From the 2024 HVPA National Conference
Tae-Hee Kim BA (The Ohio State University College of Medicine, Columbus, OH), Hannah Shenton BS, Anitra Karthic BA, Allison Heacock MD, Christina Dietz PhD
Background:
Rising healthcare costs in the U.S. are posing increasing financial strains on patients. High-value care (HVC) is a framework for clinical practice that helps physicians optimize quality of care, resource utilization, and patient outcomes, while reducing unnecessary costs burdened by patients and the healthcare system. However, despite these benefits, there is a lack of consistent formal HVC curriculum in U.S. pre-clinical medical education.
Objective:
This study aimed to evaluate the efficacy of a pilot HVC lesson compared to an expanded 3-lesson HVC curriculum.
Methods:
A two-hour HVC pilot lesson was implemented into an existing longitudinal pre-clinical course for first-year medical students facilitated by faculty physicians. Lesson topics included the value shortfall, healthcare overtreatment, and basic principles of HVC. Students participated in group discussions on the clinical applications of HVC and evaluated treatment options for a given clinical case.
The following year, the pilot lesson was expanded to a 3-lesson HVC curriculum. The first two lessons were integrated into the same first-year curriculum, covering the meaning of value in healthcare and understanding outcomes that matter to patients. The third lesson was integrated into the second-year curriculum of the same course, with a focus on the costs of care, understanding healthcare insurance, and insurance organization. Group discussions and case-based learning were similarly utilized for the expanded curriculum. Only the first two lessons were evaluated for the relevancy of this study.
Efficacy of the curriculums were evaluated using pre- and post-lesson surveys assessing HVC knowledge, attitudes towards HVC, and self-efficacy on applying HVC in clinical practice.
Results:
Sixty-seven (32.2%) of 208 students completed the pre- and post-lesson survey for the 1-lesson curriculum and 137 (65.6%) of 209 students completed both surveys for the 3-lesson curriculum.
Knowledge improved from 61.19% to 76.12% (p = 0.003) for the pilot lesson and improved from 54.38% to 71.17% (p < 0.001) for the 3-lesson curriculum. Knowledge improvement between the two curriculums was nonsignificant (p = 0.22).
Overall, attitudes towards HVC (scale: 0-33) improved from 23.36 to 24.30 (p = 0.048) for the 1-lesson and increased from 21.88 to 23.64 (p < 0.001) for the 3-lesson curriculum. Change in attitudes between the curriculums was nonsignificant (p = 0.28).
Self-efficacy (scale: 0-60) improved from 26.16 to 33.27 (p < 0.001) for the 1-lesson and 28.96 to 38.08 (p < 0.001) for the 3-lesson curriculum. Self-efficacy improvement between the two curriculums was significant (p < 0.001).
Conclusions:
Both the 1-lesson and 3-lesson curriculum significantly improved HVC knowledge, attitudes towards HVC, and self-efficacy on applying HVC in clinical practice following lesson delivery. However, the 3-lesson curriculum was more effective in improving student self-efficacy. This suggests that the expanded HVC education was more beneficial in helping students feel more prepared to apply HVC in clinical settings. These results support the need for expanded HVC education in pre-clinical medical education.
Clinical Implications:
By incorporating high-value care education into pre-clinical medical education, future medical providers may have a better understanding of HVC practices. This enables them to improve the quality of care for their patients, while reducing unnecessary costs and resources. Through participating in programs that improve self-efficacy of these skills, this allows future providers to have confidence that they can improve patient outcomes and aid in decreasing the growing financial burden of healthcare.