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Residents’ Knowledge of High-Value Care Varies

Discussions with faculty members linked to all self-reported high-value care behaviors

WEDNESDAY, July 1, 2015 (HealthDay News) — U.S. internal medicine (IM) residents report varying knowledge and practice of high-value care (HVC), according to research published online June 16 in Academic Medicine.

Kira L. Ryskina, M.D., from the University of Pennsylvania in Philadelphia, and colleagues conducted a cross-sectional survey of U.S. IM residents who took the October 2012 Internal Medicine in-Training Examination. The authors assessed correlations between self-reported knowledge and practice of HVC and exposure to HVC teaching and care intensity of the training hospital. A total of 18,102 residents (83.7 percent) completed the survey.

The researchers observed variation in self-reported HVC practices. Overall, 23.7 percent agreed that they shared estimated test and treatment costs with patients, while 88.2 percent agreed that they integrated patients’ values and concerns into clinical decisions. About 40 percent reported having discussions about balancing the benefits, harms, and costs of treatments with faculty during patient care at least a few times per week; these discussions were linked to all self-reported HVC practices. There was an inverse correlation for the training hospital’s care intensity with self-reported incorporation of costs and patients’ values into clinical decisions, but not with other behaviors.

“Faculty discussions of HVC during patient care correlated with such knowledge and practice and may represent an opportunity to improve residents’ competency in providing value-based care,” the authors write.

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