Abstract
This article was migrated. The article was marked as recommended. Background: Multiple national initiatives have been implemented to promote cost-conscious care. Yet, there remains a deficiency of formal high value care (HVC) curricula among internal medicine residency programs.We aimedto develop a curriculum that teaches HVC material that can be utilized at the point of care and to assess the curriculum's impact on the participants' attitudes, knowledge, and practice patterns pertaining to HVC. Methods: We conducted our study on the inpatient internal medicine service over two-week rotations at Johns Hopkins Bayview Medical Center. Internal medicine residentsparticipated in two collaborative educational sessions that incorporated an introduction of important concepts in HVC, Bayesian thinking, clinical cases, and a review of a hospital bill of one of the patients under the team's care. Participants were also encouraged to reflect on their practice patterns and incorporate the HVC principles taught into their daily clinical work. We administered pre- and post-curriculum surveys to assess change in reported HVC-related practice behaviors, knowledge, and attitudes. Results: Forty-seven residents participated in the study. We included the twenty participants who completed both a pre- and post-curriculum survey in the data analysis. After participation in the curriculum, there was a significant increase in the use of pre-test probabilities in clinical decision making ( p=0.005). There was also a trend toward improvement in HVC knowledge and practice patterns after the rotation. Conclusion: We implemented a curriculum that may have improved high-value practice patterns through point-of-care education on the inpatient medicine wards.
Highlights
The United States spends 765 billion dollars annually on potentially avoidable costs, almost a third of which is spent on unnecessary tests and treatments (Smith, 2012)
In order to introduce formal high value care (HVC) education in the clinical setting, we developed a curriculum that aimed to teach and practice HVC concepts that were directly related to the care being provided by residents on inpatient internal medicine wards
Out of the 20 participants, 65% were in post-graduate year (PGY) 1, 20% were in PGY 2, and 15% were in PGY 3
Summary
The United States spends 765 billion dollars annually on potentially avoidable costs, almost a third of which is spent on unnecessary tests and treatments (Smith, 2012). These unnecessary tests and treatments may lead to patient harm and suffering, such as healthcare-associated infection or increased length of hospital stay (Badgery-Parker et al, 2019). While a number of national initiatives have been implemented to promote cost-conscious care, most residency programs lack a formal curriculum that provides high value care (HVC) education to trainees (Cooke, 2010; Hackbarth and Boccuti, 2011; Weinberger, 2011; Colla et al, 2015). We aimed to develop a curriculum that teaches HVC material that can be utilized at the point of care and to assess the curriculum’s impact on the participants’ attitudes, knowledge, and practice patterns pertaining to HVC
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