Can Using an Intensive Management Program Improve Primary Care Staff Experiences With Caring for High-Risk Patients?

Lisa S Meredith; Gulrez Azhar; Evelyn T Chang; Adeyemi Okunogbe; Alissa Simon; Bing Han; Lisa V Rubenstein

doi:10.12788/fp.0090

Can Using an Intensive Management Program Improve Primary Care Staff Experiences With Caring for High-Risk Patients?

Fed Pract. 2021 Feb;38(2):68-73. doi: 10.12788/fp.0090.

Authors

Lisa S Meredith¹, Gulrez Azhar¹, Evelyn T Chang¹, Adeyemi Okunogbe¹, Alissa Simon¹, Bing Han¹, Lisa V Rubenstein¹

Affiliation

¹ is a Senior Behavioral Scientist at the RAND Corporation, Professor, Pardee RAND Graduate School, and Research Scientist at the VA Center for the Study of Healthcare Innovation, Implementation & Policy in Santa Monica, California. is a Senior Fellow, Futures Health Scenarios at the Institute for Health Metrics and Evaluation, University of Washington and an Adjunct Policy Researcher at RAND. is a Primary Care Physician and Health Services Researcher at VA Greater Los Angeles Health System (VAGLAHS) and an Assistant Clinical Professor in Health Sciences at University of California in Los Angeles (UCLA). is a Health Systems Specialist at RTI International, Washington, DC. is a Health Science Specialist at the VAGLAHS. is a Senior Statistician at the RAND Corporation in Santa Monica, California. is Professor Emeritus at UCLA Geffen School of Medicine and UCLA Fielding School of Public Health, and Physician Policy Researcher at RAND.

Abstract

Background: Complex, high-risk patients present challenges for primary care staff. Intensive outpatient management teams aim to serve as a resource for usual primary care to improve care for high-risk patients without adding burden to the primary care staff. Whether such assistance can influence the primary care staff experiences is unknown. The objective of this study was to examine improvement in job satisfaction and intent to stay for primary care staff at the US Department of Veterans Affairs (VA) who sought assistance from an intensive management program.

Methods: Longitudinal analysis of a staff cohort that completed 2 cross-sectional surveys 18 months apart, controlling for outcomes at time 1. Participants included 144 primary care providers at 5 geographically diverse VA health care systems who completed both surveys. Measured outcomes included job satisfaction and intent to stay within primary care at the VA (measured at time 2). Predictors included likelihood of using intensive management teams (measured at time 1). Covariates included outcomes and professional/practice characteristics (measured at time 1).

Results: The response rate for primary care staff that completed both surveys was 21%. Staff who indicated at time 1 that they were more likely to use intensive management teams for high-risk patients reported significantly higher satisfaction and intention to stay at VA primary care at time 2 (both P < .05).

Conclusions: A VA primary care workforce might benefit from assistance from intensive management teams for high-risk patients. Additional work is needed to understand the mechanisms by which primary care staff benefit and how to optimize them.