Development and Evaluation of High-Value Pediatrics: A High-Value Care Pediatric Resident Curriculum

Abstract

Low-value health care is pervasive in the United States, and clinicians need to be trained to be stewards of health care resources. Despite a mandate by the Accreditation Council for Graduate Medical Education to educate trainee physicians on cost awareness, only 10% of pediatric residency programs have a high-value care (HVC) curriculum. To meet this need, we set out to develop and evaluate the impact of High-Value Pediatrics, an open-access HVC curriculum. High-Value Pediatrics is a 3-part curriculum that includes 4 standardized didactics, monthly interactive morning reports, and an embedded HVC improvement project. Curriculum evaluation through an anonymous, voluntary survey revealed an improvement in the self-reported knowledge of health care costs, charges, reimbursement, and value (P , .05). Qualitative results revealed self-reported behavior changes, and HVC improvement projects resulted in higher-value patient care. The implementation of High-Value Pediatrics is feasible and reveals improved knowledge and attitudes about HVC. HVC improvement projects augmented curricular knowledge gains and revealed behavior changes. It is imperative that formal high-value education be taught to every pediatric trainee to lead the culture change that is necessary to turn the tide against low-value health care. In addition, simultaneous work on faculty education and attention to the hidden curriculum of low-value care is needed for sustained and long-term improvements.

Applying High-Value Care Principles in a Pediatric Case: A Workshop for Health Professions Students

“…In order to prepare medical students to apply HVC concepts when making medical decisions for pediatric patients, we developed an interactive workshop that reviews concepts of HVC, including the Choosing Wisely lists in pediatrics and encouraged thinking of downstream effects of medical decisions. Overall, this workshop has been well received by participants and similar to other studies, [25][26][27][28] participants reported increased confidence and self-assessed competence in providing high-value, cost-conscious care. Students reported that the curriculum improved their knowledge of HVC by pushing them to understand how an intervention changes management and to think about cost and harm.…”

“…Students reported that the curriculum improved their knowledge of HVC by pushing them to understand how an intervention changes management and to think about cost and harm. However, unlike previously published interventions, [25][26][27] our learners were not told that the case discussion was based in HVC concepts which made it more likely that students gave their initial diagnostic plan unbiased by the idea of HVC. Because the facilitator then prompted them to explain why they were asking for a test or intervention and if and how that changed management, this allowed the students to make new connections between their current thinking and HVC.…”

“…For this reason, teaching HVC principles is crucial for students as they will be the future drivers in health care. While a few studies have implemented curricula for residents [23][24][25][26][27] and medical students in internal medicine, 28,29 there are no studies to our knowledge, including on MedEdPORTAL, examining the effect of a pediatricbased curriculum on medical students alone. Unlike existing workshops, 23,29 our session was delivered in a single 1-hour session, making it efficient and easily incorporated into an existing conference schedule.…”

Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections

“…One HM team serves as the resident quality improvement (QI) team where residents collaborate in a longitudinal study under the guidance of QI‐trained coaches. The focus of this QI initiative was determined by resident consensus and aligned with a high‐value care curriculum 12 …”

“…The focus of this QI initiative was determined by resident consensus and aligned with a high-value care curriculum. 12 To identify the target patient population, we investigated IV antimicrobials frequently used in HM patients. Ampicillin and clindamycin are commonly used IV antibiotics, most frequently corresponding with the diagnoses of CAP and SSTI, respectively, accounting for half of all antibiotic use on the HM service.…”