Published studies may exaggerate the effect of burnout on quality of patient care

1. Published studies may exaggerate the effect of burnout on quality of patient care

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M19-1152


Editorial:

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M19-2760


URLs go live when the embargo lifts

Published studies have shown an association between burnout among health care professionals and quality of patient care, but those studies may exaggerate the magnitude of the effect. A systematic review is published in

Annals of Internal Medicine

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Previous literature findings associate burnout among health care professionals with poor quality of patient care. However, most studies in this field use retrospective observational designs and apply a wide range of burnout assessments and analytic tools to evaluate myriad outcomes among diverse patient populations. This lack of a standardized approach to measurement and analysis increases the risk of bias of evidence, hampering the ability to decipher which of the apparent clinically significant results represent true effects.

Researchers from Stanford University School of Medicine extended upon previous work in this field by including a comprehensive evaluation for reporting biases in the health care provider burnout literature, encompassing 145 published study populations that quantified the relation between burnout and quality of care over 25 years for 241,553 health care professionals. Quality-of-care measures were grouped into 5 categories: best practices, communication, medical errors, patient outcomes, and quality and safety. The studied relationships between burnout and quality of care were highly heterogeneous. Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor quality of care, 6 indicated burnout related to high quality of care, and 50 showed no significant effect. Excess significance was apparent, with this indicator of potential bias most prominent for the least rigorous quality measures of best practices and quality and safety. According to the researchers, these finding of excess significance imply that the true magnitude may be smaller than reported, and the studies that attempted to lower the risk of bias demonstrate fewer significant associations compared with the full evidence base.

The authors of an accompanying editorial from the University of California, Davis discuss factors that likely contribute to the observed heterogeneity in these studies. They say that variability in methods used to measure burnout and outcomes and the inattention to potential confounders are to blame. They describe the different methods and suggest that the limitations of the available literature, prior reviews, and current meta-analysis, they can conclude that higher burnout is associated with lower quality health care, but the magnitude or clinical significance of the relationship is still not clear.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at

[email protected]

. To speak with the lead author, Daniel S. Tawfik, MD, MS, please contact Mandy Erickson at

[email protected]

or Julie Greicius at

[email protected]

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2. Proposed program says to fight resistance, restrict the development of new antibiotics

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M19-1893


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A new article published in

Annals of Internal Medicine

challenges the well-publicized idea that the antibiotic resistance crisis is worse than ever. The authors say that, in fact, there has been a boom of new antibiotic development due to successful tax-funded incentives already implemented over the past decade to rekindle the antibiotic pipeline. However, many of the new antibiotics in development are redundant with others already on the market and do not address critical unmet needs.

Researchers suggest engaging clinical experts, patient advocates, and representatives from government, industry, and nonprofit organizations to establish a Developing Antibiotics for Resistant Targets (DART) Board. The DART Board would create a list focusing on serious and life-threatening infections caused by pathogens that demonstrate, or are projected to develop, extreme drug resistance (XDR). It would also focus on other important clinical needs, such as oral antibiotics, to preclude the need for prolonged intravenous therapy. The list would be dynamic because the DART Board would remove XDR pathogens as new antibiotics become available to treat them and add new ones as they develop. Other countries could establish similar boards or harmonize with the U.S. DART Board.

According to the authors, the traditional entrepreneurial model of development has provided many effective antibiotics, but at the cost of repeated pipeline collapses despite increasing resistance. The next collapse could be the last, leading to a postantibiotic era. They suggest that their proposed model is a sustainable solution to the unending challenge of antibiotic resistance.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at

[email protected]

. To speak with the lead author, Brad Spellberg, MD, please contact Conception Castro at

[email protected]

.

3. Mortality rates high but on slight decline for antineutrophil cytoplasmic autoantibody-associated vasculitis

Editorial points to possible racial disparity in diagnosis of deadly vasculitides

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http://annals.

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M19-1564


Editorial:

http://annals.

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M19-2755


URLs go live when the embargo lifts

Age-adjusted mortality rates for antineutrophil cytoplasmic autoantibody-associated vasculitides (AAV) declined nearly 2 percent per year in the United States from 1999 to 2017. The three most common underlying-cause-of-death, other than antineutrophil cytoplasmic autoantibody vasculitides were cardiovascular diseases (12%), cancers (6%), and pulmonary disorders (5%). Findings from a brief research report are published in

Annals of Internal Medicine

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Researchers from St. Joseph’s Hospital and National Jewish Health, Denver, studied death certificate data for 1999 to 2017 from the multiple-cause-of-death records from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research Database to describe the age-adjusted AAV mortality trends in the United States across demographic groups and geographic regions. They found that mortality rates were highest among non-Hispanic whites. According to the researchers, the decrease in the overall mortality and mortality among persons aged 65 to 74 years may reflect increased longevity due to improved treatment of AAV and common comorbid conditions. However, AAV outpaced other underlying causes of death, highlighting the importance of continuing efforts to increase clinical awareness and research for development of better targeted therapies for AAV.

According to the author of an accompanying editorial from Creighton University, Omaha, Nebraska, differences in mortality rates between whites and blacks and Hispanics may signify reversed racial/ethnic disparity. The data show neither that the vasculitides actually have lower mortality rates in blacks or Hispanics compared with whites, nor that the diseases are indeed less frequently in blacks and Hispanics. It may just be that these diseases go unnoticed in these populations due to social inequities, social structural violence, and inferior health care access. The authors suggest a greater focus on education and action to address possible diagnostic omissions by race/ethnicity and implementation of quality improvement measures.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at

[email protected]

. To speak with the lead author, Alexander W. Steinberg, and senior author, Evans R. Fernández Pérez, MD, MS, please contact William Allstetter at

[email protected]

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