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Pak SS, Scheid A, Hoang C, Fitzsimmons A, Topp KS. Implementation of High-Value Care for Physical Therapy Residents Through Systems-Based Practice Curriculum Development: Case Report. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00118. [PMID: 38978183 DOI: 10.1097/jte.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/30/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND PURPOSE Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice. CASE DESCRIPTION The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents. OUTCOMES The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice. DISCUSSION AND CONCLUSION This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.
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Affiliation(s)
- Sang S Pak
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Alison Scheid
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Cathy Hoang
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Amber Fitzsimmons
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Kimberly S Topp
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
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Harrison MI, Borsky AE. Funding Learning Health System Research: Challenges and Strategies. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:673-682. [PMID: 38363814 DOI: 10.1097/acm.0000000000005661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE A growing number of health systems are establishing learning health system (LHS) programs, where research focuses on rapidly improving the health system's internal operations and performance. The authors examine funding challenges facing such initiatives and identify strategies for managing tensions between reliance on external research funding and directly contributing to improvement and learning within the researchers' own system. METHOD Qualitative case studies of LHS research programs in 5 health systems were performed via 38 semistructured interviews (October 2019-April 2021) with 35 diverse respondents. Inductive and deductive rapid qualitative analysis supported interview, system-level, and cross-system summaries and analysis. RESULTS External funding awards to LHS researchers facilitated some internal improvement and learning, scientific advancements, and the reputation of researchers and their systems, but reliance on external funding also challenged researchers' responsiveness to concerns of system leaders, managers, practitioners, and system needs. Gaps between external funding requirements and internally focused projects arose in objectives, practical applicability, audiences, timetables, routines, skill sets, and researchers' careers. To contribute more directly to system improvement, LHS researchers needed to collaborate with clinicians and other nonresearchers and pivot between long research studies and shorter, dynamic improvement, evaluation, and data analysis projects. With support from system executives, LHS program leaders employed several strategies to enhance researchers' internal contributions. They aligned funded-research topics with long-term system needs, obtained internal funding for implementing and sustaining practice change, and diversified funding sources. CONCLUSIONS To foster LHS research contributions to internal system learning and improvement, LHS program leaders need to manage tensions between concentrating on externally funded research and fulfilling their mission of providing research-based services to their own system. Health system executives can support LHS programs by setting clear goals for them; appropriately staffing, budgeting, and incentivizing LHS researchers; and developing supportive, system-wide teamwork, skill development programs, and data infrastructures.
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Gonzalo JD, Wolpaw DR, Cooney R, Mazotti L, Reilly JB, Wolpaw T. Evolving the Systems-Based Practice Competency in Graduate Medical Education to Meet Patient Needs in the 21st-Century Health Care System. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:655-661. [PMID: 35044981 DOI: 10.1097/acm.0000000000004598] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medical education is increasingly recognizing the importance of the systems-based practice (SBP) competency in the emerging 21st-century U.S. health care landscape. In the wake of data documenting insufficiencies in care delivery, notably in patient safety and health care disparities, the Accreditation Council for Graduate Medical Education created the SBP competency to address gaps in health outcomes and facilitate the education of trainees to better meet the needs of patients. Despite the introduction of SBP over 20 years ago, efforts to realize its potential have been incomplete and fragmented. Several challenges exist, including difficulty in operationalizing and evaluating SBP in current clinical learning environments. This inconsistent evolution of SBP has compromised the professional development of physicians who are increasingly expected to advance systems of care and actively contribute to improving patient outcomes, patient and care team experience, and costs of care. The authors prioritize 5 areas of focus necessary to further evolve SBP: comprehensive systems-based learning content, a professional development continuum, teaching and assessment methods, clinical learning environments in which SBP is learned and practiced, and professional identity as systems citizens. Accelerating the evolution of SBP in these 5 focus areas will require health system leaders and educators to embrace complexity with a systems thinking mindset, use coproduction between sponsoring health systems and education programs, create new roles to drive alignment of system and educational goals, and use design thinking to propel improvement efforts. The evolution of SBP is essential to cultivate the next generation of collaboratively effective, systems-minded professionals and improve patient outcomes.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Daniel R Wolpaw
- D.R. Wolpaw is professor of medicine and humanities, Penn State College of Medicine, Hershey, Pennsylvania
| | - Robert Cooney
- R. Cooney is associate professor of emergency medicine, Geisinger Health, Danville, Pennsylvania
| | - Lindsay Mazotti
- L. Mazotti is assistant physician-in-chief, education and development, Kaiser Permanente, Oakland, California, and assistant dean, clinical education, Kaiser Permanente School of Medicine, Pasadena, California
| | - James B Reilly
- J.B. Reilly is associate professor of medicine, senior vice president for academic affairs, and designated institutional official for graduate medical education, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Terry Wolpaw
- T. Wolpaw is professor of medicine and vice dean for educational affairs, Penn State College of Medicine, Hershey, Pennsylvania
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Arora VM, Rosenbluth G, O'Rourke A, Pappas RM, Hamilton AC, Vath RJ, Blanchard AK. Pursuing Excellence: Integrating Clinical Learning Environment Staff and Learners Into the Pursuit of Quality, Safety, Equity, and Value. J Grad Med Educ 2021; 13:294-300. [PMID: 33897969 PMCID: PMC8054589 DOI: 10.4300/jgme-d-21-00197.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vineet M. Arora
- Vineet M. Arora, MD, MAPP*, is Herbert T. Abelson Professor of Medicine and Associate Chief Medical Officer-Clinical Learning Environment, University of Chicago Medicine
| | - Glenn Rosenbluth
- Glenn Rosenbluth, MD*, is Professor of Pediatrics and Director of Quality and Safety Programs, GME, University of California, San Francisco
| | - Amanda O'Rourke
- Amanda O'Rourke, MBA, is Director, GME, CME, and Simulation Finance, University of Chicago Medicine
| | - Rita M. Pappas
- Rita M. Pappas, MD, is Medical Director, Hospital Operations, Division of Medical Operations, Cleveland Clinic Health System
| | - Aaron C. Hamilton
- Aaron C. Hamilton, MD, MBA, is Associate Chief Safety and Quality Officer, Cleveland Clinic Health System
| | - Richard J. Vath
- Richard J. Vath, MEd, is Senior Director and Dean of Education, Our Lady of the Lake Regional Medical Center
| | - Anita K. Blanchard
- Anita K. Blanchard, MD, is Professor of Obstetrics and Gynecology, Associate Dean for Graduate Medical Education, and Designated Institutional Official, University of Chicago Medicine
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Godwin PO, Desai NR, Wachsberg K. Improving Exposure of Physician Trainees to Patient Safety and Quality Improvement. South Med J 2021; 113:643-644. [PMID: 33263135 DOI: 10.14423/smj.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Patrick O Godwin
- From the Department of Medicine, Division of Academic Internal Medicine, and the Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois College of Medicine, Chicago, and the Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Neeraj R Desai
- From the Department of Medicine, Division of Academic Internal Medicine, and the Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois College of Medicine, Chicago, and the Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kelley Wachsberg
- From the Department of Medicine, Division of Academic Internal Medicine, and the Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois College of Medicine, Chicago, and the Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Dulay M, Saxe JM, Odden K, Strewler A, Lau A, O'Brien B, Shunk R. Promoting Quality Improvement in Primary Care Through a Longitudinal, Project-Based, Interprofessional Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10932. [PMID: 32934977 PMCID: PMC7485912 DOI: 10.15766/mep_2374-8265.10932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/17/2020] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Health professionals must demonstrate competencies in quality improvement (QI) and interprofessional (IP) practice. Yet few curricula are designed to address these competencies in an integrated, longitudinal way. Our experiential IP QI curriculum addresses this gap. METHODS The IP QI curriculum was part of a San Francisco VA Health Care System training program for second-year internal medicine residents and adult gerontology primary care nurse practitioner students, pharmacy residents, and postdoctoral psychology fellows. Trainees worked in mentored IP teams to select, design, implement, evaluate, and present a project as part of a 9-month curriculum. Teaching methodologies included didactics and project-based skills application. Curriculum evaluation included trainees' QI knowledge and skills self-assessments, trainee satisfaction, mentor appraisals, and project results and impact assessments. RESULTS From 2011-2012 to 2017-2018, 242 trainees completed the curriculum and 41 QI projects. Trainees reported high satisfaction with the introductory sessions (M = 4.4, SD = 0.7). They also reported improvement in comfort with QI knowledge and skills by the curriculum's completion. QI mentors (n = 23) observed growth in trainees' QI knowledge and skills, felt confident in trainees' ability to orchestrate a QI initiative, and believed their mentored QI projects added value to the organization. Thirty-eight projects resulted in system modifications. DISCUSSION This IP QI curriculum offers team-based, workplace experiences for trainees to learn and apply QI knowledge and skills. Leading factors for successful implementation included attention to team-building and faculty development. Challenges included reliably collecting evaluation data, accurately measuring ongoing systems changes, and variable trainee engagement.
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Affiliation(s)
- Maya Dulay
- Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Director for Clinical Care and Education, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
- Corresponding author:
| | - JoAnne M. Saxe
- Professor Emerita, University of California, San Francisco, School of Nursing; Faculty Consultant, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
| | - Krista Odden
- Assistant Clinical Professor, University of California, San Francisco, School of Nursing; Associate NP Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
| | - Anna Strewler
- Assistant Clinical Professor, University of California, San Francisco, School of Nursing; Co-Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
| | - Andrew Lau
- Assistant Professor, University of California, San Francisco, School of Pharmacy; Associate Director of Pharmacy, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
| | - Bridget O'Brien
- Adjunct Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Director of Scholarship and Evaluation, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
| | - Rebecca Shunk
- Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Chief of Staff for Education, San Francisco VA Health Care System; Co-Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
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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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Gonzalo JD, Chuang CH, Glod SA, McGillen B, Munyon R, Wolpaw DR. General Internists as Change Agents: Opportunities and Barriers to Leadership in Health Systems and Medical Education Transformation. J Gen Intern Med 2020; 35:1865-1869. [PMID: 31898138 PMCID: PMC7280380 DOI: 10.1007/s11606-019-05611-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023]
Abstract
Health systems are increasingly engaging in mission development around the quadruple aim of patient experience of care, population health, cost of care, and work-life balance of clinicians. This integrated approach is closely aligned with the education principles and competencies of health systems science (HSS), which includes population health, high-value care, leadership, teamwork, collaboration, and systems thinking. Influenced by health outcomes research, the systems-based practice competency, and the Clinical Learning Environment Review, many medical schools and residency programs are taking on the challenge of comprehensively incorporating these HSS competencies into the education agenda. General internal medicine physicians, inclusive of hospitalists, geriatricians, and palliative and primary care physicians, are at the frontlines of this transformation and uniquely positioned to contribute to and lead health system transformation, role model HSS competencies for trainees, and facilitate the education of a new workforce equipped with HSS skills to accelerate change in healthcare. Although GIM faculty are positioned to be early adopters and leaders in evolving systems of care and education, professional development and changes with academic health systems are required. This Perspective article explores the conceptualization and opportunities to effectively link GIM with healthcare and medical education transformation.
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Affiliation(s)
- Jed D Gonzalo
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Susan A Glod
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Brian McGillen
- Division of Hospital Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ryan Munyon
- Division of Hospital Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R Wolpaw
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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Mordang SBR, Könings KD, Leep Hunderfund AN, Paulus ATG, Smeenk FWJM, Stassen LPS. A new instrument to measure high value, cost-conscious care attitudes among healthcare stakeholders: development of the MHAQ. BMC Health Serv Res 2020; 20:156. [PMID: 32122356 PMCID: PMC7053044 DOI: 10.1186/s12913-020-4979-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/11/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Residents have to learn to provide high value, cost-conscious care (HVCCC) to counter the trend of excessive healthcare costs. Their learning is impacted by individuals from different stakeholder groups within the workplace environment. These individuals' attitudes toward HVCCC may influence how and what residents learn. This study was carried out to develop an instrument to reliably measure HVCCC attitudes among residents, staff physicians, administrators, and patients. The instrument can be used to assess the residency-training environment. METHOD The Maastricht HVCCC Attitude Questionnaire (MHAQ) was developed in four phases. First, we conducted exploratory factor analyses using original data from a previously published survey. Next, we added nine items to strengthen subscales and tested the new questionnaire among the four stakeholder groups. We used exploratory factor analysis and Cronbach's alphas to define subscales, after which the final version of the MHAQ was constructed. Finally, we used generalizability theory to determine the number of respondents (residents or staff physicians) needed to reliably measure a specialty attitude score. RESULTS Initial factor analysis identified three subscales. Thereafter, 301 residents, 297 staff physicians, 53 administrators and 792 patients completed the new questionnaire between June 2017 and July 2018. The best fitting subscale composition was a three-factor model. Subscales were defined as high-value care, cost incorporation, and perceived drawbacks. Cronbach's alphas were between 0.61 and 0.82 for all stakeholders on all subscales. Sufficient reliability for assessing national specialty attitude (G-coefficient > 0.6) could be achieved from 14 respondents. CONCLUSIONS The MHAQ reliably measures individual attitudes toward HVCCC in different stakeholders in health care contexts. It addresses key dimensions of HVCCC, providing content validity evidence. The MHAQ can be used to identify frontrunners of HVCCC, pinpoint aspects of residency training that need improvement, and benchmark and compare across specialties, hospitals and regions.
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Affiliation(s)
- Serge B R Mordang
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P. O. Box 616, 6200 MD, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands.
| | - Karen D Könings
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P. O. Box 616, 6200 MD, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands
| | | | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Frank W J M Smeenk
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P. O. Box 616, 6200 MD, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands
- Department of Pulmonary Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Laurents P S Stassen
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P. O. Box 616, 6200 MD, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Hartley B, Roberts C. The future of academic medical centres in the US: Consolidation or extinction? Injury 2019; 50:2149-2151. [PMID: 31668354 DOI: 10.1016/j.injury.2019.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Brandi Hartley
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, Louisville, KY 40292, United States
| | - Craig Roberts
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, Louisville, KY 40292, United States.
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Gupta R, Steers N, Moriates C, Wali S, Braddock CH, Ong M. High-Value Care Culture Among the Future Physician Workforce in Internal Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1347-1354. [PMID: 31460932 DOI: 10.1097/acm.0000000000002619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Training in high-spending regions correlates with higher spending patterns among practicing physicians. This study aimed to evaluate whether trainees' exposure to a high-value care culture differed based on type of health system in which they trained. METHOD In 2016, 517 internal medicine residents at 12 California graduate medical education programs (university, community, and safety-net medical centers) completed a cross-sectional survey assessing perceptions of high-value care culture within their respective training program. The authors used multilevel linear regression to assess the relationship between type of medical center and High-Value Care Culture Survey (HVCCS) scores. The correlation between mean institutional HVCCS and Centers for Medicare and Medicaid Services' Value-Based Purchasing (VBP) scores was calculated using Spearman rank coefficients. RESULTS Of 517 residents, 306 (59.2%), 83 (16.1%), and 128 (24.8%) trained in university, community, and safety-net programs, respectively. Across all sites, the mean HVCCS score was 51.2 (standard deviation [SD] 11.8) on a 0-100 scale. Residents reported lower mean HVCCS scores if they were from safety-net-based training programs (β = -4.4; 95% confidence interval: -8.2, -0.6) with lower performance in the leadership and health system messaging domain (P < .001). Mean institutional HVCCS scores among university and community sites positively correlated with institutional VBP scores (Spearman r = 0.71; P < .05). CONCLUSIONS Safety-net trainees reported less exposure to aspects of high-value care culture within their training environments. Tactics to improve the training environment to foster high-value care culture include training, increasing access to data, and improving open communication about value.
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Affiliation(s)
- Reshma Gupta
- R. Gupta is interim chief value director, UCLA-Olive View Medical Center, assistant professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, and director, Evaluation and Outreach, Costs of Care, Boston, Massachusetts. N. Steers is biostatistician, VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, and adjunct associate professor of medicine and sociology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. C. Moriates is assistant dean for healthcare value, associate chair of quality, safety and value, and associate professor, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, and director of implementation, Costs of Care, Boston, Massachusetts. S. Wali is chair, Department of Medicine at Olive View-UCLA Medical Center, and professor and executive vice chair of medicine for affiliated University of California, Los Angeles hospitals, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. C.H. Braddock III is vice dean for education, David Geffen School of Medicine, and professor, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. M. Ong is professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, and chief, Hospitalist Division, Greater Los Angeles VA Health Care System, Los Angeles, California
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Sklar DP. Creating a Medical Education Continuum With Competencies and Entrustable Professional Activities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1257-1260. [PMID: 31460904 DOI: 10.1097/acm.0000000000002805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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O'Brien BC, Reed DA. Exploring the Intersections of Education and Healthcare Delivery Using a Clinical Learning Environment Framework. J Gen Intern Med 2019; 34:654-656. [PMID: 30993626 PMCID: PMC6502912 DOI: 10.1007/s11606-019-04929-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, 533 Parnassus Ave. Suite U-80, San Francisco, CA, 94143-0710, USA.
| | - Darcy A Reed
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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