Improving Residents’ Skills for Providing High Value Care · PDF file ·...
Transcript of Improving Residents’ Skills for Providing High Value Care · PDF file ·...
Improving Residents’ Skills for Providing High Value Care Through a Curricular Innovation: A Cost Conscious - Clinical
Reasoning Conference (CC-CRC) Kavitha Kesari MD, MS, FACP;
Shagufta Ali MD, FACP Susan J. Smith MD, FACP
[email protected] (810)342 3063
10/24/2014
The Disclosure
Educational Innovative Method
National Need • US - 30% of healthcare costs (more than $750
billion annually) are spent on wasted care • Canada spends ≤ U.S. by $1,589 per capita • Physician’s professional responsibility
– Use healthcare resources judiciously – Keep the individual patient in focus – Need: training about healthcare costs
* Pozen A, Eckstein D. Medical Spending Differences in the United States and Canada: The Role of Prices, Procedures, and Administrative Expenses, 2002
Objectives and Goals*
• To increase residents’ knowledge of healthcare’s value, quality, and cost metrics
Increase Knowledge
• To improve trainees attitudes regarding high value care by discussing Clinical Cases
Improve Attitudes
• Cultivate and sustain more cost-effective physician ordering behaviors Skills
*ACP-AAIM High value cost conscious care curriculum
ACGME
• Milestones Linked to Systems-Based Practice • Understand and apply cost-benefit analysis • Identify health care stakeholders and their impact
on cost of, and access to, health care • Identify costs for common diagnostic tests and
treatment • Minimize unnecessary care • Demonstrate incorporation of cost-awareness
into standard clinical decision-making
CANMEDS
HEALTH ADVOCATE • Demonstrate patient advocacy for beneficial
services and resources (EBM) • Facilitate timely patient access to services and
resources
HEALTH CANMEDS ADVOCATE • Advocate for
beneficial services or resources
• Timely patient access services and resources
Systems-Based Practice • Cost-benefit analysis • Various health care
stakeholders • Identify costs • Minimize unnecessary
care • Cost-awareness
principles
M I L E S T O N E s
CANMEDS/ ACGME
VALUE = Health Outcomes/Cost
Background
• Last year, we implemented ACP's High Value, Cost Conscious Care (HVCCC) as formal curriculum.
• IM residents participated in interactive case-based workshops and didactic sessions
HVCC CIRRICULUM
Workshop Didactic sessions
CC-CRC
Clinical Reasoning Conference
Introducing High Value Care
Teams structure
Case History and physical
exam findings are disclosed sequentially
Team 1 Team 2
Methods
• CRC - progressive disclosure of a case in response to residents’ – hypothesis-driven questions
• Analytical, conscious
– pattern recognition • Non-analytical, unconscious
Case Presentation Chief Complaint*
Mental Representation History/ PE/
Diagnostic WU Hypothesis tested
Analytic ↔ Non-analytic
*Eva K.What every teacher needs to know about clinical reasoning. Medical Education 2004:39:98106
In Brief
• History and physical exam findings are disclosed sequentially
• Two resident teams compete • Each has PGY-1 through PGY-3 residents • Teams selectively choose tests to confirm or
disprove diagnostic impressions
Methods
• Health Care Blue Book* residents choose diagnostic tests – evidence – cost and – diagnostic yield (using HVCCC)
• The team that diagnoses the condition at the least cost wins
*The Healthcare Bluebook is a guide to help you determine Fair Prices in your area for
healthcare services.
Concludes with Case Discussion
• Reviews the Case-Salient Features • Differential Diagnosis • Costs and Diagnostic yield • Risks of various tests and procedures
Survey Questions SA A N D SD
1. I am able to effectively use history and physical examination skills to minimize the need for further diagnostic testing
2. I am able to recognize and account for the unique characteristics of a patient while trying to generate a differential diagnosis
3. I am able to incorporates cost-awareness principles into standard clinical judgments and decision-making, including screening tests
4. I am able to understand the concepts of pre-test probability and test performance characteristics
5. I am able to interprets complex diagnostic tests accurately
6. I am able to assess potential costs to the patient when ordering tests
7. I am able to assess the costs to the health care system when ordering tests
8. I am able to fully understand the rationale and risks associated with common diagnostic imaging/procedures
9. I am able to understand how test results will affect management
10. I will incorporate HVC principles in my future practice
Resident’s Reflection about the Impact of Cost-Conscious CRC on their daily clinical practice
SA-Strongly Agree, A- Agree N- Neutral D- Disagree SD- Strongly Disagree
Results
8 8
7
6 6 6
5
7 7
11
7 7 7
5 5 5
7
6
7
4
1
3
4
3
2 2
1 1 1 1
0
2
4
6
8
10
12
Q 1 Q 2 Q 3 Q 4 Q 5 Q 6 Q 7 Q 8 Q 9 Q 10
Cost Conscious Care CRCs
Strongly Agree
Agree
Neutral
Disagree
StronglyDisagree
Summary
• We modified our CRC – competition – evidence-based teaching – awareness of cost-consciousness – high value care – Our CC-CRC reinforces the Can MEDS framework
and the ACGME competencies.
Thank you
Can MEDS framework ACGME competencies
• Medical Knowledge • Patient Care • Professionalism • Interpersonal &
Communication Skills • Practice-based Learning • System based learning