• Samuel T Edwards, Christian D Helfrich, David Grembowski, Elizabeth Hulen, Walter L Clinton, Gordon B Wood, Linda Kim, Danielle E Rose, and Greg Stewart.
• From the Section of General Internal Medicine and the Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR (STE, EH); the Division of General Internal Medicine and Geriatrics and the Department of Family Medicine (STE), Oregon Health & Science University, Portland; the Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, WA (CDH, WLC, GBW); the Department of Health Services, University of Washington School of Public Health, Seattle (CDH, DG); the VA HSR&D Center for Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles Health Care System, Los Angeles, CA (LK, DER); the VISN 23 Patient Aligned Care Team Demonstration Laboratory, Iowa City VA Health Care System, Iowa City, IA (GS); and the Department of Management, University of Iowa, Iowa City (GS). samuel.edwards@va.gov.
• J Am Board Fam Med. 2018 Jan 1; 31 (1): 83-93.

PurposeAppropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown.MethodsWe performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout.ResultsAmong 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5).ConclusionsTask delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses.© Copyright 2018 by the American Board of Family Medicine.

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