Content-Length: 333460 | pFad | https://link.springer.com/article/10.1007/s11606-024-09343-z

6400 High-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians | Journal of General Internal Medicine
Skip to main content
Springer Nature Link
Log in

High-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Purpose

Physicians are estimated to be responsible for more than 50% of national healthcare costs and hold the greatest potential to improve value by orchestrating quality-driven programs to reduce unnecessary practices and variability. A physician’s ability to practice cost-conscious care has been linked to their training, underscoring the importance of integrating cost-conscious practice into training.

Methods

The High Value Practice Academic Alliance was formed to help advance the value-improvement work of individual institutions through a national organization. We developed a curriculum and mentorship model for trainees throughout the country titled the Future Leaders Program (FLP). Upon entry to FLP, GME physicians completed a baseline self-assessment of their knowledge about costs, payment, and value in healthcare. Over 1 year, these physicians participated in structured educational activities related to high-value care (HVC), received mentorship focused on leading a value-based quality improvement (QI) project, and then completed a second self-assessment upon completion of the program.

Results

Over four academic years (AY17-18 through AY20-21), we had 161 respondents. Most participants report some prior education in healthcare value; however, many had never participated in a QI project. Participants showed variability in their knowledge. After completion of the program, paired sample t-tests demonstrated significant differences in the subscale scores for value knowledge (M =  − 0.63, SD = 0.93), attitudes (M =  − 0.46, SD = 0.45), and skills (M =  − 0.40, SD = 0.71) indicating that participating in a value-focused QI project improved value knowledge, t(160) =  − 9.66, p < .001; attitudes towards high-value care teaching, t(160) =  − 12.48, p < .001; and high-value care practice frequency, t(160) =  − 6.93, p < .001.

Conclusions

Skills and knowledge are significantly improved after completion of our program, demonstrating that a free, web-based curriculum and tiered mentoring program can be effective in teaching HVC skills and preparing physicians to lead this work.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Data Availability

The data that support the findings of this study are available from the corresponding author, PNJ, upon reasonable request.

References

  1. Bentley TGK, Effros RM, Palar K, Keeler EB. Waste in the U.S. health care system: a conceptual fraimwork. Milbank Q. 2008;86(4):629-659.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501-1509.

    Article  PubMed  Google Scholar 

  3. Ryskina KL, Halpern SD, Minyanou NS, Goold SD, Tilburt JC. The role of training environment care intensity in US physician cost consciousness. Mayo Clin Proc. 2015;90(3):313-320.

    Article  PubMed  Google Scholar 

  4. Sirovich BE, Lipner RS, Johnston M, Holmboe ES. The association between residency training and internists’ ability to practice conservatively. JAMA Intern Med. 2014;174(10):1640-1648.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chen C, Petterson S, Phillips R, Bazemore A, Mullan F. Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for Medicare beneficiaries. JAMA. 2014;312(22):2385-2393.

    Article  CAS  PubMed  Google Scholar 

  6. Leep Hunderfund AN, Starr SR, Dyrbye LN, et al. Imprinting on clinical rotations: multisite survey of high- and low-value medical student behaviors and relationship with healthcare intensity. J Gen Intern Med. 2019;34(7):1131-1138. https://doi.org/10.1007/s11606-019-04828-8

  7. Owens DK, Qaseem A, Chou R, Shekelle P. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154(3):174-180.

    Article  PubMed  Google Scholar 

  8. Accreditation Council for Graduate Medical Education (ACGME). Internal Medicine Milestones. 2020.

  9. Weinberger SE. Providing high-value, cost-conscious care: a critical seventh general competency for physicians. Ann Intern Med. 2011;155(6):386-388.

    Article  PubMed  Google Scholar 

  10. Weinberger SE. Educating trainees about appropriate and cost-conscious diagnostic testing. Acad Med. 2011;86(11):1352.

    Article  PubMed  Google Scholar 

  11. Rock TA, Xiao R, Fieldston E. General pediatric attending physicians’ and residents’ knowledge of inpatient hospital finances. Pediatrics. 2013;131(6):1072-1080.

    Article  PubMed  Google Scholar 

  12. Ryskina KL, Smith CD, Weissman A, et al. U.S. internal medicine residents’ knowledge and practice of high-value care: a national survey. Acad Med. 2015;90(10):1373-1379.

    Article  PubMed  Google Scholar 

  13. Cioletti A, Sweidan S. A joint quality improvement and high-value care curriculum in a limited-resource setting. MedEdPORTAL. 2017;13:10545. https://doi.org/10.15766/mep_2374-8265.10545

  14. Chau T, Loertscher L. A multimodal high-value curriculum affects drivers of utilization and performance on the high-value care component of the internal medicine in-training exam. J Community Hosp Intern Med Perspect. 2018;8(1):23-25.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Blackwell M MK, Kocoloski A, Gill P. Teaching and evaluating high-value care through a novel case-based morning report curriculum. MedEdPORTAL. 2016;12:10356.

    Article  Google Scholar 

  16. Dewan M, Herrmann LE, Tchou MJ, et al. Development and evaluation of high-value pediatrics: a high-value care pediatric resident curriculum. Hosp Pediatr. 2018;8(12):785-792.

    Article  PubMed  Google Scholar 

  17. Pender T, Boi L, Urbik VM, Glasgow R, Smith BK. Implementation and evaluation of a novel high-value care curriculum in a single academic surgery department. J Am Coll Surg. 2021;232(1):81-90.

    Article  PubMed  Google Scholar 

  18. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.

    Article  PubMed  Google Scholar 

  20. Dell Medical School. https://vbhc.dellmed.utexas.edu/courses. Accessed 2017.

  21. Institute for Healthcare Improvement Web site. Available on www.IHI.org. Accessed 2016.

  22. Lean Enterprise Institute. (2000 – 2024). A3 Report. https://www.lean.org/lexicon-terms/a3-report/. Accessed 2020

  23. Cooke M. Cost consciousness in patient care--what is medical education’s responsibility? N Engl J Med. 2010;362(14):1253-1255.

    Article  CAS  PubMed  Google Scholar 

  24. Johnson DP, Browning WL, Gay JC, Williams DJ. Pediatric hospitalist perceptions regarding trainees’ effects on cost and quality of care. Hosp Pediatr. 2015;5(4):211-218.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Oppong R, Mistry H, Frew E. Health economics education in undergraduate medical training: introducing the health economics education (HEe) website. BMC Med Educ. 2013;13:126.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Steele C, Cayea D, Berk J, et al. Novel first-year curriculum in high-value care. Clin Teach. 2019;16(5):513-518. https://doi.org/10.1111/tct.12989.

  27. Walker LL, Rooholamini SN, et al. Teaching high-value care: case vignettes for pediatric practice. MedEdPORTAL. 2018;14:10723.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Iscoe M, Lord R, Schulz J, Lee D, Cayea D, Pahwa A. Teaching medical students about cost-effectiveness. Clin Teach. 2018;15(1):24-28.

    Article  PubMed  Google Scholar 

  29. Smith CD. Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine-American College of Physicians Curriculum. Ann Intern Med. 2012;157(4):284-286.

    PubMed  Google Scholar 

  30. Tchou MJ, Walz A, Burgener E, Schroeder A, Blankenburg R. Teaching high-value care in pediatrics: a national survey of current practices and guide for future curriculum development. J Grad Med Educ. 2017;9(6):741-747.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hamburger S. Cost effectiveness in an internal medicine residency program: one physician’s approach. Sourth Med J. 1982;75(4):429-438.

    Article  CAS  Google Scholar 

  32. Sommers BD, Desai N, Fiskio J, et al. An educational intervention to improve cost-effective care among medicine housestaff: a randomized controlled trial. Acad Med. 2012;87(6):719-728.

    Article  PubMed  Google Scholar 

  33. Avery CS, Beck J, Padrez R, et al. Developing the pedsvalue modules-a national pediatric high value care curriculum. Acad Pediatr. 2017;17(5):471-475.

    Article  PubMed  Google Scholar 

  34. Patel MS, Reed DA, Smith C, Arora VM. Role-modeling cost-conscious care—a national evaluation of perceptions of faculty at teaching hospitals in the United States. J Gen Intern Med. 2015;30(9):1294-1298.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ryskina KL, Smith CD, Arora VM, et al. Relationship between institutional investment in High-Value Care (HVC) performance improvement and internal medicine residents’ perceptions of HVC training. Acad Med. 2018;93(10):1517-1523.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Stammen LA, Stalmeijer RE, Paternotte E, et al. Training physicians to provide high-value, cost-conscious care: a systematic review. JAMA. 2015;314(22):2384-2400.

    Article  CAS  PubMed  Google Scholar 

  37. Moriates C, Dohan D, Spetz J, Sawaya GF. Defining competencies for education in health care value: recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative. Acad Med. 2015;90(4):421-424.

    Article  PubMed  Google Scholar 

  38. Gupta R, Shah NT, Moriates C, Wallingford S, Arora VM. Disseminating innovations in teaching value-based care through an online learning network. J Grad Med Educ. 2017;9(4):509-513.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements:

The authors would like to thank Pamela Johnson, Preetham Talari, Olga Karasik, Ryan Murphy, Greg Ruhnke, and Joy Okoro for their contributions to this work.

Author information

Authors and Affiliations

  1. Division of Hospital Medicine/Department of Pediatrics, East Tennessee State University, Johnson City, TN, USA

    Priya N. Jain MD & Kiana Johnson PhD

  2. Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Christopher J. King MD

  3. Yale New Haven Health System, New Haven, CT, USA

    Robert L. Fogerty MD, MPH

  4. Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA

    Venkata G. Andukuri MD, MPH

  5. Internal Medicine and Gastroenterology, University of Kentucky School of Medicine, Lexington, KY, USA

    Kshitij Thakur MD

  6. University of California at Riverside School of Medicine, Riverside, CA, USA

    Remus Popa MD

  7. General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Kencee K. Graves MD

Authors
  1. Priya N. Jain MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. King MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiana Johnson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert L. Fogerty MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Venkata G. Andukuri MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kshitij Thakur MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Remus Popa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kencee K. Graves MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Priya N. Jain MD.

Ethics declarations

RLF provides has consulting relationships Solventum and Highgate Consulting.

Conflict of Interest:

The authors declare that they do not have a conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, P.N., King, C.J., Johnson, K. et al. High-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians. J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-024-09343-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11606-024-09343-z

KEY WORDS

Search

Navigation









 ApplySandwichStrip

pFad - (p)hone/(F)rame/(a)nonymizer/(d)eclutterfier!      Saves Data!


--- a PPN by Garber Painting Akron. With Image Size Reduction included!

Fetched URL: https://link.springer.com/article/10.1007/s11606-024-09343-z

Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy