Schickedanz Adam, Gupta Reshma, Arora Vineet M, Braddock Clarence H
1 University of California Los Angeles, CA.
2 University of Chicago, Chicago, IL.
Am J Med Qual. 2018 Nov/Dec;33(6):604-613. doi: 10.1177/1062860618767312. Epub 2018 Apr 11.
Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.
毕业后医学教育（GME）缺乏对住院医师进行高质量、注重成本效益的实践准备情况的衡量标准。作者使用公开报告的教学医院价值指标，比较内科住院医师培训项目在高价值医疗培训方面的情况，并对照项目主任对价值的看法来验证这些指标。项目层面的价值培训得分是利用医疗保险和医疗补助服务中心基于价值的采购（VBP）项目的医院质量和成本效率数据构建的。使用逻辑回归分析了与内科项目主任协会年度调查中的高价值医疗培训指标的相关性。项目层面的VBP得分每增加一分，住院医师培训项目主任就更有可能同意，GME项目有责任控制医疗成本（调整后的优势比[aOR]为1.18，P = 0.04），其教员树立了高价值医疗的典范（aOR为1.07，P = 0.03），并且住院医师已做好做出高价值医疗决策的准备（aOR为1.07，P = 0.09）。公开报告的临床数据为GME价值培训提供了有效的衡量标准。
