Article Figures & Data
Tables
Characteristic All Practicesa Independent Hospital Owned Federally Qualified Health Center Total responding 1,973 690 910 373 Clinicians responding 467 170 239 58 Staff responding 1,506 520 671 315 Outcome Culture of learning, mean score (95% CI)b 3.0 (2.9–3.0) 2.9 (2.8–3.1) 3.0 (2.9–3.1) 2.9 (.2.7–3.0) Work environment, mean score (95% CI)b Enjoyment with work 3.6 (3.5–3.7) 3.5 (3.3–3.6) 3.7 (3.6–3.9)c 3.4 (3.3–3.6) Place of joy and hope 3.5 (3.4–3.6) 3.4 (3.2–3.6) 3.6 (3.5–3.7)c 3.4 (3.2–3.6) Psychological safety, mean score (95% CI)b 3.5 (3.4–3.6) 3.4 (3.2–3.5) 3.7 (3.6–3.9)d 3.2 (3.0–3.3) Burnout scale, mean score (95% CI)b 2.1 (2.00–2.14) 2.2 (2.1–2.3) 2.0 (1.9–2.1)d 2.1 (2.0–2.2) Burnout indicator, mean score (95% CI)e 0.24 (0.21–0.28) 0.28 (0.24–0.34) 0.20 (0.15–0.26) 0.27 (0.22–0.33) Practice No. of clinicians, mean % (95% CI)a 1–5 38.9 (30.9–47.5) 27.5 (17.4–40.6) 49.4 (36.3–62.6) 34.7 (17.9–56.9) 6–10 32.1 (24.0–41.5) 30.6 (18.4–46.2) 30.4 (19.8–43.6) 40.3 (19.2–65.7) ≥11 29.0 (19.2–41.1) 41.9 (25.7,−60.0) 20.2 (8.5–40.9) 24.9 (7.7–56.7) Specialty mix, mean % (95% CI) Single specialty 60.7 (50.4–70.2) 76.6 (58.8–88.3) 62.4 (47.1–75.5) 21.5 (8.8–43.9)f Multispecialty 39.3 (29.8–40.6) 23.4 (11.7–41.2) 37.6 (24.5–52.9) 78.4 (56.1–91.2) Medically underserved area, mean % (95% CI) 69.3 (59.7–77.4) 51.9 (35.6–67.9) 78.0 (67.7–85.7)d 83.0 (53.6–95.3) Patients with Medicare, mean % (95% CI) 28.1 (24.2–32.0) 29.1 (21.6–36.6) 30.9 (25.5–36.3) 18.9 (13.4–24.4)c Patients with Medicaid/uninsured, mean % (95% CI) 24.1 (19.1–29.1) 14.9 (10.0–19.8) 19.6 (14.6–24.7) 56.8 (45.5–68.0)f Total practices, No. 189 61 104 24 Note: P values generated by comparison with independent practices using t tests for differences in means, and χ2 tests of independence for proportions, adjusted for the survey design.
↵a Estimates adjusted for practice-level nonresponse.
↵b Scored on a scale from 1 to 5, where higher scores indicate higher levels; see text for response categories.
↵c P <.05.
↵d P <.01
↵e Scored on an indicator of burnout defined by a rating of 3 or higher.
↵f P <.001.
- Table 2
Association of Practice Ownership With Work Environment, Learning Culture, Psychological Safety, and Burnout, All Survey Respondents
Characteristic Culture of Learninga
β (95% CI)Enjoyment With Worka
β (95% CI)Place of Joy and Hopea
β (95% CI)Psychological Safetya
β (95% CI)Burnouta
β (95% CI)Practice ownership Independent Reference Reference Reference Reference Reference Hospital 0.062 (−0.141 to 0.265) 0.273 (0.014 to 0.533)b 0.194 (−0.057 to 0.446) 0.363 (0.118 to 0.609)c −0.287 (−0.509 to −0.063)b FQHC −0.106 (−0.385 to 0.172) −0.171 (−0.505 to 0.162) −0.191 (−0.536 to 0.155) −0.264 (−0.549 to 0.021) −0.048 (−0.364 to 0.268) Incremental difference between hospital-owned and independent practices by response category Response categorya Difference Difference Difference Difference Difference Level 1 −0.011 −0.017 −0.011 −0.027 0.098 Level 2 −0.012 −0.041 −0.028 −0.054 −0.010 Level 3 −0.001 −0.042 −0.037 −0.055 −0.045 Level 4 0.014 0.039 0.033 0.052 −0.023 Level 5 0.009 0.061 0.043 0.085 −0.020 Total number 1,989 1,988 1,988 1,992 1,984 FQHC = federally qualified health center.
Note: Multivariate ordered probit models adjusted for practice-level nonresponse and clustering at practice level and controlling for ownership (independent, hospital system, or federally qualified health center), whether practice is located in a medical underserved area, practice size, single- or multispecialty practice, percentage of patients with Medicare coverage, and percentage of patients with Medicaid coverage or uninsured.
↵a Scored on a scale from 1 to 5, where higher scores indicate higher levels; see text for response categories.
↵b P <.05.
↵c P <.01.
- Table 3a
Association of Practice Ownership With Work Environment, Learning Culture, Psychological Safety, and Burnout, Clinician Respondents
Characteristic Culture of Learninga
β (95% CI)Enjoyment With Worka
β (95% CI)Place of Joy and Hopea
β (95% CI)Psychological Safetya
β (95% CI)Burnouta
β (95% CI)Practice ownership Independent Reference Reference Reference Reference Reference Hospital −0.131 (−0.409 to 0.146) 0.094 (−0.243 to 0.430) −0.063 (−0.403 to 0.276) 0.100 (−0.242 to 0.443) −0.192 (−0.545 to 0.161) FQHC −0.470 (−0.919 to −0.021)b −0.552 (−0.996 to −0.109)b −0.567 (−1.089 to −0.045)b −0.723 (−1.194 to −0.252)c 0.219 (−0.317 to 0.755) Incremental difference between FQHC and independent practices by response category Response categorya Difference Difference Difference Difference Difference Level 1 0.108 0.033 0.045 0.088 −0.055 Level 2 0.071 0.088 0.081 0.122 −0.021 Level 3 −0.009 0.083 0.089 0.060 0.033 Level 4 −0.109 −0.117 −0.129 −0.153 0.019 Level 5 −0.061 −0.088 −0.086 −0.116 0.024 No. of respondents 467 466 466 467 466 FQHC = federally qualified health center.
Note: Multivariate ordered probit models adjusted for practice-level nonresponse and clustering at the practice level and controlling for ownership (independent, hospital system, or federally qualified health center), whether practice is located in a medical underserved area, practice size, single or multispecialty practice, percentage of patients with Medicare coverage, and percentage of patients with Medicaid coverage or uninsured.
↵a Scored on a scale from 1 to 5, in which higher scores indicate higher levels; see text for response categories.
↵b P < .05.
↵c P < .01.
- Table 3b
Association of Practice Ownership With Work Environment, Learning Culture, Psychological Safety and Burnout, Staff Respondents
Characteristic Culture of Learninga
β (95% CI)Enjoyment With Worka
β (95% CI)Place of Joy and Hopea
β (95% CI)Psychological Safetya
β (95% CI)Burnouta
β (95% CI)Ownership Independent Reference Reference Reference Reference Reference Hospital-owned 0.111 (−0.157 to 0.378) 0.282 (−0.007 to 0.571) 0.275 (−0.012 to 0.562) 0.372 (0.131 to 0.613)b −0.328 (−0.608 to −0.049)c FQHC −0.018 (−0.367 to 0.331) −0.063 (−0.446 to 0.321) −0.085 (−0.443 to 0.274) −0.157 (−0.456 to 0.141) −0.066 (−0.411 to 0.280) Incremental difference between hospital-owned and independent practices by response category Response categorya Difference Difference Difference Difference Difference Level 1 −0.020 −0.020 −0.017 −0.030 0.116 Level 2 −0.044 −0.044 −0.040 −0.056 −0.018 Level 3 −0.041 −0.041 −0.049 −0.057 −0.051 Level 4 0.044 0.044 0.045 0.060 −0.026 Level 5 0.061 0.061 0.062 0.082 −0.021 No. of respondents 1,503 1,503 1,503 1,506 1,472 FQHC = federally qualified health center.
Note: Multivariate ordered probit models adjusted for practice-level nonresponse and clustering at the practice level and controlling for ownership (independent, hospital system, or federally qualified health center), whether practice is located in a medical underserved area, practice size, single or multispecialty practice, percentage of patients with Medicare coverage, and percentage of patients with Medicaid coverage or uninsured.
↵a Scored on a scale from 1 to 5, in which higher scores indicate higher levels; see text for response categories.
↵b P <.01.
↵c P <.05.
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Supplemental Table
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