Variance in Clinical Reminder volume across Veteran Health Administration facilities and association with primary care burnout: a cross-sectional study (Preprint)

BACKGROUND Clinical decision support tools are deployed to help clinicians follow guideline-based care however, there is concern that these tools can cause burnout, particularly in primary care. The Veteran Health Administration (VHA) uses clinical reminders (CRs), non-interruptive electronic decision support tools, to improve ambulatory care. Evidence is lacking as to whether the volume of decision support alerts across different institutions is associated with facility-wide changes in burnout. OBJECTIVE The primary objective is to compare patient demographics and facility characteristics between low, medium, and high CR burden facilities. The secondary objective is to study the nationwide association of CR volume with primary care staff burnout at VHA facilities. METHODS A national survey was sent to 134 VHA facilities in 2022 to quantify CR burden at each facility. Staff burnout and VHA facility information was obtained from the VHA Corporate Data Warehouse. We studied the association of CR burden with primary care staff burnout using multivariable and logistic regression models, controlling for facility characteristics. RESULTS 100% of VHA facilities responded to the survey. There was substantial facility variation in the number of CRs from 5 at the lowest facility to 254 at the highest. There were no significant differences in patient or facility characteristics between low, middle, and high CR facilities. Despite the high variation in CR volume, there was no significant association between the number of facility CRs and primary care staff burnout. CONCLUSIONS We found no association between CR burden and burnout, suggesting that health systems should broaden focus beyond alert volume when addressing clinical staff burnout.