Appendix A: Cross-tabulation of burnout values for the non-proprietary single-item burnout measure and the single-item Maslach Burnout Inventory Emotional Exhaustion (MBI:EE) measure*

Single MBI:EE item:
I feel burned-out from my work
Never / A few times a year or less / Once a month or less / A few times a month / Once a week / A few times a week / Every day / Total
Non-proprietary single-item burnout measure:
I enjoy my work. I have no symptoms of burnout / 748 / 154 / 34 / 8 / 4 / 5 / 2 / 955
78.3% / 16.1% / 3.6% / 0.8% / 0.4% / 0.5% / 0.2% / 100%
63.1% / 15.2% / 6.5% / 1.2% / 1.0% / 0.6% / 0.3% / 17.7%
Occasionally I am under stress, and I don’t always have as much energy as I once did, but I don’t feel burned out / 427 / 805 / 402 / 412 / 170 / 137 / 16 / 2,369
18.0% / 34.0% / 17.0% / 17.4% / 7.2% / 5.8% / 0.7% / 100%
36.0% / 79.5% / 76.9% / 59.0% / 41.2% / 16.1% / 2.2% / 43.8%
I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion / 9 / 48 / 76 / 238 / 207 / 466 / 189 / 1,233
0.7% / 3.9% / 6.2% / 19.3% / 16.8% / 37.8% / 15.3% / 100%
0.8% / 4.7% / 14.5% / 34.1% / 50.1% / 54.7% / 26.3% / 22.8%
The symptoms of burnout that I’m experiencing won’t go away. I think about frustration at work a lot / 0 / 4 / 11 / 37 / 31 / 194 / 269 / 546
0.0% / 0.7% / 2.0% / 6.8% / 5.7% / 35.5% / 49.3% / 100%
0.0% / 0.4% / 2.1% / 5.3% / 7.5% / 22.8% / 37.4% / 10.1%
I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help / 2 / 2 / 0 / 3 / 1 / 50 / 243 / 301
0.7% / 0.7% / 0.0% / 1.0% / 0.3% / 16.6% / 80.7% / 100%
0.2% / 0.2% / 0.0% / 0.4% / 0.2% / 5.9% / 33.8% / 5.6%
Total / 1,186 / 1,013 / 523 / 698 / 413 / 852 / 719 / 5,404
22.0% / 18.8% / 9.7% / 12.9% / 7.6% / 15.8% / 13.3% / 100%
100% / 100% / 100% / 100% / 100% / 100% / 100% / 100%

Pearson Chi2(24) = 5.9e+03Pr = 0.000

*The first row is the frequency of responses.The second row is the row percentages. The third row is the column percentages.

Appendix B: Sensitivity analyses with 3-item Maslach Burnout Inventory Emotional Exhaustion (MBI:EE) measure.

Appendix B reports findings from a sensitivity analysis using a 3-item version of the Maslach Burnout Inventory Emotional Exhaustion (MBI:EE) scale that was validated by LeiterShaughnessy.34 The 3-item MBI:EE form was a post-hoc derivation from the 16-item MBI-General Survey (including the other two MBI scales: depersonalization and cynicism), which resulted from the factor analysis solution that minimized correlations among item errors.1The 3 MBI:EE items are: “I feel tired when I get up in the morning and have to face another day on the job”, “Working all day is really a strain for me,” and “I feel burned-out from my work.” Responses were rated on a 7-point Likert scale ranging from 0 “Never” to 6 “Every day”. Responses were summed to create an overall score. We dichotomized the 3-item MBI:EE based on the published cut-off for high burnout (a subscale mean of >=3.2) for the Emotional Exhaustion subscale in the MBI General Survey.2

We repeated all of the analyses reported in the paper: Pearson correlation, kappa values, sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV),and area under thereceiver operator curve (AUC). Analyses were conducted with all respondents combined, and separately within each occupation (PCP, nurse care manager, clinical associate, and clerk).We calculated all statistics and conducted analyses using Stata (SE) version 12 (StataCorps., College Station, TX).

Summary of results

The prevalence of burnout was 40% as measured on the 3-item MBI:EE(Appendix Table 1). Including all 5,404 respondents,the 3-item MBI:EE and the non-proprietary single-item burnout measureshad a Pearson correlation of 0.77 (comparing the ordinal items), an inter-rater agreement (Kappa) of 0.66 for agreement on whether the respondent was burned out, indicating 66% greater agreement than chance between the two measures (Appendix Table 2). Compared to the 3-item MBI:EE, the non-proprietary single-item measure had a sensitivity of 78%,specificity of 88%, positive-predictive value (PPV) of 81%, and negative-predictive value (NPV) of 86%.The AUC was 0.91(se=0.004).As with the primary analysis,when compared by respondent occupation, the discrimination statistics were very similar.

Appendix Table 1: Cross-tabulation of burnout assessed by the 3-item and the Maslach Burnout Inventory Emotional Exhaustion Scale (MBI:EE) and the non-proprietary single-item burnout measure, for the entire sample

Presence of burnout / MBI:EE
Single item / Yes / No / Total
Yes / 1,680 / 400 / 2,080
No / 480 / 2,844 / 3,324
Total / 2,160 / 3,244 / 5,404

Appendix Table 2: Discrimination statistics, overall and by occupation

Total
n=5,404 / Provider
n=1,769 / Nurse Care & Case Managers
n=1,380 / Clinical associate
n=1,358 / Clerk
n=557
Correlation / 0.77 / 0.77 / 0.75 / 0.78 / 0.78
Kappa / 0.66 / 0.65 / 0.65 / 0.66 / 0.67
Sensitivity / 77.8% / 79% / 78% / 77% / 80%
Specificity / 87.7% / 86% / 87% / 89% / 88%
PPV / 80.8% / 83% / 81% / 76% / 79%
NPV / 85.6% / 81% / 85% / 90% / 88%
AUC / .91 (.004) / .91(.008) / .91(.009) / .92(.009) / .92(.01)

References:

1.Leiter M, Shaughnessy K. The areas of worklife model of burnout: tests of mediation relationships. Ergonomia: An International Journal. 2006;28:327-341.

2.Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual, Third Edition. Third ed: Mind Garden; 1996.