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Niehus H, Gunesch AN, Rodriguez N, Khoury J, Ma A, Gu N, Cao T, Muller M, Moriates C, Linker AS, Prochaska M, Fish D, Moulder G, Stephens M, Carney PA, Smeraglio A. Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study. J Gen Intern Med 2024:10.1007/s11606-024-08783-x. [PMID: 38710863 DOI: 10.1007/s11606-024-08783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Because physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC. OBJECTIVE To explore the relationship between medical student experiences and HVCCC attitudes. DESIGN Quantitative and qualitative analysis of a multi-institutional survey. PARTICIPANTS Medical students from nine US medical schools. APPROACH A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis. KEY RESULTS A total of 740 students completed the survey (response rate 15%). Students pursuing a "continuity-oriented" specialty held more favorable attitudes towards HVCCC than those pursuing "technique-oriented" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes. CONCLUSION Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.
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Affiliation(s)
- Hunter Niehus
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
- Portland Veterans Hospital Administration, Portland, OR, USA
| | - Ali Noel Gunesch
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Nina Rodriguez
- Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Julianna Khoury
- Dell Medical School at The University of Austin, Austin, TX, USA
| | - Annie Ma
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nina Gu
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Thy Cao
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Megan Muller
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Christopher Moriates
- Costs of Care, Boston, MA, USA
- VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, CA, USA
| | - Anne S Linker
- Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Micah Prochaska
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - David Fish
- University of Massachusetts Chan Medical School Bay State, Northampton, MA, USA
| | - Glenn Moulder
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Melissa Stephens
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Patricia A Carney
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Andrea Smeraglio
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA.
- Portland Veterans Hospital Administration, Portland, OR, USA.
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Lane BH, Mand SK, Wright S, Santen S, Punches B. Emergency Medicine Resident Needs Assessment and Preferences for a High-value Care Curriculum. West J Emerg Med 2024; 25:43-50. [PMID: 38205984 PMCID: PMC10777185 DOI: 10.5811/westjem.59622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/03/2023] [Accepted: 11/03/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction Consideration of the cost of care and value in healthcare is now a recognized element of physician training. Despite the urgency to educate trainees in high-value care (HVC), educational curricula and evaluation of these training paths remain limited, especially with respect to emergency medicine (EM) residents. We aimed to complete a needs assessment and evaluate curricular preferences for instruction on HVC among EM residents. Methods This was a qualitative, exploratory study using content analysis of two focus groups including a total of eight EM residents from a single Midwestern EM residency training program. Participants also completed a survey questionnaire. Results There were two themes. Within the overall theme of resident experience with and perception of HVC, we found five sub-themes: 1) understanding of HVC focuses on diagnosis and decision-making; 2) concern about patient costs, including the effects on patients' lives and their ability to engage with recommended outpatient care; 3) conflict between internal beliefs and external expectations, including patients' perceptions of value; 4) approach to HVC changes with increasing clinical experience; and 5) slow-moving, political discussion around HVC. Within the overall theme of desired education and curricular design, we identified four sub-themes: 1) limited prior education on HVC and health economics; 2) motivation to receive training on HVC and health economics; 3) desire for discussion-based format for HVC curriculum; and 4) curriculum targeted to level of training. Respondents indicated greatest acceptability of interactive, discussion-based formats. Discussion We conducted a targeted needs assessment for HVC among EM residents. We identified broad interest in the topic and limited self-reported baseline knowledge. Curricular content may benefit from incorporating resident concerns about patient costs and conflict between external expectations and internal beliefs about HVC. Curricular design may benefit from a focus on interactive, discussion-based modalities and tailoring to the learner's level of training.
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Affiliation(s)
- Bennett H. Lane
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio
- University of Cincinnati Health Air Care & Mobile Care, Cincinnati, Ohio
| | - Simanjit K. Mand
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio
| | - Stewart Wright
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio
| | - Sally Santen
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio
| | - Brittany Punches
- Ohio State University, Colleges of Nursing and Medicine, Department of Emergency Medicine, Columbus, Ohio
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Hadley M, Jardaly A, Paul K, Ponce B, Wise B, Patt J, Templeton K. Teaching of Cost-Effective Care in Orthopaedic Surgery Residency Training: A Survey of Residency Programs in the US. JB JS Open Access 2023; 8:e22.00111. [PMID: 37255672 PMCID: PMC10226615 DOI: 10.2106/jbjs.oa.22.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Costs of healthcare in the US continue to rise at rates that are unsustainable. Prior studies, most of which come from non-surgical specialties, indicate that a variety of strategies to teach this material are utilized but without consensus on best practices. No studies exist regarding the teaching of cost-effective care in orthopaedic residency training programs. The goal of this study was to assess the landscape in this area from the perspective of program leadership. Methods A survey was developed that was sent to orthopaedic residency program leadership via email through their interaction with the COERG. Additional programs were included to enhance diversity of responding programs. The survey, based on those published from other areas of medicine, included questions about the experiences of the respondents in learning about cost-effective care, as well as how faculty and residents learned about this topic. Results Seventy one percent (30) of respondents noted that their faculty did not receive formal training in cost-effective care, and education in this area was likely to come from the department, especially review of practice data (12, 44%). Only 19% (8) of respondents agreed with the statement that "the majority of teaching faculty in our program consistently model cost-effective healthcare to residents". Few of the programs (10, 24%) had formal curricula for residents regarding cost-effective care, and the primary mode of education in cost-effective care was through informal discussions with faculty (17, 43%). Few residents (3, 13%) were able to easily find the costs of tests or procedures. Discussion There is not consistent education in cost-effective care for orthopaedic surgery program leadership, faculty, or trainees. The results of this survey demonstrate a need for discussion of best practices, including increasing access to cost data at a local level, and engaging with the AOA, CORD, and the American Academy of Orthopaedic Surgeons more broadly in the development of standard education modules for faculty and residents, to improve the current and future delivery of cost-effective musculoskeletal care.
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Affiliation(s)
- Morgan Hadley
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Achraf Jardaly
- Department of Orthopaedic Surgery, St. Louis University, St. Louis, Missouri
| | - Kyle Paul
- Department of Orthopaedic Surgery, UT Health San Antonio, San Antonia, Texas
| | | | - Brent Wise
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Joshua Patt
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Kimberly Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Noben CYG, Stammen LA, Vaassen S, Haeren R, Stassen L, Mook WV, Essers B. Discrete choice experiment on educating value-based healthcare. Postgrad Med J 2020; 97:515-520. [PMID: 32796111 DOI: 10.1136/postgradmedj-2019-137190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/19/2020] [Accepted: 06/20/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Identifying costs and values in healthcare interventions as well as the ability to measure and consider costs relative to value for patients are pivotal in clinical decision-making and medical education. This study explores residents' preferences in educating value-based healthcare (VBHC) during postgraduate medical education. Exploring residents' preferences in VBHC education, in order to understand what shapes their choices, might contribute to improved medical residency education and healthcare as a whole. METHODS A discrete choice experiment (DCE) examined which conditions for educating VBHC are preferred by residents. DCE gives more insight into the trade-off's residents make when choosing alternatives, and which conditions for educating VBHC have the most influence on residents' preference. RESULTS This DCE shows that residents prefer knowledge on both medical practice as well as the process of care-to be educated by an expert on VBHC together with a clinician. They prefer limited protected time to conduct VBHC initiatives (thus while at work) and desire the inclusion of VBHC in formal educational plans. CONCLUSION When optimising graduate and postgraduate medical education curricula, these preferences should be considered to create necessary conditions for the facilitation and participation of residents in VBHC education and the set-up of VBHC initiatives.
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Affiliation(s)
- Cindy Y G Noben
- Academy of Postgraduate Medical Education, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Lorette A Stammen
- Department of Educational Development and Research, Maastricht University - Location Randwyck, Maastricht, Netherlands
| | - Sanne Vaassen
- Pediatrics, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Roel Haeren
- Neurosurgery, Maastricht University Medical Centre+, Maastricht, Netherlands.,Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Laurents Stassen
- Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands.,Department of Educational Development and Research, Maastricht University, Maastricht, Netherlands
| | - Brigitte Essers
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, Netherlands
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Nagle SJ, Aakhus E. Preparing Trainees to Deliver High-Value and Cost-Conscious Care in Hematology. Curr Hematol Malig Rep 2020; 15:248-253. [PMID: 32632656 DOI: 10.1007/s11899-020-00595-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Despite national-level directives to reduce healthcare waste and promote high-value care (HVC), clinical educators struggle to equip trainees with the knowledge and skills needed to practice value-based care. In this review, we analyze ongoing efforts in graduate medical education (GME) to enhance trainee competence in delivery of high-value and cost-conscious care. RECENT FINDINGS Surveys of residents and program directors have shown that while many training programs want to offer formal training in high-value care delivery, few succeed. Although several studies suggest that trainees model stewardship behaviors after clinical preceptors, there remains a shortage of faculty role models skilled in providing HVC. Preparing future hematologist-oncologists to provide cost-conscious care will require significant cultural change at the institutional and program levels and will depend heavily on the development of skilled clinical role models.
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Affiliation(s)
- Sarah J Nagle
- Knight Cancer Institute, Oregon Health & Sciences University, Portland, OR, USA
| | - Erin Aakhus
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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