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APDIM Programmatic Innovation Abstract: Poster 22

Implementation of the High Value, Cost-Conscious Care Curriculum in a Community-Based Internal Medicine Residency
Parul Sud, Shagufta N Ali, McLaren Regional Medical Center/Michigan State University

Description of How the Problem Was Identified and Explored
The cost of health care in US is increasing at an ‘unsustainable’ rate while quality metrics reveal our performance to be much lower than many other countries. A 2010 Institute of Medicine report cites that up to 30% of health care cost may be avoidable. AAIM joined hands with ACP to create a high value, cost conscious care (HVCCC) curriculum for internal medicine residents. Prior to this the ACGME, under its Systems-Based Practice core competency, explicitly stated that residents/fellows are “expected to incorporate considerations of cost awareness and risk benefit analysis in patient care.” These national trends as well as our pre-test results confirmed our residents’ deficits in HVCCC.

Description of the Innovation
Goals and Objectives To incorporate the AAIM-ACP’s HVCCC curriculum in internal medicine residency training at a community hospital, thereby raising resident’ self awareness in performing unnecessary, low value interventions, at the same time using cost-effective, evidence-based medicine (EBM) to achieve better quality patient care. Description In accordance with the HVCCC curricular format, a one-hour faculty development session was presented to all core faculty. This was followed by a four-hour interactive workshop during which the first 3 modules of HVCC were presented using the small group discussion format. Subsequent modules were presented at noon conferences over the next three months. Residents’ knowledge, skills and attitude were assessed by a questionnaire distributed by Survey Monkey™ at the beginning and end of curricular dissemination. During small group sessions in ambulatory clinic, residents will be asked to reflect on their own cases, identifying opportunities for the application of HVCC care using the “traffic signal” approach.

Results to Date
Pending post-test.

Discussion/Reflection/Lessons Learned
Escalating costs of health care combined with suboptimal health care quality reports, serve as a wake-up call to all US physicians. While most residency educators emphasize EBM and critical appraisal, we have neglected to address cost-conscious care. Furthermore, unrestrained defensive medicine provides poor role modeling for learners. By implementing the HVCCC curriculum, we hope to inculcate principles of best practice and cost consciousness among our residents and faculty. By embedding this curriculum in our existing formal EBM and Quality Improvement curricula we anticipate it will be self-sustaining.

Submitting Author
Shagufta N. Ali, MD
Clinical Assistant Professor
Department of Internal Medicine
McLaren Regional Medical Center/Michigan State University
Telephone: (810) 210-4387
Email: shagufta.Ali@mclaren.org