Dataset Information

Teaching High-Value Care: Case Vignettes for Pediatric Practice.

ABSTRACT:

Introduction

As health care systems recognize the importance of high-value care (HVC), physicians must focus on individualized patient outcomes using economically responsible and evidence-based medicine. The best ways to teach medical trainees HVC principles that can result in meaningful practice and behavior changes are unknown.

Methods

We designed a case-based curriculum mapping six common pediatric clinical scenarios to HVC principles. Each scenario included learning objectives, small-group activities, educational resources, a facilitator guide, and participant evaluations. After internal and external review, the scenarios were piloted at four teaching institutions (Children's Hospital Los Angeles, Johns Hopkins All Children's Hospital, Seattle Children's Hospital, and Texas Children's Hospital). Facilitators were encouraged to adapt each vignette to learner needs and site-specific conference characteristics. All participants were asked to complete anonymous case-specific evaluations at the end of each session.

Results

Approximately 331 individuals (students, residents, attendings) participated, with an evaluation response rate of 76% (n = 253). Participants across all sites acknowledged the sessions as a valuable use of time (range: 4.2-4.6 on a 5-point Likert scale) and identified HVC principles that could be applied daily in clinical practice (range: 4.4-4.6).

Discussion

Implementation of six case-based HVC vignettes at four pilot institutions was both feasible and well received by a diverse group of learners. The curriculum was perceived as valuable and applicable to learners' clinical practice. Next steps include longitudinal assessments of learners and the development of tools measuring HVC-related behaviors to understand better the impact of the curriculum on clinical practice.

SUBMITTER: Walker LL

PROVIDER: S-EPMC6342384 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Publications

Teaching High-Value Care: Case Vignettes for Pediatric Practice.

Walker Lauren LaRue LL Hopkins Akshata A Rooholamini Sahar Nayereh SN McDaniel Corrie C Jones Yemisi Y Herrmann Lisa E LE Lee Vivian V Bynum Francine F Tchou Michael M Beck Jimmy J

MedEdPORTAL : the journal of teaching and learning resources 20180615

<h4>Introduction</h4>As health care systems recognize the importance of high-value care (HVC), physicians must focus on individualized patient outcomes using economically responsible and evidence-based medicine. The best ways to teach medical trainees HVC principles that can result in meaningful practice and behavior changes are unknown.<h4>Methods</h4>We designed a case-based curriculum mapping six common pediatric clinical scenarios to HVC principles. Each scenario included learning objectives ...[more]

PMID: 30800923

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Project description:Importance:Use of health care services and physician practice patterns have been shown to vary widely across the United States. Although practice patterns-in particular, physicians' ability to provide high-quality, high-value care-develop during training, the association of a physician's regional practice environment with that ability is less well understood. Objective:To examine the association between health care intensity in the region where physicians practice and their ability to practice high-value care, specifically for physicians whose practice environment changed due to relocation after residency. Design, Setting, and Participants:This cohort study included a national sample of 3896 internal medicine physicians who took the 2002 American Board of Internal Medicine initial certification examination followed approximately 1 decade (April 21, 2011, to May 7, 2015) later by the Maintenance of Certification (MOC) examination. At the time of the MOC examination, 2714 of these internists were practicing in a new region. Data were analyzed from March 6, 2016, to May 21, 2018. Exposures:Intensity of care in the Dartmouth Atlas hospital referral region (HRR), measured by per-enrollee end-of-life physician visits (primary) and current practice type (secondary). Main Outcomes and Measures:The outcome, a physician's ability to practice high-value care, was assessed using the Appropriately Conservative Management (ACM) score on the MOC examination, measuring performance across all questions for which the correct answer was the most conservative option. The exposure, regional health care intensity, was measured as per-enrollee end-of-life physician visits in the Dartmouth Atlas HRR of the physician's practice. Results:Among the 3860 participating internists included in the analysis (2030 men [52.6%]; mean [SD] age, 45.6 [4.5] years), those who moved to regions in the quintile of highest health care intensity had an ACM score 0.22 SD lower (95% CI, -0.32 to -0.12) than internists who moved to regions in the quintile of lowest intensity, controlling for postresidency ACM scores. This difference reflected scoring in the 44th compared with the 53rd percentile of all examinees. This association was mildly attenuated (0.18 SD less; 95% CI, -0.28 to -0.09) after adjustment for physician and practice characteristics. Conclusions and Relevance:This study found that practice patterns of internists who relocate after residency training appear to migrate toward norms of the new region. The demands of practicing in high-intensity regions may erode the ability to practice high-value conservative care.

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Dataset Information

Teaching High-Value Care: Case Vignettes for Pediatric Practice.

Introduction

Methods

Results

Discussion

Publications

Teaching High-Value Care: Case Vignettes for Pediatric Practice.

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