Ellika Mardh (Greenwich Hospital), Charles Seelig (Greenwich Hospital)
Healthcare costs in the US are unsustainable and it’s estimated that 30 % of health care costs are wasted care. Graduate medical education provides an opportunity to influence future physicians regarding cost consciousness, stewardship of resources, and future practice behaviors.
In 2014 a Hi-Value Curriculum was implemented in our 24 resident Internal Medicine Residency Program at Greenwich hospital, a 204 bed community teaching hospital The objective was for house staff to learn and demonstrate a questioning attitude regarding the principles of test ordering; the benefits, harms and costs of potential tests and to decrease or eliminate interventions that provide no benefit. Also to identify system level opportunities and be advocates for Hi-Value Care, producing abstracts and poster presentations at local and national venues.
Resources include Choosing Wisely, The ACP Hi-Value Curriculum, Dell Hi-Value Care Modules and mandatory completion of IHI Open School modules.
Individual and Interdisciplinary (including Laboratory) Chart Review sessions occur monthly, evaluating clinical reasoning, test ordering and cost in the Inpatient and Outpatient Setting, using chart review forms and the Laboratory’s Charge list. Support by hospital administration allow resident participation in Hospital PI projects and committees. Completed Resident Hi-Value PI projects are shared with all House staff and presented to the Board of trustees, Medical Staff, Laboratory and Nursing Leadership. Flier updates reflecting adherence to choosing wisely recommendations are disseminated regularly. This repetitive learning occurs in the Inpatient and Outpatient setting, Morning report, Case discussions and all aspects of patient care. A designated faculty leader coordinates these activities.
Residents’ knowledge is assessed thru the yearly in-training exam section on Hi-Value Care
We compared the results on the Hi-Value Section on the yearly in-training exam for the three years (2012-2014), pre- implementation of our Hi -Value Curriculum to the subsequent three years (2015-2017) post- implementation. The average percentile pre-intervention was in the 39th percentile, and in the 89th percentile for the three years post intervention (statistically significant with a p < 0.05 (Students t-test).
Since curriculum implementation 2014 we have had 6 local and national poster presentations on Hi-Value Care, including one podium presentation at HVPAA national conference. Three residents have been accepted into the HVPAA Future Leader’s Program.
Implementing a Hi-Value Educational Curriculum has significant impact on house staff engagement and knowledge of Hi -Value Care. A key aspect of our curriculum is repeating the educational message over and over again; providing the best possible evidence based, safe, hi-value care for our patients.
An additional benefit of our curriculum is that our residents are now viewed and respected as an integral part of our organization and their voices heard as ambassadors for Hi-Value Care.
Implications for the Patient
The house staff will recognize the advantages to their patients and to society of applying the principles learned and practiced in the area of Hi-Value Care, becoming lifelong agents of change.