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Frese W, Ford-Davis J, Hanson K, Lombardo M, Shen S. Increasing High-Value, Cost-Conscious Care Family Rounding Discussions Via an Educational Rounding Tool. Hosp Pediatr 2024:e2023007628. [PMID: 39129499 DOI: 10.1542/hpeds.2023-007628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/21/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Family-centered rounds (FCR) are an important time to engage in high-value, cost-conscious care (HV3C) discussions. However, research suggests HV3C conversations occur in a minority of FCRs. Best-practice support tools can improve provider performance, but no research has evaluated whether an HV3C-focused tool may increase pediatricians' HV3C FCR discussions. This study aimed to assess if an educational and practice-based HV3C Rounding Tool's introduction would increase providers' HV3C FCR performance and competence. METHODS This study involved a hospitalist teaching service at a tertiary-care hospital. Evidence-based HV3C Rounding Tool and Quick Reference interventions were designed for use on FCRs, using a validated tool to measure baseline and postintervention HV3C performance. Underlying family, nursing presence/participation, and other factors' impacts upon HV3C performance were also explored. Anonymous baseline and postintervention surveys compared providers' perceived competence and comfort engaging families in HV3C discussions, as well as the tools' usefulness. RESULTS Out of the 197 baseline and 157 intervention encounters recorded, the tools respectively increased from 3.8 to 5.8 HV3C performance measures addressed (P < .001), with 80% of performance measures showing significant improvement (P < .002). Aside from family presence for select performance measures, the tools had an independent, significant, positive effect upon HV3C performance. Users generally reported the tools as helpful and easy to use, noting significant increases in faculty role-modeling and trainee competence practicing HV3C. CONCLUSIONS Introduction of HV3C Rounding and Quick Reference tools were generally perceived as helpful and beneficial, resulting in an increase of providers' HV3C discussions and care delivery during FCRs.
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Affiliation(s)
- William Frese
- University of Illinois, College of Medicine, Peoria, Illinois
- OSF HealthCare, Children's Hospital of Illinois, Peoria, Illinois; and
| | - Jessica Ford-Davis
- University of Illinois, College of Medicine, Peoria, Illinois
- OSF HealthCare, Children's Hospital of Illinois, Peoria, Illinois; and
| | - Keith Hanson
- University of Illinois, College of Medicine, Peoria, Illinois
- OSF HealthCare, Children's Hospital of Illinois, Peoria, Illinois; and
| | - Monica Lombardo
- University of Illinois, College of Medicine, Peoria, Illinois
| | - Sprina Shen
- Loma Linda University School of Medicine, Loma Linda, California, formerly University of Illinois College of Medicine, Chicago, Illinois
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2
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Moriates C, Silverstein WK, Bandeira de Mello R, Stammen L, Wong BM. High-value care education can learn from the evidence-based medicine movement: moving beyond competencies and curricula to culture. BMJ Evid Based Med 2024; 29:147-150. [PMID: 37479241 DOI: 10.1136/bmjebm-2023-112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Christopher Moriates
- Departments of Internal Medicine and Medical Education, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Executive Director, Costs of Care, Boston, Massachusetts, USA
| | - William K Silverstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Choosing Wisely Canada, Toronto, ON, Canada
| | - Renato Bandeira de Mello
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porte Alegre, Brazil
| | - Lorette Stammen
- School of Health Professions Education, Maastricht University, Maastricht, Limburg, Netherlands
| | - Brian M Wong
- Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Bock LA, Westra D, Noben CY, Essers BA, van Mook WN. A Social Network Analysis of Influences on Residents' Value-Based Decisions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1304-1312. [PMID: 37332220 PMCID: PMC10589424 DOI: 10.1097/acm.0000000000005298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PURPOSE To ensure a value-based health care system, it is becoming increasingly important that residents are trained in making value-based decisions. This study explored the social network influencing residents' value-based decisions. METHOD To explore the social network influencing residents' value-based decisions, the authors used a semistructured individual and mini-group interviewing approach and participatory visual mapping. In total, 17 residents across 13 different specialties were interviewed from the southeastern postgraduate medical education and training region of the Netherlands, May-November 2021. Two researchers independently coded the transcribed data using an integrated inductive thematic approach. Subsequently, social network analysis was used to visualize the results. RESULTS Residents indicated that their value-based decisions were influenced by direct actors who influenced decisions related to patients and indirect actors who shaped decisions related to patients without directly modifying them. Different interaction-aspects (i.e., personal, situational, and institutional) further affected residents' ability to make value-based decisions. Thus, residents' value-based decisions were a product of the interplay between various interactions with actors and different interaction-aspects. Residents defined value-based decisions differently, even within an interview. CONCLUSIONS These results suggest residents' value-based decisions are influenced by a multitude of actors, including hierarchically superior colleagues who can directly alter decisions and patients (and their families) and nurses with whom residents consider it important to maintain good relationships. In addition, more experienced actors, mainly from the medical and nursing profession, contribute most to learning. Furthermore, residents' value-based decisions are deeply underpinned by the hidden curriculum. However, many senior physicians may not have received sufficient training in the concept of value-based health care. Consequently, an approach of formally educating residents in value-based health care will likely have limited effects unless social influences in day-to-day clinical settings reinforce its importance.
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Affiliation(s)
- Lotte A. Bock
- L.A. Bock is a PhD student, Academy of Postgraduate Medical Education, Maastricht University Medical Centre, and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-5249-4522
| | - Daan Westra
- D. Westra is assistant professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-1791-3626
| | - Cindy Y.G. Noben
- C.Y.G. Noben is strategic and medical educational advisor, Academy of Postgraduate Medical Education, Maastricht University Medical Centre, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-2766-8057
| | - Brigitte A.B. Essers
- B.A.B. Essers is senior researcher, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-7703-7114
| | - Walther N.K.A. van Mook
- W.N.K.A. van Mook is medical doctor and full professor, Academy of Postgraduate Medical Education, Department of Intensive Care Medicine, Maastricht University Medical Centre, and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-2398-8878
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Moriates C. How can we finally reduce repetitive routine laboratory tests for hospitalised patients? BMJ Qual Saf 2023; 32:498-501. [PMID: 37328268 DOI: 10.1136/bmjqs-2023-016315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Christopher Moriates
- Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
- Executive Director, Costs of Care, Boston, Massachusetts, USA
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Navanandan N, McNulty MC, Suresh K, Freeman J, Scherer LD, Tyler A. Factors Associated With Clinician Self-Reported Resource Use in Acute Care and Ambulatory Pediatrics. Clin Pediatr (Phila) 2022; 62:329-337. [PMID: 36199256 PMCID: PMC10073349 DOI: 10.1177/00099228221128074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study is to determine predictors of resource use among pediatric providers for common respiratory illnesses. We surveyed pediatric primary care, emergency department (ED)/urgent care (UC), and hospital medicine providers at a free-standing children's hospital system. Five clinical vignettes assessed factors affecting resource use for upper respiratory infections, bronchiolitis, and pneumonia, including provider-type, practice location, tolerance to uncertainty, and medical decision-making behaviors. The response rate was 75.3% (168/223). The ED/UC and primary care providers had higher vignette scores, indicating higher resource use, compared with inpatient providers; advanced practice providers (APPs) had higher vignette scores compared with physicians. In multivariate analysis, being an ED/UC provider, an APP, and greater concern for bad outcomes were associated with higher vignette scores. Overall, provider type and location of practice may predict resource use for children with respiratory illnesses. Interventions targeted at test-maximizing providers may improve quality of care and reduce resource burden.
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Affiliation(s)
- Nidhya Navanandan
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monica C McNulty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Krithika Suresh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Julia Freeman
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura D Scherer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Tyler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Section of Pediatric Hospital Medicine, Children's Hospital of Colorado, Aurora, CO, USA
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van Engen V, Bonfrer I, Ahaus K, Buljac-Samardzic M. Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review. Front Public Health 2022; 9:800702. [PMID: 35096748 PMCID: PMC8792751 DOI: 10.3389/fpubh.2021.800702] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Healthcare systems increasingly move toward “value-based healthcare” (VBHC), aiming to further improve quality and performance of care as well as the sustainable use of resources. Evidence about healthcare professionals' contributions to VBHC, experienced job demands and resources as well as employee well-being in VBHC is scattered. This systematic review synthesizes this evidence by exploring how VBHC relates to the healthcare professional, and vice versa.Method: Seven databases were systematically searched for relevant studies. The search yielded 3,782 records, of which 45 were eligible for inclusion based on a two-step screening process using exclusion criteria performed by two authors independently. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Based on inductive thematic analysis, the Job Demands-Resources (JD-R) model was modified. Subsequently, this modified model was applied deductively for a second round of thematic analysis.Results: Ten behaviors of healthcare professionals to enhance value in care were identified. These behaviors and associated changes in professionals' work content and work environment impacted the experienced job demands and resources and, in turn, employee well-being and job strain. This review revealed 16 constructs as job demand and/or job resource. Examples of these include role strain, workload and meaning in work. Four constructs related to employee well-being, including engagement and job satisfaction, and five constructs related to job strain, including exhaustion and concerns, were identified. A distinction was made between job demands and resources that were a pure characteristic of VBHC, and job demands and resources that resulted from environmental factors such as how care organizations shaped VBHC.Conclusion and Discussion: This review shows that professionals experience substantial job demands and resources resulting from the move toward VBHC and their active role therein. Several job demands are triggered by an unsupportive organizational environment. Hence, increased organizational support may contribute to mitigating or avoiding adverse psychosocial factors and enhance positive psychosocial factors in a VBHC context. Further research to estimate the effects of VBHC on healthcare professionals is warranted.
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Naderi R, Oberndorfer TA, Jordan SR, Dollar B, Cumbler EU, Jones CD. Resident perspectives on the value of interdisciplinary conference calls for geriatric patients. BMC MEDICAL EDUCATION 2021; 21:314. [PMID: 34082723 PMCID: PMC8173720 DOI: 10.1186/s12909-021-02750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are limited competency-based educational curricula for transitions of care education (TOC) for internal medicine (IM) residency programs. The University of Colorado implemented a virtual interdisciplinary conference call, TEAM (Transitions Expectation and Management), between providers on the inpatient Acute Care of the Elder (ACE) unit and the outpatient Seniors Clinic at the University of Colorado Hospital. Residents rotating on the ACE unit participated in weekly conferences discussing Seniors Clinic patients recently discharged, or currently hospitalized, to address clinical concerns pertaining to TOC. Our goals were to understand resident perceptions of the educational value of these conferences, and to determine if these experiences changed attitudes or practice related to care transitions. METHODS We performed an Institutional Review Board-approved qualitative study of IM housestaff who rotated on the ACE unit during 2018-2019. Semi-structured interviews were conducted to understand perceptions of the value of TEAM calls for residents' own practice and the impact on patient care. Data was analyzed inductively, guided by thematic analysis. RESULTS Of the 32 IM residents and interns who rotated on ACE and were invited to participate, 11 agreed to an interview. Three key themes emerged from interviews that highlighted residents' experiences identifying and navigating some of their educational 'blind spots:' 1) Awareness of patient social complexities, 2) Bridging gaps in communication across healthcare settings, 3) Recognizing the value of other disciplines during transitions. CONCLUSIONS This study highlights learner perspectives of the benefit of interdisciplinary conference calls between inpatient and outpatient providers to enhance transitions of care, which provide meaningful feedback and serve as a vehicle for residents to recognize the impact of their care decisions in the broader spectrum of patients' experience during hospital discharge. Educators can maximize the value of these experiences by promoting reflective debriefs with residents and bringing to light previously unrecognized knowledge gaps around hospital discharge.
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Affiliation(s)
- Roxana Naderi
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, Mailstop F782, Aurora, CO 80045 USA
| | - Tyson A. Oberndorfer
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Mailstop 8111, Aurora, CO 80045 USA
| | - Sarah R. Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Mailstop 8111, Aurora, CO 80045 USA
| | - Blythe Dollar
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Aurora, CO 80045 USA
| | - Ethan U. Cumbler
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, Mailstop F782, Aurora, CO 80045 USA
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, Mailstop F782, Aurora, CO 80045 USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, 1700 North Wheeling Street, Aurora, CO 80045-7211 USA
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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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