High Value Care

HVC Learner Assessment Tools

Assessing resident or student understanding of high value care principles.

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Standardized Cases

Various standardized patient cases with a focus on HVC communication, standardized system cases (OSSIES), and an online virtual patient module that teaches good clinical practice and costs.

Standardized Patient Case

Learner Level: Residents (applicable to medical students as well)
Program/School: State University of New York Upstate Medical University College of Medicine
Submitted by: Stephen Knohl, MD
Context: Outpatient
Description: Standardized patient case with focus on HVC communication skills intended for self-assessment/ formative assessment. Residents interview SP and review the video of themselves to discuss HVC and communication skills. Includes script, checklist for SP to fill out, checklist for resident viewing own video, test/procedure requisition forms with and without cost.

View Case

Standardized Patient and "System" Cases (OSSIES)

Program/School: Southern Illinois University College of Medicine
Submitted by: Susan Hingle, MD
Context: Outpatient
Description: Previously published on MedEdPORTAL. Three standardized patient cases with checklist (on practicing cost-effective patient care, cost-effective disease prevention and health promotion, and cost of medication); and 13 standardized "system" cases (OSSIEs) designed to help programs assess systems-based practice; includes scenarios, target objectives, and assessment tool.
Co-authors: Richard Rosher, MD, Sherry Robinson PhD

View Practicing Cost-Effective Patient Care Case

View Cost-Effective Disease Prevention & Health Promotion Case

View Cost of Medication Case

View 13 Standardized "System" Cases

Virtual Patient

Learner Level: Medical students
Program/School: Johns Hopkins School of Medicine
Submitted by: Amit Pahwa, MD
Context: Outpatient
Description: This online module is a novel way to assess by giving real time feedback about ordering "efficiency" that teaches both appropriate care and the costs of healthcare. Students are given three patients and asked to enter orders with the Medicare Allowable Fee or Average Wholesale Price. This is to simulate Maryland's new global budget revenue with capitated payment system that reimburses a fix fee per patient.

For access to the site, contact Amit Pahwa, MD directly.

Secure Exam Case

Learner Level: Medical Student (year 3 or 4)
Program/School: Ohio State University College of Medicine
Submitted by: Kimberly Tartaglia, MD
Context: Not specified (could be inpt, ED or outpt)
Description: Standardized patient case with checklist to assess communication with patient about unnecessary imaging for straightforward syncope.

For access to the case, contact Kimberly Tartaglia, MD directly.

Cases with Communication Checklist

Learner Level: Medical students, residents, fellows
Program/School: University of Minnesota Medical School
Submitted by: Jill Bowman Peterson, MD and Alisa Duran, MD
Description: Three standardized patient encounters with facilitator guides for use in high value care scenarios. These can be used for training to evaluate learner's ability in high value communication skills.
Co-authors: Crystal Donelan, Sophia P. Gladding, PhD, Peter Weissman MD, and Craig Roth MD

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Reflection and Narrative Exercises

Exercises to help learners recognize medical overuse and reflect more deeply on their own clinical practice and experiences with patients.

Reflection

Learner Level: Medical Student, Resident
Program/School: Ohio State University College of Medicine
Submitted by: Kimberly Tartaglia, MD
Context: Not specified. (could be inpatient, ED, or outpatient)
Description: After a module on HVC, learner reflects on own experience with a patient. Narrative and reflective exercise focusing on cost conscious care developed for students but easily adapted for residents.

View Reflection Exercise

Narrative Exercise

Learner Level: Medical Students, Residents
Program/School: University of Colorado School of Medicine and the Lown Institute
Submitted by: Brandon Combs, MD
Description: The Do No Harm Project uses narrative medicine to help residents recognize medical overuse and reflect more deeply on their own clinical practice. Provides a general framework for structuring the narrative and a method for implementation into the residency training program. Easily implemented for medical students as well.

View Do No Harm Project

Checklists

Decision support checklist of tests and procedures from Choosing Wisely and a value based care communication checklist developed using the Four Habits Model of communication.

Decision Support Checklist

Learner Level: Clerkship Medical Student (but adaptable for GME level trainees)
Program/School: Medical College of Wisconsin
Submitted by: Martin Muntz, MD
Context: Inpatient
Description: Decision support checklist utilizing the five areas of waste (plus two additional) identified by the Society of Hospital Medicine for the Choosing Wisely Campaign. Checklist is utilized on an Ipad and used to guide testing and treatment decisions. This tool may be used as a guide for HVC feedback within the team structure.

View Checklist

Communication Checklist

Learner Level: Residents, Students, Fellows
Program/School: University of Minnesota Medical School
Submitted by: Alisa Duran, MD
Context: Inpatient
Description: Value based care communication checklist developed using the Four Habits Model of communication. The tool was utilized in a standardized patient encounter but could be adapted for use in outpatient clinic settings with any learner. This model provides a framework for a patient-centered encounter and allows providers to explore patients' feelings and beliefs behind their desire for diagnostic testing and negotiate a mutually agreeable solution.
Co-authors: Craig Roth, MD, Jill Bowman Peterson, MD, Peter Weissmann, MD, Sophia Gladding, PhD, and Crystal Donelan.

View Checklist

Facilitated Discussions

Facilitated small group cases focusing on HVC in preventive/screening and an educational conference to explore and identify drivers of medical overuse and associated harms.

Facilitated Small Group Cases

Learner Level: Residents (could be used for medical students)
Program/School: University of Tennessee Medical Center at Knoxville
Submitted by: Mark Rasnake, MD
Context: Outpatient
Description: Facilitated discussion/structured small group cases focusing on high value care in preventive care and screening in (Case 1) older female and (Case 2) younger, newly diagnosed Type II diabetic.

View Case 1

View Case 2

Right Care Rounds

Learner Level: Administration, Practicing Physicians, Medical Students, Residents, Fellows
Program/School: University of Colorado School of Medicine and the Lown Institute
Submitted by: Brandon Combs, MD
Description: “Right Care Rounds” uses the familiar case presentation format to explore and identify drivers of medical overuse and the associated harms in an individual patient case. Right Care Rounds is meant to be easily adaptable and can occur within existing educational time slots e.g. morning report, noon conference, or Grand Rounds and uses the familiar cause‐and‐effect diagram, or “fishbone” as a cognitive tool. Provides a general framework for structuring the narrative and a method for implementation into the residency training program.

View "Right Care Rounds"

Chart Audits

Chart stimulated recall with focus on diagnostic testing and management decisions and tool for auditing own or another person's chart for providing preventive care.

Chart Stimulated Recall

Learner Level: Residents
Program/School: University of Nebraska College of Medicine
Submitted by: Sarah Richards, MD
Context: Inpatient
Description: Chart stimulated recall with focus on diagnostic testing and management decisions. Learners review costs of tests and treatments for one inpatient and discuss with the hospitalist. Identify social determinants that may have impacted choices, readmissions, and LOS, identify opportunities for HVC, and generate ideas for a QI project.
Co-author: Kelly J. Caverzagie, MD

View Chart

Chart Audit

Learner Level: Residents (IM, Med-Peds, or FM)
Program/School: Baylor College of Medicine
Submitted by: Frene' LaCour-Chestnut, MD
Context: Outpatient
Description: Pre-visit planning chart tool for auditing own chart or another person’s chart with focus on high value care for providing preventive care. Use limited to the outpatient setting but can be used with residents or students.

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Key Features Exam & Attitudes Scale

15 key features examination and clinical decision-making questions on HVC and an assessment tool for attitudes surrounding HVC practice.

Attitudinal Scale

Learner Level: Medical Student (clerkship, subinternship students)
Program/School: University of Rochester School of Medicine and Dentistry
Submitted by: Valerie J. Lang, MD
Context: Inpatient, outpatient or ED
Description: Assessment tool for attitudes surrounding the practice of high value care utilized for medical students at different levels of training. Easily adaptable for learners at different levels. Tool could be additionally utilized in high value care discussions. Narrative and reflective exercise focusing on cost conscious care developed for students but easily adapted for residents.
Co-authors: C. Daisy Smith, MD, Anthony Artino, PhD, and Norman Berman, MD

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Key Features Exam

Learner Level: Medical Student (clerkship, subinternship students)
Program/School: University of Rochester School of Medicine and Dentistry
Submitted by: Valerie J. Lang, MD
Context: Inpatient, outpatient or ED
Description: 15 HVC fey features examination online cases plus clinical decision making assessment from Med U. Secured cases are scored. Contact info@Med-U.org for access.

View Key Features

Learn More About High Value Care

Submit a HVC Tool

These member submitted tools were reviewed by members of the AAIM High Value Care Work Group.

Send AAIM an email if you would like to submit a HVC assessment tool to be included.