The Relationship Between Clinician Turnover and Client Outcomes in Community Behavioral Health Settings

被引:8
作者
Johnson-Kwochka, Annalee [1 ]
Wu, Wei [1 ,2 ]
Luther, Lauren [1 ,4 ]
Fischer, Melanie W. [1 ]
Salyers, Michelle [1 ,2 ]
Rollins, Angela L. [2 ,3 ]
机构
[1] Indiana Univ Purdue Univ, Dept Psychol, Sch Sci, Indianapolis, IN 46205 USA
[2] ACT Assert Community Treatment Ctr Indiana, Indianapolis, IN USA
[3] Richard L Roudebush Vet Affairs Med Ctr, Ctr Hlth Informat & Commun, 1481 W 10th St, Indianapolis, IN 46202 USA
[4] Massachusetts Gen Hosp, Martinos Ctr Biomed Imaging, Boston, MA 02114 USA
关键词
STAFF TURNOVER; PRIMARY-CARE; PATIENT ACTIVATION; COLLABORATIVE CARE; PROVIDER TURNOVER; DEPRESSION; IMPLEMENTATION; MANAGEMENT; VALIDITY; PROGRAM;
D O I
10.1176/appi.ps.201900169
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective: High clinician turnover in community behavioral health settings can lead to increased costs and can have a negative impact on care quality. Few studies have examined the implications of clinician turnover for client outcomes. This study investigated changes in client outcomes associated with clinician turnover. Methods: The study used prospective observational data collected as part of a larger randomized controlled trial. Clients (N=328) from two community behavioral health centers identified the clinician (N=121) whom they saw most often. Clients completed measures of depression, anxiety, mental and physical health functioning, and patient activation at baseline, 6 months, and 12 months. Clinician turnover during the 12-month study was obtained from agency records. Latent growth curve modeling was used to analyze the data. Results: Of the 328 clients, 24% experienced clinician turnover. For all outcomes except depression, the association with turnover was moderated by baseline status on the outcome measure. Turnover tended to be associated with clinical decline for clients who at baseline had low to moderate anxiety, high patient activation, or high physical health functioning. Surprisingly, turnover was associated with increased mental health functioning for clients who at baseline had very low mental health functioning. For physical health functioning, the association with turnover was also moderated by age. Turnover was associated with a sharper decline in functioning for older clients. Conclusions: Results suggest that clinician turnover was associated most strongly with decline for higher functioning or older clients, but it was not uniformly associated with worsening clinical outcomes.
引用
收藏
页码:28 / 34
页数:7
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