Teaching High Value Care: Case Vignettes for Pediatric Practice

From the 2018 HVPAA National Conference

Lauren Walker (Baylor College of Medicine), Akshata Hopkins (Johns Hopkins All Childrens Hospital), Lisa Hermann (Cincinnati Children’s Hospital Medical Center), Corrie Mcdaniel (University of Washington School of Medicine), Sahar Rooholamini (University of Washington School of Medicine), Yemisi Jones (Cincinnati Children’s Hospital Medical Center), Michael Tchou (Cincinnati Children’s Hospital Medical Center), Vivian Lee (Keck School of Medicine of University of South California), Jimmy Beck (University of Washington School of Medicine)


As healthcare systems recognize the importance of high value care (HVC), physicians must focus on individualized patient outcomes using economically responsible and evidence-based medicine. The best ways to teach HVC principles to medical trainees that can result in meaningful practice and behavior changes are unknown.


By the end of the activity, learners will be able to:

1) Identify examples of common areas of misuse and overuse in pediatric care

2) Use evidence-based guidelines to support clinical decision-making

3) Utilize statistics in making appropriate decisions about diagnosis and treatment

4) Discuss strategies for care discussions involving HVC principles with patients and families.


We designed a case-based curriculum mapping six common pediatric clinical scenarios to HVC principles. Each scenario included learning objectives, small group activities, educational resources, a facilitator guide, and participant evaluations. After internal and external review, the scenarios were piloted at four teaching institutions. Facilitators adapted each vignette to learner needs and site-specific conference characteristics. Participants were asked to complete anonymous case-specific evaluations at the end of each session.


Approximately 331 individuals (students, residents, attendings) participated with an evaluation response rate of 76% (n=253). Participants across all sites acknowledged the sessions as a valuable use of time (range 4.2- 4.6 on a 5 point Likert scale) and identified HVC principles that could be applied daily in clinical practice (range 4.4- 4.6).


Implementation of six case-based HVC vignettes at 4 pilot institutions was both feasible and well received by a diverse group of learners. The curriculum was perceived as valuable and applicable to learners’ clinical practice.  Next steps include longitudinal assessments of learners to better understand how knowledge, skills, attitudes, and behaviors related to HVC may change over the course of training.

Implications for the Patient

Vignettes represent common high value care challenges faced by clinicians. This curriculum provides learners with a framework on how to apply various HVC principles at the bedside.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog