Improving Value-Based Care Education in a University Hospitals Fellowship Program
April 10, 2020
UH Research & Education Update | April 2020
Although controlling medical costs is a stated priority for the medical profession, clinical educators are provided almost no guidance as to how to teach value-based care effectively. Residents and fellows can be taught the cost of medical tests and treatments, and clinical educators can easily evaluate them for their knowledge of this cost. However, the further integration of medical knowledge and clinical judgment with knowledge of cost is essential to ensure that the best value-based clinical outcomes are maintained. This meta-cognitive skill is far more complex to teach, and establishing a resident’s or fellow’s competency in practicing value-based care is far more difficult to measure.
At University Hospitals, a team of physician-educators developed and tested an education conference strategy that consistently integrated the teaching of medical knowledge and patient care with a robust overlay of related value-based medical concepts. Fellows then embarked on a quality practice review comparing clinical decisions prior to and after the education intervention.
The quality review served to define metrics and effective methodology for measuring quality. However, the quality review was simultaneously used as an assessment tool to determine the efficacy of the education intervention itself, and thus the competency of fellows in the clinical application of value-based care decisions.
Their data demonstrated a significant increase in the use of high-value interventions and a simultaneous significant reduction in low-value interventions in the care domains of interest, suggesting the effectiveness of this strategy in bridging the gap between simply teaching knowledge of cost to effectively teaching the practical application of value-based care decisions.
Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies. Zanotti K, Somasegar S, Hooper MW, Hopp E. J Grad Med Educ. 2019 Dec;11 (6):668-673.
This project was funded by the University Hospitals Graduate Medical Education Innovation in Medical Education Research Award and was led by a team of UH physicians, Dr. Kristine Zanotti, Associate Professor and Program Director, Division of Gynecologic Oncology, Dr. Elizabeth Hopp, who was a Fellow in the Division of Gynecologic Oncology at the time of the study, Dr. Monica Webb Hooper, Director of Office of Cancer Disparities Research, Case Comprehensive Cancer Center, Case Western Reserve University, and Dr. Sahana Somasegar, a resident in the Department of Obstetrics and Gynecology University of Chicago at the time of the study.