From the 2024 HVPA National Conference
Hannah Shenton BS (The Ohio State University College of Medicine, Columbus, OH), Tae-Hee Kim BA, Anitra Karthic BA, Allison Heacock MD, Christina Dietz PhD
Background:
As costs of healthcare continue to rise in the United States, medical care is posing a new harm to patients: financial harm. One solution to this problem is high-value care (HVC), which aims to optimize value of care by improving patient outcomes while minimizing costs. Despite the overall acceptance of HVC into clinician’s practices, there remains a lack of HVC education for undergraduate medical students, specifically in the pre-clinical years.
Objective:
This study aims to evaluate the efficacy of a three-lesson HVC series.
Methods:
The three-lesson series was incorporated into the mandatory longitudinal “doctoring” course for pre-clinical medical students at the Ohio State University College of Medicine (OSUCOM) within the required system-based practice curricular learning objectives on HVC. The first lesson focused on the value of healthcare, including the value shortfall, financial harms of healthcare, and the value healthcare equation. The second lesson, delivered at 3-month, focused on determining outcomes that matter to patients, screening patients for financial harm, and understanding some cost-saving strategies. The third lesson, delivered 13 months, focused on costs of care, insurance types, and insurance reimbursement.
Students completed an anonymous pre-survey prior to the first lesson. They completed the same survey immediately following the third lesson. The survey assessed students’ self-efficacy in HVC application (0-10), knowledge of HVC principles, and HVC attitudes via a 4-point Likert, where higher value was more aligned with HVC. The survey was developed using the 2015 medical student survey items published by Hunderfund et al. in Academic Medicine. Pre- and post-survey results were analyzed using Wilcoxon-signed rank tests in Microsoft Excel.
Results:
209 pre-clinical medical students received the three-lesson series. 103 (49.28%) students completed both the pre- and post-survey. Student reported self-efficacy for the 6 statements increased from 34.94 to 43.66 (p < 0.001). Knowledge improved from 49.03% to 72.82% (p < 0.001). The 11 assessed attitudes increased 24.14 to 24.51 (p = .23).
Conclusions:
There was a significant increase in self-efficacy and knowledge after the 3-lesson series. However, there was a non-significant increase in attitudes. These results demonstrate an efficacious HVC curriculum that prepares pre-clinical students to implement HVC into practice on clinical rotations.
Limitations of this study include an incomplete capture of the pre-clinical student population, variations in lesson delivery, and extensive time between administration of the pre- and post-lesson. Developers of this curriculum chose to implement each lesson at their respective times in the curriculum as it aligned with curricular content.
Clinical Implications:
Physician decision making is guided by the four pillars of medical ethics. Financial harm poses a threat to patients and is a newer consideration in medical decision making, under the pillar of non-maleficence. The goal of educating pre-clinical medical students about HVC is to equip them with skills that can be applied in their clinical years. This program’s resulting increase in self-efficacy in HVC allows them to feel more confident in discussing desired outcomes and cost of care with patients. Through educating early in their career, students have more opportunities to practice these skills and reduce financial harm to patients as their career progresses.