Prospective Observational Study on High-Value Care Topics Discussed on Multidisciplinary Rounds

Beck, Jimmy; McDaniel, Corrie E.; Bradford, Miranda C.; Brock, Dan W.; Sy, Carolyn D.; Chen, Tiffany; Foti, Jeffrey; White, Andrew A.

doi:10.1542/hpeds.2017-0183

Cited by 9 publications

(21 citation statements)

References 39 publications

(31 reference statements)

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“…Of these, only 31% of HVC discussions were initiated by a trainee (resident or medical student) and fewer than half (41%) of HVC discussions were initiated by attending physicians or fellows. 27 Successful HVC curricula need to provide a foundation for knowledge transmission; however, additional supports, including faculty development in which informal HVC education is addressed and broader educational efforts to address the institutional culture of value and hidden curriculum, are necessary.…”

Section: Problem Identificationmentioning

confidence: 99%

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

Dewan

Herrmann

Tchou

et al. 2018

Hospital Pediatrics

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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.

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Section: Problem Identificationmentioning

confidence: 99%

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

Dewan

Herrmann

Tchou

et al. 2018

Hospital Pediatrics

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“…The findings of Beck et al 13 reinforce the need to further develop physician leaders as role-models and teachers of HVC. We have come to understand that the practice and behaviors learned in training often carry forward into clinical careers, 15 and the authors of several recent studies have identified a lack of supervisor role models as a factor driving low-value care for residents.…”

mentioning

confidence: 84%

“…As institutions and physicians determine how best to encourage HVC, the findings of Beck et al 13 support the idea that formal curricula are necessary but likely not sufficient. We should strive to expand the HVC educational environment beyond the lecture hall to include any place where patient care occurs.…”

mentioning

confidence: 92%

“…11 As we seek to develop local cultures of HVC, it' s important to understand this "hidden curriculum" and the way it may interact with our educational efforts. 12 In this edition of Hospital Pediatrics, Beck et al 13 seek to better understand one of these informal educational environments: the inpatient rooms and hallways where most clinical care decisions are discussed and finalized.…”

mentioning

confidence: 99%

“…Within each group was a list of specific observable HVC discussions. Beck et al 13 found that only 29% of patient rounding encounters contained at least 1 HVC discussion. This proportion was the same for both general medicine and subspecialty services, and only 4.5% of patient rounding sessions had multiple HVC discussions.…”

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confidence: 99%

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Confronting the Hidden Curriculum of High-Value Care Education

Tchou

Dewan

Herrmann³

2018

Hospital Pediatrics

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Nearly a decade ago, Porter 1 issued a call to restructure health care to focus on maximizing value, defined as the outcomes achieved over the cost of providing that care. By focusing on value, physicians and health systems are encouraged to switch from providing high-volume care, with an implicit assumption that more care leads to better outcomes, to a more balanced approach. This value-focused approach emphasizes providing care that leads to the most benefit to patients while minimizing the harms, wasted resources, and excess costs associated with overuse 2 and overdiagnosis. 3 Although the health care field has become more aware of the need to improve value, over the last decade we have continued to see increasing overall health spending, 4 including pediatric-specific health spending. 5

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High-Value, Cost-Conscious Care Attitudes in the Graduate Medical Education Learning Environment: Various Stakeholder Attitudes That Residents Misjudge

et al. 2020

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Background Training residents in delivering high-value, cost-conscious care (HVCCC) is crucial for a sustainable healthcare. A supportive learning environment is key. Yet, stakeholders’ attitudes toward HVCCC in residents’ learning environment are unknown. Objective We aimed to measure stakeholders’ HVCCC attitudes in residents’ learning environment, compare these with resident perceptions of their attitudes, and identify factors associated with attitudinal differences among each stakeholder group. Design We conducted a cross-sectional survey across the Netherlands between June 2017 and December 2018. Participants Participants were 312 residents, 305 faculty members, 53 administrators, and 1049 patients from 66 (non)academic hospitals. Main Measures Respondents completed the Maastricht HVCCC Attitude Questionnaire (MHAQ), containing three subscales: (1) high-value care, (2) cost incorporation, (3) perceived drawbacks. Additionally, resident respondents estimated the HVCCC attitudes of other stakeholders, and answered questions on job demands and resources. Univariate and multivariate analyses were used to analyze data. Key Results Attitudes differed on all subscales: faculty and administrators reported more positive HVCCC attitudes than residents (p ≤ 0.05), while the attitudes of patients were less positive (p ≤ 0.05). Residents underestimated faculty’s (p < 0.001) and overestimated patients’ HVCCC attitudes (p < 0.001). Increasing age was, among residents and faculty, associated with more positive attitudes toward HVCCC (p ≤ 0.05). Lower perceived health quality was associated with less positive attitudes among patients (p < 0.001). The more autonomy residents perceived, the more positive their HVCCC attitude (p ≤ 0.05). Conclusions Attitudes toward HVCCC vary among stakeholders in the residency learning environment, and residents misjudge the attitudes of both faculty and patients. Faculty and administrators might improve their support to residents by more explicitly sharing their thoughts and knowledge on HVCCC and granting residents autonomy in clinical practice.

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Prospective Observational Study on High-Value Care Topics Discussed on Multidisciplinary Rounds

Cited by 9 publications

References 39 publications

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

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

Confronting the Hidden Curriculum of High-Value Care Education

High-Value, Cost-Conscious Care Attitudes in the Graduate Medical Education Learning Environment: Various Stakeholder Attitudes That Residents Misjudge

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