View from the Association of Pediatric Program DirectorsDeveloping the PedsValue Modules—A National Pediatric High Value Care Curriculum
Section snippets
Step 1: Problem Identification and General Needs Assessment
The United States spent 17.8% of its gross domestic product on health care in 2015.4 Despite spending twice as much on health care per child compared with other industrialized nations,5 the United States consistently performs poorly on critical child health outcomes such as infant mortality, child poverty, and immunization rates.6, 7 Improving health care value (defined as quality/cost)8 has become a national priority. Although there is a deficit of measurable and meaningful pediatric value
Step 2: Needs Assessment of Targeted Learners
Few survey tools exist to assess learners' true understanding of the complex nature of practicing HVC. Most surveys to date have focused on knowledge of costs. A survey of pediatric attendings and residents at one institution reported poor knowledge of costs, charges, and reimbursements and concluded that pediatricians “needed further financial education.”2 In 2010, the Alliance for Academic Internal Medicine (AAIM) and the ACP published a curriculum to teach internal medicine residents HVC in
Duke University Medical Center
Responses from an optional survey of pediatric and internal medicine-pediatric residents (response rate 48.6%; n = 34 of 70) before curriculum implementation self-reported “poor” knowledge of insurance types/payment models by 38% (n = 13) and “poor” knowledge of costs by 35% (n = 12). Ninety-seven percent of respondents (n = 33) believed knowing more about health care costs and payment models would affect their ordering habits.
In response to this knowledge gap, Duke University Medical Center
University of California, San Francisco
In 2014, University of California, San Francisco (UCSF) held a 7-part didactic series on value in pediatrics. The value series covered basic knowledge (eg, costs vs charges, major drivers of costs in pediatrics, cost utility analysis), value-based management (eg, high value diagnosis and treatment of urinary tract infection), key policy factors shaping value in pediatrics (eg, Affordable Care Act, physician reimbursement, financial incentives), and a session on the lifelong return on investment
Development of the PedsValue Modules
Although various pediatrician-educators have created materials to teach trainees and faculty HVC at their individual institutions, no pediatric-focused HVC educational tools had yet been developed across institutions or endorsed for national implementation by any pediatric professional society. Our team of pediatrician-educators who were each working on value-based curricular material across 6 academic health centers (Duke University Medical Center, UCSF, University of California Los Angeles,
Step 3: Goals and Objectives
The overall goal of the curriculum was to develop a series of Web-accessible, case-based HVC educational modules for trainees and practicing physicians in pediatrics, the PedsValue Modules. To accomplish this, we agreed upon a set of overarching HVC learning objectives and competencies for all of the modules that included 1) avoid unnecessary testing, 2) use emergency- and hospital-level care judiciously, 3) improve outcomes with health promotion and disease prevention, and 4) overcome barriers
Step 4: Educational Strategies
Six commonly encountered cases were chosen to highlight these learning objectives, competencies, and milestones focused on areas of overuse and inappropriate use specific to pediatrics. The value tenets highlighted in these cases were drawn from Choosing Wisely lists, the American College of Radiology Appropriateness Criteria, and published evidence-based clinical practice guidelines. They emphasized 1 of 3 HVC categories: High Value Diagnostic Testing, High Value Communication, and High Value
Step 5: Implementation
Because learner preferences and training program educational needs vary, we developed materials that can be adapted for use in a variety of settings to increase their utility and likelihood of being integrated meaningfully into existing pediatric curricula. The PedsValue Modules are available as online case modules organized around themes in value-based care, best suited for self-directed learning by an individual with Web access. They were modeled after the ACP Online Interaction High Value
Step 6: Evaluation and Feedback
The PedsValue Modules launched in April 2016. To evaluate the educational effect of the modules, we will be measuring learner participation, self-reported changes in knowledge, and self-reported changes in clinical behavior and practice. Web analytics will allow for assessment of scale and reach by tracking number and location of views of the online modules and downloads of facilitator guides. Changes in trainee attitudes and knowledge as a result of use of the PedsValue Modules will be
Limitations
There are several limitations of this curriculum development. First, we were unable to predict the extent of reach and utilization before implementation. Although facilitator guides are available, we do not have an assessment by nondevelopers of how useful the facilitator guides will be or the likelihood that implementers will be able to use the materials in the way the authors intended. We currently do not have any outcome data. The outcome data that we are in the process of collecting does
Conclusion
Pediatrics faces an imperative to deliver high value clinical care that will improve the lives of generations of children and the adults they will become. New and emerging value-based tools and educational resources, such as the PedsValue Modules, represent an important shift in pediatric medical education toward preparing the future pediatric clinical workforce to practice HVC. The PedsValue Modules can serve not only residency program directors in search of standardized HVC curriculum, but
Acknowledgments
Financial disclosure: The authors acknowledge the UCSF Center for Healthcare Value, which provided grant funding for this project through a 2015/2016 “Teaching to Choose Wisely” award. Funds from this award were used to support the publishing of the cases online with contributions and editorial direction from the ACP.
The authors also acknowledge Daisy Smith, senior physician educator, and Steven Spadt, senior vice president of technology, of the ACP, for their guidance and support in the
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Cited by (0)
The authors have no conflicts of interest to disclose.