Jonas Jennifer A, Davies Eleanor L, Keddem Shimrit, Barg Frances K, Fieldston Evan S
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.
Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
Acad Pediatr. 2015 Jul-Aug;15(4):461-6. doi: 10.1016/j.acap.2015.02.003. Epub 2015 Apr 10.
In preparation for the development of a curriculum on health care costs and value for pediatricians, the goal of this study was to assess pediatricians' baseline perceptions about the concepts of "cost" and "value" in health care, and topics that should be included in a curriculum that teaches about costs and value in pediatrics.
Physicians in the Department of Pediatrics at The Children's Hospital of Philadelphia received an online freelisting survey asking them to generate lists of words that come to mind when thinking about "costs" in health care, "value" in health care, and topics to include in a curriculum on costs and value in pediatrics. AnthroPac software generated salience scores, indicating the relative importance of each term.
A total of 207 surveys were completed for a 40% response rate. For the "cost" prompt, the most salient responses were "excessive," "waste," and "insurance." For the "value" prompt, the most salient responses were "outcomes" and "quality." For elements to include in a curriculum, the most salient responses were "insurance" and "costs." Analyzing responses based on years in practice, percentage clinical time, and division resulted in slightly different lists and salience scores.
In this freelisting exercise, there was general agreement that health care costs are "excessive," that "outcomes" and "quality" are integral to value, and that there is a need for education in these areas, especially around "insurance." Differences based on years in practice, percentage clinical time, or division can inform the development of targeted curricula that consider the needs, knowledge, and interests of these groups.
为制定面向儿科医生的医疗保健成本与价值课程做准备，本研究的目的是评估儿科医生对医疗保健中“成本”和“价值”概念的基线认知，以及儿科医疗保健成本与价值课程应涵盖的主题。
费城儿童医院儿科系的医生收到一份在线自由列举式调查问卷，要求他们列出在思考医疗保健中的“成本”、“价值”以及儿科医疗保健成本与价值课程应包含的主题时脑海中浮现的词汇清单。AnthroPac软件生成了显著性分数，表明每个术语的相对重要性。
共完成207份调查问卷，回复率为40%。对于“成本”提示，最显著的回答是“过高”、“浪费”和“保险”。对于“价值”提示，最显著的回答是“结果”和“质量”。对于课程应包含的内容，最显著的回答是“保险”和“成本”。根据从业年限、临床时间百分比和科室对回答进行分析，得到的清单和显著性分数略有不同。
在这项自由列举练习中，普遍达成的共识是，医疗保健成本“过高”，“结果”和“质量”是价值的组成部分，并且在这些领域需要开展教育，尤其是围绕“保险”的教育。基于从业年限、临床时间百分比或科室的差异可为制定有针对性的课程提供参考，该课程需考虑这些群体的需求、知识和兴趣。
