included external contextual problems (reimbursement, scarce resources, and access to/communication with specialty mental health), individual attitudes (physician and patient resistance), and internal care process barriers (organizational and condition complexity, difficulty standardizing and measuring care). Although many of these barriers are challenging, we can overcome them by setting clear priorities for change and allocating adequate resources. We must improve primary care of depression if we are to reduce its enormous adverse social and economic impacts

Patient-Centered Outcomes Measurement: Does It Require Information From Patients?

Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR) or health insurance claims. Methods: We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants’ EHR progress notes over the time period between the imaging test and survey completion. We also compared survey data with algorithmically extracted data from claims files for outcomes for which data might be available from that source. Results: Of the 16 outcomes for which patients’ survey responses were considered to be the best information source, only 2 outcomes for back pain and 3 for abdominal pain had kappa scores above a very modest level of ≥ 0.2 for chart audit of EHR data and none for algorithmically obtained EHR/claims data. Of the other 5 outcomes for which claims data were considered to be the best information source, only 2 outcomes from patient surveys and 3 outcomes from chart audits had kappa scores ≥ 0.2. Conclusions: For the types of outcomes studied here, medical record or claims data do not provide an adequate source of information except for a few outcomes where patient reports may be less accurate

Measuring an Organization\u27s Ability to Manage Change: The Change Process Capability Questionnaire and Its Use for Improving Depression Care

Objectives. To describe a new survey tool for assessing medical group capability to improve care and to test the relationship between survey scores and other factors among 41 medical groups. Methods. The 30 factors and strategies that experienced quality improvement leaders ranked as most important for successful implementation were incorporated in a questionnaire. The scores from 41 medical directors on this Change Process Capability Questionnaire (CPCQ) in relation to depression improvement were correlated with organizational factors. Results. On a 5-point response scale, there was high variation on nearly all CPCQ items (standard deviation, 0.59-1.63) and for overall scores for factors and strategies. The total CPCQ score also correlated highly with organizational priority for depression improvement as well as with the presence of overall systems for depression care. Conclusions. This measure appears to distinguish among medical groups and to demonstrate an association with both change priorities and implemented systems for depression

Use of Practice System Tools by Medical Groups for Depression

Objective: To describe the types of practice system tools that medical groups use for depression care, and to compare these with the tools used for care of other chronic conditions. Study Design: Cross-sectional survey. Methods: We surveyed the medical directors of 41 medical groups in Minnesota with sufficient numbers of patients with depression to be included in public reporting of performance measures for depression. The survey asked about the presence of practice systems used for depression and other chronic conditions. Results: The response rate to the survey was 100%. Group sizes ranged from 7 to 2000 physicians and were evenly divided between metropolitan and nonmetropolitan areas. About 60% of the groups were multispecialty. Medical groups were most likely to have information support, decision support, and performance tools (such as a registry, flow sheets or check lists, written standards of care, reminder systems, and performance feedback to physicians) to support management of diabetes (ranging from 65% with a registry to 95% with written standards of care). In general, the fewest of these system tools were in place for management of depression (ranging from 12% with a registry to 58% with written standards of care). One exception was the use of patient self-assessment tools, which was most common for depression (51%). Conclusions: Our findings suggest that a lack of practice system tools may be one element that is hampering improvement in depression care. Further study is needed to demonstrate that implementing and maintaining these changes will improve depression care in diverse medical practices

Smoking and Cessation Behaviors Among Young Adults of Various Educational Backgrounds

Objectives. We sought to determine whether the educational backgrounds of young adult smokers (aged 18 to 24 years) affect their cessation attitudes or behaviors in ways that could be used to improve smoking interventions

Relationship Between the Presence of Practice Systems and the Quality of Care for Depression

A valid measure of practice systems for improving chronic disease care is needed as a guide for both improvement and public accountability. We tested whether a new survey measure of the presence of practice systems (the PPC-R) is associated with performance measure rates for depression among 40 medical groups in Minnesota. These PPC-R scores were compared with standardized medical group measures of antidepressant persistence. Only 54% of potentially important systems were present, and there was high variability. However, there was a positive correlation between systems and quality on the 90-day measure of antidepressant persistence, both overall (r = .33, P = .04) and for the Chronic Care Model domains of decision support (r = .38, P = .02) and delivery system redesign (r = .31, P = .05). Thus, practice systems overall and several domains of the Chronic Care Model appear to be associated with higher quality care for depression. This questionnaire may help practices identify particular systems to improve