Trends in High-Value Care as Reported by Internal Medicine Program Directors.

Abstract

The value of care, defined as the relationship of cost, harm, and benefit, has garnered increased focus in recent years. Program directors (PDs) can provide information about resident skill and institutional priorities related to high-value care. The objective of the study was to evaluate changes between 2012 and 2014 in PD-reported resident skills and institutional priorities related to high-value care. We performed annual surveys of US internal medicine PDs from 2012-2014 and evaluated responses to identical questions related to high care value. The survey was developed by the American College of Physicians and the Alliance for Academic Internal Medicine. Response rates were 235 of 378 (62.2%) in 2012, 213 of 380 (56.1%) in 2013, and 215 of 391 (54.9%) in 2014. The majority of PDs reported that balancing benefits, harms, and costs was (1) a teaching priority; (2) the subject of didactics; (3) discussed by residents; and (4) emphasized by institutional leadership. Approximately one-third reported that unnecessary ordering occurred most or all the time, with no changes in the survey period. When asked about resident ordering compared to 3 years ago, 42.5% (88 of 207) of PDs reported residents ordering fewer unnecessary tests most or all the time in 2014, compared to 28.1% (63 of 224) in 2012 (P = .002). Internal medicine PDs reported high levels of institutional interest in and teaching of care value between 2012 and 2014, but responses for later years suggest improvement in trainees avoiding unnecessary testing.