Term of Award

Spring 2024

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


College of Public Health

Committee Chair

Bettye Apenteng

Committee Member 1

Linda Kimsey

Committee Member 2

Ana Palacios



Primary care is integral to achieving high-quality health outcomes for the population and decreasing healthcare costs. However, primary care clinicians suffer from conflicting demands, impossible expectations, and burdensome processes. With burnout and mental fatigue increasing, leadership must find innovative programs to implement in their organizations. This mixed-methods research study assessed the impact of one such intervention, protected administrative time (PRAT), on improving provider well-being.


The first aim was to evaluate the association of PRAT on the service delivery indicators of primary care clinicians’ productivity, average appointments per day, patient satisfaction (likelihood to recommend), clinician time to the next available appointment for new patients, established sick patients, and established patient physicals. The second aim was to describe the implementation of PRAT using the Consolidation Framework for Implementation Research (CFIR).


Multivariable linear and Poisson regressions were used within a difference-in-difference framework to analyze the intervention's impact on chosen service delivery indicators. The CFIR framework analyzed qualitative data from interviews and open-ended surveys collected from three stakeholders: leaders, managers, and providers.


The PRAT intervention did not result in statistically significant differences in productivity measured in wRVUS (β =2.96, [CI] -4.75, 10.67), access measured in average appointments per day (β =-0.47, [CI] -1.37, 0.42) and new patient sick visits (β = 2.24, [CI] -.4.64, 9.12), or patient experience measured by likelihood to recommend (β =-0.49, [CI] -2.99, 2.02). There was a significant increase in two access measures: time to next available appointment for new patients (β = 18.24, [CI] -0.17, 36.65) and established patient physicals (β = 36.55, [CI] 12.33, 60.76). The CFIR analysis showed one implementation barrier, one neutral construct, and numerous implementation facilitators. Respondents felt the intervention was associated with positive actual and anticipated implementation outcomes, and respondents reported overwhelmingly positive innovation recipient impact.


This study showed that implementing PRAT was not statistically associated with worsening productivity, patient satisfaction, and reduced access to sick visits. Results of the qualitative analysis showed that providers were satisfied with the implementation of PRAT and that there were numerous facilitators to the implementation that management could use when implementing similar programs.

OCLC Number


Research Data and Supplementary Material