From the 2018 HVPAA National Conference
Christopher King (University of Colorado School of Medicine), Jeannette Guerrasio (University of Colorado School of Medicine), Christine Jones (University of Colorado School of Medicine)
Physicians are responsible for 80% of healthcare costs, and multiple tools have been developed to teach trainees how to practice high value care. There has been no focus on utilizing these tools in a comprehensive bedside curriculum. We sought to empower teaching teams to discuss value at the bedside.
Team-V is a multi-modality bedside curriculum that aims to reach medical students, residents, advanced practice fellows, and faculty on an inpatient medicine teaching team. By the end of the rotation, participants are expected to be able to:
- Discuss value with their patients at the bedside.
- Understand how to screen patients for inability to afford their medications.
- Describe methods for improving value at the bedside.
- Identify prescription medication cost saving measures for patients.
Team-V utilizes several different tools to create a space for discussing value at the bedside with patients. The SOAP-V format is used for patient presentations in order to highlight a point in the presentation to discuss what is improving the value of care a patient receives. Students are enlisted as High Value Care Officers to empower them to take an active role in assessing areas of common overuse in the healthcare setting, based off of Choosing Wisely recommendations. Finally all team members are trained to screen patients for inability to afford their medications and in simple tools to reduce medication costs with use of the GOT MeDS mnemonic. In order to determine changes in attitudes regarding value in healthcare, a survey was administered to two control teams as well as the intervention team. Each team member received a survey on the first day of their rotation as well as the final day of their rotation. Survey administration was through the online platform REDCap.
Since the start of the Team-V curriculum, 56 unique individuals have rotated on either the control or intervention teams. To date, 51% of individuals have completed both the pre- and post-rotation survey. Individuals rotating on Team-V have shown a change in attitudes in regards to value by being less likely to agree with statements that more testing results in better outcomes, that there is too much emphasis on cost, and that cost is the last thing physicians should consider when making clinical decisions (Figure 1).
Creating a multi-modality bedside rounding curriculum to help clinical teams focus on value at the point of care can help improve attitudes towards healthcare value. By building a curriculum that encompasses the whole team rather than just one target population, all members are able to work together with a focus on healthcare value that impacts their attitudes.
Implications for the Patient
Residency training has been shown to impact clinical practice in regards to resource utilization for at least ten years. By creating a bedside rounding curriculum to focus on value, faculty and learners have an improvement in attitudes towards value and may start to change the culture of a training program.