Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study

Abstract

Background: While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety. Design: A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City. Participants: Primary care clinicians and their diabetic and hypertensive patients. Interventions: Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline. Main Measures: We measured work conditions and clinician and patient outcomes both at baseline and 6–12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category. Key Results: There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09). Limitations: Few quality metrics, short time span, fewer clinicians recruited than anticipated. Conclusions: Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care. Clinical trial registration number: ClinicalTrials.gov # NCT02542995.