# Practice Environments and Electronic Health Records Use in Primary Care: Reducing Nurse Practitioner Burnout

> **NIH AHRQ R36** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $42,319

## Abstract

Primary care provider burnout is a public health crisis with nearly 48% of providers reporting burnout. Provider
burnout is also a threat to the United States (U.S.) primary care system because it is associated with poor
patient, provider, and organizational outcomes. Currently, researchers have identified organizational (i.e.,
practice environment) and structural predictors (i.e., electronic health record [EHR] use) in primary care
practices contributing to physician burnout. Yet, there is a dearth of scientific evidence on the association
between primary care practice environment and EHR use with nurse practitioner (NP) burnout (i.e., an
internalized feeling of emotional exhaustion, depersonalization, and low personal accomplishment). This is a
problem because NPs are the largest growing primary care provider workforce in the U.S., and they increase
access to care for Agency for Healthcare Research and Quality (AHRQ) priority populations such as low
income and minorities including women, children, the elderly, and individuals with disabilities and living in rural
and urban communities. Furthermore, primary care NPs are using complex EHRs and work in challenging
environments with inefficient organizational policies and limited support and resources to deliver high quality
patient care. Since use of complex EHRs and a poor primary care practice environment are predictors of
physician burnout, the proposed secondary data analysis seeks to determine if this is also the case for primary
care NPs. This dissertation will use cross-sectional survey data from 1014 NPs across two states in the 2018-
2019 Primary Care NP Study, which is the only existing dataset containing valid and reliable measures of
primary care NP practice environment, EHR use, and burnout. The following specific aims are proposed. Aim
1 is to describe the NP practice environment, EHR use (i.e., computerized capabilities for patient care and
electronic reminders for decision support), and burnout among NPs in primary care practices. Aim 2 is to
investigate whether primary care NP practice environments (i.e., NP-physician relations, NP-administration
relations, independent practice and support, and professional visibility) affect burnout. Aim 3 is to examine if
use of complex EHRs contributes to NP burnout in primary care practices. We hypothesize that NPs in poor
practice environments and use of complex EHRs will be associated with NP burnout. The Principal Investigator
will build multi-level logistic regression models and cluster NPs within their practices to examine if EHR use
and practice environments are associated with burnout. Findings will generate knowledge on primary care
practice environment, EHR use, and burnout in NPs which can inform future interventions to improve NP,
patient, and organizational outcomes. This R36 dissertation award will provide a valuable opportunity for a pre-
doctoral student, who aspires to become an independent health services researcher, to genera...

## Key facts

- **NIH application ID:** 9922484
- **Project number:** 1R36HS027290-01
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Cilgy Abraham
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $42,319
- **Award type:** 1
- **Project period:** 2020-01-01 → 2020-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9922484

## Citation

> US National Institutes of Health, RePORTER application 9922484, Practice Environments and Electronic Health Records Use in Primary Care: Reducing Nurse Practitioner Burnout (1R36HS027290-01). Retrieved via AI Analytics 2026-05-31 from https://api.ai-analytics.org/grant/nih/9922484. Licensed CC0.

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