Teaching and Evaluating High-Value Care Through a Novel Case-Based Morning Report Curriculum

Abstract

Abstract Introduction It's the responsibility of medical educators to train residents to be responsible stewards of finite health care resources. Thus, we developed an interactive morning report curriculum that focuses on high-value care (HVC) decision making using real-world cases. In addition, we developed a novel evaluation tool to assess residents' application of cost-conscious care principles through the use of an HVC scoring algorithm. Methods For each HVC morning report session, a resident presents a case that they encountered recently. Prior to their presentation, the resident reviews guidelines and meets with a physician with expertise in the field to determine the best practice for the case with regard to what imaging, laboratory studies, procedures, and/or consultations were necessary to arrive at the correct diagnosis and treatment course. The resident presents the case while indicating what they would order based on the information provided. Following the session, an HVC score is determined for each participant by awarding points for appropriate, cost-conscious utilization of resources. Points are deducted for unnecessary overuse of health care services and inappropriate underuse of services. Results Over the course of the 2014–2015 academic year 34 internal medicine residents participated in at least one HVC Morning Report session. The number of participants reporting that their knowledge of health care costs was poor, dropped from 70% on the precurriculum survey to 29% of the postcurriculum survey. Discussion The HVC Morning Report Curriculum was successful in improving resident knowledge of HVC and comfort with cost effective decision making. Due to the real-world nature of the cases presented, there was a great deal of variability in the complexity of the cases presented by residents. Future directions might include developing a collection of high-yield cases for increased standardization of the learning.

Keywords

• Morning Report
• Teaching Rounds
• Health Care Costs
• High-Value Care
• Cost of Care
• Value-Added Care