Beyond Clinician Well-Being

BACKGROUND: Most care for persons with dementia is provided in primary care practices, yet high rates of burnout and job dissatisfaction may challenge the delivery of high-quality care. The complexity of dementia care may further contribute to clinician strain. Nurse practitioners increasingly deliver primary care to persons with dementia, yet little is known about whether their job outcomes (satisfaction and burnout) impact acute care utilization (emergency department visits and hospitalizations) for persons with dementia. OBJECTIVES: This study examined the association between primary care nurse practitioner job outcomes and acute care utilization among persons with dementia. METHODS: This was a national cross-sectional study linking survey data from 847 primary care nurse practitioners to Medicare claims for 74,157 persons with dementia. Burnout and job satisfaction were measured using single items. Risk Ratios [RR], calculated from multivariable Cox proportional hazards models with time as a constant, estimated associations between nurse practitioner job outcomes and acute care utilization. RESULTS: Most nurse practitioners (92%) reported job satisfaction; 30% reported some burnout, and 8% reported high burnout. Job satisfaction was associated with lower risk of emergency department visits (RR=0.91; 95% CI: 0.85-0.97) and hospitalizations (RR=0.92; 95% CI: 0.86-0.99). High burnout was associated with a higher risk of emergency department visits (RR=1.09; 95% CI: 1.01-1.17) and hospitalizations (RR=1.08; 95% CI: 1.00-1.17). CONCLUSIONS: Nurse practitioner burnout and job satisfaction were independently associated with acute care utilization among persons with dementia. Workforce well-being may be an important factor in delivering high-quality, dementia-capable primary care.