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Relationship Between Institutional Investment in High-Value Care (HVC) Performance Improvement and Internal Medicine Residents’ Perceptions of HVC Training

Ryskina, Kira L., MD, MS; Smith, Cynthia D., MD; Arora, Vineet M., MD; Zaas, Aimee K., MD, MHS; Halvorsen, Andrew J., MS; Weissman, Arlene, PhD; Wahi-Gururaj, Sandhya, MD, MPH

doi: 10.1097/ACM.0000000000002257
Research Reports

Purpose To measure the association between institutional investment in high-value care (HVC) performance improvement and resident HVC experiences.

Method The authors analyzed data from two 2014 surveys assessing institutions’ investments in HVC performance improvement as reported by program directors (PDs) and residents’ perceptions of the frequency of HVC teaching, participation in HVC-focused quality improvement (QI), and views on HVC topics. The authors measured the association between institutional investment and resident-reported experiences using logistic regression, controlling for program and resident characteristics.

Results The sample included 214 programs and 9,854 residents (59.3% of 361 programs, 55.2% of 17,851 residents surveyed). Most PDs (158/209; 75.6%) reported some support. Residents were more likely to report HVC discussions with faculty at least a few times weekly if they trained in programs that offered HVC-focused faculty development (odds ratio [OR] = 1.19; 95% confidence interval [CI] 1.04–1.37; P = .01), that supported such faculty development (OR = 1.21; 95% CI 1.04–1.41; P = .02), or that provided physician cost-of-care performance data (OR = 1.19; 95% CI 1.03–1.39; P = .02). Residents were more likely to report participation in HVC QI if they trained in programs with a formal HVC curriculum (OR = 1.83; 95% CI 1.48–2.27; P < .001) or with HVC-focused faculty development (OR = 1.46; 95% CI 1.15–1.85; P = .002).

Conclusions Institutional investment in HVC-related faculty development and physician feedback on costs of care may increase the frequency of HVC teaching and resident participation in HVC-related QI.

K.L. Ryskina is assistant professor of medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3379-6394.

C.D. Smith is vice president, Clinical Programs, American College of Physicians, and adjunct associate professor of medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-1910-9546.

V.M. Arora is associate professor and director, Graduate Medical Education Clinical Learning Environment Innovation, Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4745-7599.

A.K. Zaas is associate professor, Division of Infectious Diseases and International Health, and program director, Duke Internal Medicine Residency, Duke University School of Medicine, Duke University, Durham, North Carolina.

A.J. Halvorsen is assistant professor of medicine, Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1272-616X.

A. Weissman is director, Research Center, American College of Physicians, Philadelphia, Pennsylvania.

S. Wahi-Gururaj is associate professor of medicine, Section of General Internal Medicine, and program director, Internal Medicine Residency, Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, Nevada.

Funding/Support: Dr. Ryskina is supported by the National Institute on Aging Career Development Award (K08AG052572). This study received no external funding.

Other disclosures: None reported.

Ethical approval: This study was deemed exempt from review by The Institutional Review Board of the University of Pennsylvania.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A551 and http://links.lww.com/ACADMED/A552.

Correspondence should be addressed to Kira L. Ryskina, 1230 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104; telephone: (215) 898-3935; e-mail: ryskina@pennmedicine.upenn.edu; Twitter: @KiraRyskinaMD.

© 2018 by the Association of American Medical Colleges