High-value care modeling: Evaluating cost conscious and potentially wasteful behaviors.

Abstract

42 Background: Value-based care is key to decreasing waste, addressing increasing healthcare costs, and minimizing patient financial toxicity - especially in the treatment of high-cost diagnoses such as cancer. Medical student exposure to role-modeling of high-value care (HVC) behaviors may help shape professional identity formation and have long-term effects on future practices. Our study aimed to investigate the frequency and characteristics of faculty role-modeling of HVC in medical student core clinical rotations. Methods: A cross-sectional survey study was performed with third- and fourth-year medical students on clinical rotations at 11 U.S. medical schools. The survey assessed thirteen variables associated with cost conscious role-modeling behaviors or potentially wasteful role-modeling behaviors, as well as questions characterizing the rotation such behaviors were observed on, demographic information, and organizational culture around HVC. Results: Cost-conscious role-modeling behaviors were observed “sometimes” or “often” between 52.9-70.5% of the time across all clinical rotations, with the exception of observing a student or resident being praised for ordering a cost-effective diagnostic work-up (seen only 25.7% of the time). Potentially wasteful role modeling behaviors were observed “sometimes” or “often” 5%-14.3% of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests (45.1%) and repeating tests rather than attempting to obtain recently performed test results (42.9%). HVC was most often observed on internal medicine rotations (58.3%) and least frequently on surgery rotations (34.5%). Attendings were significantly more likely to model HVC compared to residents/fellows in 5/7 domains. Organizational culture correlated with frequency of HVC behavior observed. Conclusions: HVC role-modeling behaviors, as observed by medical students, are variable across clinical rotations. HVC practices are essential not only within oncology, but across all medical specialties; future studies should strive to identify factors which promote or inhibit HVC modeling and understand differences between HVC education in undergraduate medical curriculum.