Table 2.
Study results stratified by outcomea
| Author, Year b | Study Design (Oxford Levels of Evidence) | Sample Size (n) | Population | Intervention (4Ts) | Outcomes |
||
|---|---|---|---|---|---|---|---|
| Burnout c | Satisfaction d | Stress e | |||||
| Agha, 201014 | NR (IV) | 9 | Specialistsf,g,h | Technology | – | ↓* | – |
| Amis, 201817 | Pre-post survey (IV) | 13 | First year residents | Time, Transitions | – | ↑* | – |
| Babbott, 201320 | Prospective (IV) | 422 | IM and FM physicians | Technology | NS | NS | ↑+ |
| Baccei, 202021 | Pre-post survey (IV) | 6 | Radiologists | Time, Teamwork, Transitions | - | ↑* | - |
| Beam, 201722 | Pre-post survey (IV) | 158 | Physicians | Technology | – | NS | – |
| Chapman, 201727 | Cross-sectional (IV) | 886 | PC physicians | Teamwork, Transitions | – | ↑* | – |
| Contratto, 201529 | Pre-post survey (IV) | 9 | PC physicians | Time, Teamwork, Transitions | ↓* | – | – |
| Contratto, 201728 | Quasi-experimental mixed methods (IV) | 7 | IM physicians | Time, Teamwork, Transitions | ↓* | – | – |
| Danila, 201830 | Pre-post survey (IV) | 6 | Specialistsg, h | Teamwork, Transitions | – | NS | – |
| Dunn, 200732 | Prospective study (IV) | 22–32 | Physicians | Time, Teamwork, Transitions | ↓++ | NS | – |
| Ehrlich, 201635 | Pre-post survey (IV) | 25 | Ophthalmologists | Time | – | NS | – |
| Gidwani, 201739 | RCT (IB) | 4 | Physicians | Time, Teamwork, Transitions | – | ↑+++ | – |
| Goyal, 201841 | Prospective cohort (IIB) | 7 | IM physicians (including residents) | Time, Teamwork, Transitions, Technology | – | ↑+++ | – |
| Heaton, 201643 | Systematic review (IIA) | NA | NA | Time, Teamwork | – | ↑* | – |
| Heyworth, 201244 | Pre-post survey (IV) | 163 | PC and specialty | Technology | – | – | ↑+ |
| Hung, 201845 l | Pre-post survey (IV) | 680 | Physicians | Teamwork, Transitions | ↑+++ | ↑+ | ↑+++ |
| Imdieke, 201746 | Quasi-experimental pre-post intervention study (IV) | 2 | IM physicians | Time, Teamwork, Transitions | – | ↑+++ | – |
| Joseph, 201749 | Pre-post survey (IV) | NR | Providers | Time, Transitions Technology | – | ↑* | – |
| Keefer, 201851 | Pre-post survey (IV) | NR | Physicians | Time, Teamwork, Transitions | - | - | ↓* |
| Koshy, 201053 | Static-group comparison study (IV) | 5 | Urologists, residents | Teamwork, Transitions | – | ↑+++ | – |
| Lapointe, 201856 | Pre-post survey (IV) | 25 | IM residents | Time, Transitions, Technology | – | ↑* | ↓* |
| Lee, 201857 | Pre-post survey (IV) | 15 | Neuroradiologists and fellows | Transitions | – | ↑+++ | ↓+++ |
| Linzer, 201559 | Cluster RCT (IIB) | 135 | FM and IM physicians | Teamwork, Transitions | ↓+ | NS | NS |
| Linzer, 201758 | Cluster RCT (IIB) | 165 | FM and IM physicians | Teamwork, Transitions | – | ↑+++ | ↓+++ |
| Mazur, 201962 | Prospective cohort (IIB) | 38 | IM, FM, and specialisti, j, k residents and fellows | Time, Transitions, Technology | - | NS | - |
| McCormick, 201863 | Pre-post survey (IV) | 6 | Urologists | Time, Teamwork, Transitions | – | ↑+ | – |
| Mehta, 201864 | Pre-post survey (IV) | NR | Hospitalists | Time, Teamwork, Transitions, Technology | - | ↑* | - |
| Menachemi, 200965 | Cross-sectional (IV) | 4,203 | PC physicians and clinical specialists | Technology | – | ↑++ | – |
| Michelotti, 201366 | Pre-post survey (IV) | 59 | Faculty ophthalmologists | Technology | - | ↓+++ | - |
| Milenkiewicz, 201767 | Pre-post survey (IV) | NR | Physicians | Time, Technology | – | ↑* | – |
| Mishra, 201870 | Crossover prospective cohort study (IIB) | 18 | PC providers | Time, Teamwork, Transitions | - | ↑* | – |
| Payne, 201875 | RCT (IIB) | 31 | IM residents and attending hospitalists | Technology | - | NS | – |
| Pierce, 201776 | Pre-post survey (IV) | 55 | Physicians and advanced practice clinicians | Teamwork, Transitions | ↓* | – | – |
| Pozdnyakova, 201877 | Prospective, pre-post-pilot study (IV) | 6 | General IM faculty | Teamwork, Transitions, Technology | NS | – | – |
| Shaw, 201783 | Pre-post survey (IV) | NR | Medical doctors | Teamwork, Transitions | – | NS | – |
| Willard-Grace, 201792 | Cross-sectional (IV) | 236 | Clinicians | Time, Teamwork, Transitions | ↓++ | – | – |
| Wylie, 201493 | Cross-sectional (IV) | 2365 | PC providers | Technology | – | ↓+ | – |
Note: The arrows indicate the directionality of the intervention on the effect of burnout, satisfaction, and stress. Improvements are denoted by green color where the associations of the intervention on burnout or proxy measures were statistically significant (see below). Red color indicates the intervention did not improve the burnout or proxy measure (interpreted by a nonsignificant result or P values were not provided) or resulted in detractions whereby the outcome measure worsened with the intervention. White content with dashes indicates no data was reported. Levels of evidence: IB, Individual randomized controlled trial (RCT) (with narrow confidence interval); IIA, Systematic review with homogeneity; IIB, Individual cohort study (including low RCT; eg, < 80% follow-up); IV, Case-series, poor-quality cohort, case-control studies, and systematic review with heterogeneity.
Table adapted from DeChant et al (2019).10
DeChant et al. (2019) was not included in this table as the relevant interventions are already included in the table under the original author names.10
Burnout includes overall burnout, emotional exhaustion, depersonalization, personal accomplishment, and cynicism.
Satisfaction includes outcomes reported as satisfaction, professional fulfillment, well-being, and joy of practice.
Stress includes outcomes reported as stress, psychological strain, and job distress.
Pulmonology, grheumatology, hendocrinology, ipediatrics, jsurgery, or kother specialists.
Hung et al. describe findings of increased engagement, teamwork, and stress suggesting that their work redesign improved physician experiences, but not sufficiently to overcome workflow challenges linked to stress and burnout.
Symbols: + = P < .05; ++ = P < .01; +++ = P < .001; NS = Not significant; * = No P value reported. FM = Family medicine; IM = Internal medicine; NA = Not applicable; NR = Not reported; NS = Not significant; PC = Primary care.