{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:53:05Z","timestamp":1781707985228,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T00:00:00Z","timestamp":1721174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n We combined EHR active use data capturing physicians\u2019 hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/jamia\/ocae193","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T19:20:59Z","timestamp":1721244059000},"page":"2246-2254","source":"Crossref","is-referenced-by-count":4,"title":["Accounting for taste: preferences mediate the relationship between documentation time and ambulatory physician burnout"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7775-8544","authenticated-orcid":false,"given":"Nate C","family":"Apathy","sequence":"first","affiliation":[{"name":"Health Policy & Management, University of Maryland School of Public Health , College Park, MD 20742, United States"},{"name":"Regenstrief Institute , Indianapolis, IN 46202, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Hartman-Hall","sequence":"additional","affiliation":[{"name":"MedStar Health Center for Wellbeing, MedStar Health , Columbia, MD 21044, United States"},{"name":"Clinical Medicine, Georgetown University School of Medicine , Washington, DC 20007, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberta","family":"Tran","sequence":"additional","affiliation":[{"name":"Institute for Quality and Safety, MedStar Health Research Institute , Columbia, MD 21044, United States"},{"name":"Cecil B. Sheps Center for Health Services Research, University of North Carolina\u2014Chapel Hill , Chapel Hill, NC 27599, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Health Management and Policy, Georgetown University School of Health , Washington, DC 20007, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj M","family":"Ratwani","sequence":"additional","affiliation":[{"name":"National Center for Human Factors in Healthcare, MedStar Health Research Institute , Columbia, MD 21044, United States"},{"name":"Emergency Medicine, Georgetown University School of Medicine , Washington, DC 20007, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Marchalik","sequence":"additional","affiliation":[{"name":"MedStar Health Center for Wellbeing, MedStar Health , Columbia, MD 21044, United States"},{"name":"Urology, Georgetown University School of Medicine , Washington, DC 20007, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,17]]},"reference":[{"key":"2024092007522699200_ocae193-B1","author":"Whang","year":"2022"},{"issue":"8","key":"2024092007522699200_ocae193-B2","doi-asserted-by":"crossref","first-page":"555","DOI":"10.7326\/M19-1152","article-title":"Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis","volume":"171","author":"Tawfik","year":"2019","journal-title":"Ann Intern Med"},{"issue":"10","key":"2024092007522699200_ocae193-B3","doi-asserted-by":"crossref","first-page":"e2128790","DOI":"10.1001\/jamanetworkopen.2021.28790","article-title":"Analysis of electronic health record use and clinical productivity and their association with physician turnover","volume":"4","author":"Melnick","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"2024092007522699200_ocae193-B4","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.3122\/jabfm.2023.230052R2","article-title":"Why do physicians depart their practice? 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