Clinical Professor at The University of California,RiversideConnection Pending
Academic Hospitalist. HVC enthusiast.Connection Pending
Assistant Professor of Medicine, Hospitalist at University of Colorado HospitalConnection Pending
GME Physician Lead for QI, Safety and High Value Care at Creighton University School of MedicineConnection Pending
Physicians are estimated to be responsible for 80% of national healthcare costs. A physician’s ability to practice cost-conscious care is linked to the residency program from which they graduate, yet there is little information regarding what physicians-in-training nationally understand about value. The High Value Practice Academic Alliance (HVPAA) is a national organization focusing on high value care across academic medical centers. The Future Leaders Program (FLP) is a free, web-based educational program was started within the HVPAA to develop the next generation of leaders for high value care.
Prior to initiation of the curriculum, a survey evaluating skills, attitude and knowledge was sent to all FLP participants. Seventy-six participants completed the survey. The trainees represented eleven specialties, predominantly in university-based programs, with 15% from community based programs. Most were residents (63/76; 83%), with the rest being fellows. Very few had education in value or quality in healthcare during medical school (5/76, 7%) and less than half (35/76, 46%) had such training during residency. Interestingly, the majority (55/76, 72%) had participated in a quality, patient safety or cost reduction project. Less than half of respondents identified the correct definitions of costs, charges or price in healthcare. Only 14% agreed or strongly agreed that they were comfortable with incorporating cost into medical decisions, and 4% agreed or strongly agreed that they had access to information about costs. However, the majority felt that it was important to factor information about cost into patient care and that physicians should know the costs of care.
Participants then completed a structured one-year curriculum, including online resources to learn leadership skills as well as to build knowledge in healthcare value. The FLP uses the Costs of Care modules from Dell Medical School as well as modules from the Institute of Healthcare Improvement to engage participants. Lastly, participants have direct mentoring from the FLP curriculum directors to work on a value-based project over the duration of the year. Project examples include reduction of unnecessary laboratory studies, appropriate use of telemetry and reduction of inappropriate medication prescribing.
After our one year curriculum, a post-curriculum survey was sent to FLP participants. Sixty-five participants completed the survey. Overall, knowledge of the correct definitions of costs, charges and price in healthcare was improved. In addition, participants demonstrated improved knowledge, skills and attitudes for providing high-value healthcare. On a 1 to 4 scale, where 1 is never and 4 is often, participants also reported more high-value behaviors than they did pre-curriculum; such as discussing costs of treatment with patients (2.55 versus 3.09, p<0.001) and not repeating tests before attempting to obtain prior results (2.80 versus 2.40, p<0.001). Further information on these results can be seen in the attached table 1 and table 2.
The HVPAA FLP demonstrates that there is a need for free and easily accessible education for providing high-value healthcare, and that a web-based curriculum with remote mentors can be effective in delivering this education. During the first year of FLP, more than 50% of proposed projects were completed and many participants were able to publish their work. The FLP has demonstrated that there is a large cohort of energetic residents and fellows interested in solving the value crisis. By arming these future leaders with the tools necessary to create impactful work at the frontlines, our program has been able to impact patient care outcomes across the country. The FLP curriculum directors recently launched its second cohort of participants, and a similar program for junior faculty this fall (VITAL).
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