Cost-Aware Care

Chandawarkar, Rajiv Y.; Taylor, Shiv; Abrams, Peter; Duffy, Andrew; Voytovich, Anthony E.; Longo, Walter E.; Kozol, Robert A.

doi:10.1001/archsurg.142.3.222

Cited by 15 publications

(3 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Organisations such as the American Association of Medical Colleges (AAMC) have advocated for new residents to "incorporate cost awareness and principles of cost-effectiveness" in their diagnostic evaluations ([8] p19). This growing recognition of the importance of raising awareness of the cost of healthcare and effective use of limited healthcare resources is also apparent in other countries and contexts [9][10][11][12]. However, there is little guidance on when, where or how to incorporate teaching on cost conscious care.…”

Section: Introductionmentioning

confidence: 99%

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Tan,

Ng,

Soh

et al. 2023

BMC Med Educ

View full text Add to dashboard Cite

Context Cost-conscious care is critical for healthcare sustainability but evidence suggests that most doctors do not consider cost in their clinical decision making. A critical step in changing this is understanding the barriers to encouraging behaviours and attitudes related to cost-conscious care. We therefore conducted a qualitative study to address the research question: what factors influence consideration of cost in emergency medicine (ED) clinical decision making? Methods This was a qualitative focus group study using patient vignettes to explore attitudes towards cost-conscious clinical decision making. Participants were Year 4 and Year 5 medical students from Singapore, a country with a fee-for-service healthcare system. After a data-driven initial data analysis, and to make sense of a multitude of factors impacting on cost conscious care, we selected Fishbein’s integrative model of behavioural prediction to underpin secondary data analysis. Results Via four focus groups with 21 participants, we identified five main themes relevant to the integrative model of behavioural prediction. These were: attitudes towards considering cost when managing a patient (e.g., “better safe than sorry”); normative beliefs (e.g., doing what others do, perceptions of patient wishes); efficacy beliefs (e.g., no authority to take decisions or challenge); skills and knowledge (e.g., little knowledge of costs), and environmental constraints (e.g., the nature of the healthcare system). Discussion Medical students do not consider cost in their clinical decision making due to numerous factors, of which lack of knowledge of costs is but one. While some of the factors identified reflect those found in previous studies with residents and fully-trained staff, and in other contexts, theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making. Our findings provide insight to inform how best to engage and empower educators and learners in teaching and learning about cost-conscious care.

show abstract

Section: Introductionmentioning

confidence: 99%

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Tan,

Ng,

Soh

et al. 2023

BMC Med Educ

View full text Add to dashboard Cite

show abstract

“…Those that have focused on costs associated with diagnostic tests. 2 However, trainees' understanding of operating room supply costs has been unaddressed and remains ill-defined. This study evaluates surgical residents' knowledge of the costs of items commonly used in surgical operations.…”

Section: Introductionmentioning

confidence: 99%

Surgical Residents’ Awareness of the Costs of Common Operating Room Supplies

White

Hernandez

Coppersmith

et al. 2022

The American Surgeon™

View full text Add to dashboard Cite

Background The Accreditation Council for Graduate Medical Education mandates that residency programs incorporate cost awareness into patient care. This presents a challenge for surgical residents because they must understand operating room costs in addition to other expenses. Trainees’ understanding of operating room supply costs is not well understood. Methods A survey was distributed to surgical residents (N = 73) at an urban, university-based residency program. Residents estimated the costs of 21 single-use operating room items. Descriptive statistics and a regression analysis were calculated. Results The response rate was 62%. Respondents accurately estimated costs for a median of 7/21 items, with error ranging from 26% to 5438%. They substantially underestimated the three highest-cost items. Increasing post-graduate year did not improve estimation accuracy (β = .233, P = .138). Discussion Residents have a poor understanding of single-use item costs, and this does not improve with post-graduate training, suggesting inefficiencies. There is opportunity to educate residents and ultimately decrease surgical health care costs.

show abstract

“…Most educational interventions in value-based care focus on a single dimension of this competencycost-which can be assessed through various tests of knowledge. [2][3][4][5][6][7][8][9] However, the integration of clinical judgment with knowledge of cost is crucial to ensure the preservation of high-quality care. This interplay is illustrated in a study by Rudy and colleagues, 9 in which residents were presented with a hypothetical case.…”

Section: Introductionmentioning

confidence: 99%

Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies

Zanotti

Somasegar

Hooper

et al. 2019

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Background Most value-based care educational interventions teach knowledge of cost but fail to recognize the interrelatedness of the Accreditation Council for Graduate Medical Education (ACGME) competencies of medical knowledge, patient care, practice-based learning and improvement, and systems-based practice. Objective We analyzed the impact on clinical decision-making of an educational curriculum that incorporated the spectrum of ACGME competencies. Methods Five didactic sessions for a gynecologic oncology fellowship were modified to incorporate cost- and value-based care considerations for each clinical topic addressed. After discussion, the group of fellows identified 1 high-value and 5 low-value practices to target for improvement. The fellows then undertook a chart audit of clinical decisions occurring for patients seen in the outpatient clinics. The frequency of low- and high-value practices was compared before and after the educational intervention. Results A total of 126 patients with a cervical cancer diagnosis were seen by participants in the outpatient setting during the entire observation period. After the intervention, the occurrence of 3 identified low-value practices was reduced by 13% to 33%, demonstrating modest effect sizes (effect size ϕ = 0.2–0.3). One high-value practice (smoking cessation counseling) increased 100% after a fellow-initiated quality improvement project was undertaken. Two low-value practices, including routine surveillance imaging, remained unchanged. Conclusions Overlaying value-based concepts in didactic conference teaching resulted in measurable changes in decision-making behavior. Engaging learners in a subsequent, focused quality practice review served as a vital part of their educational experience and allowed us to assess learner competency in its practical application.

show abstract

Cost-Aware Care

Cited by 15 publications

References 10 publications

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Surgical Residents’ Awareness of the Costs of Common Operating Room Supplies

Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies

Contact Info

Product

Resources

About