Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care : Medical Care

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Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care

McDonald, Kathryn M. MM/MBA, PhD*; Rodriguez, Hector P. PhD, MPH; Shortell, Stephen M. MBA, PhD, MPH

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Medical Care 56(10):p 822-830, October 2018. | DOI: 10.1097/MLR.0000000000000974



Primary care teams face daily time pressures both during patient encounters and outside of appointments.


We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure.

Research Design: 

Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients.


Patients (n=1291 respondents, 73.5% response rate) with diabetes and/or coronary artery disease established with practice teams (n=353 respondents, 84% response rate) at 16 primary care sites, randomly selected from 2 Accountable Care Organizations.

Measures and Analysis: 

We measured team member perceptions of 2 potentially distinct time pressure constructs: (1) encounter-level, from 7 questions about likelihood that time pressure results in missing patient management opportunities; and (2) practice-level, using practice atmosphere rating from calm to chaotic. The Patient Assessment of Chronic Illness Care (PACIC-11) instrument measured patient-reported experience. Multivariate logistic regression models examined organizational predictors of each time pressure type, and hierarchical models examined time pressure predictors of patient-reported experiences.


Encounter-level and practice-level time pressure measures were not correlated, nor predicted by the same organizational variables, supporting the hypothesis of two distinct time pressure constructs. More encounter-level time pressure was most strongly associated with less health information technology capability (odds ratio, 0.33; P<0.01). Greater practice-level time pressure (chaos) was associated with lower PACIC-11 scores (odds ratio, 0.74; P<0.01).


Different organizational factors are associated with each forms of time pressure. Potential consequences for patients are missed opportunities in patient care and inadequate chronic care support.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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