内科领域未来医师群体中的高价值医疗文化。

High-Value Care Culture Among the Future Physician Workforce in Internal Medicine.

机构信息

R. Gupta is interim chief value director, UCLA-Olive View Medical Center, assistant professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, and director, Evaluation and Outreach, Costs of Care, Boston, Massachusetts. N. Steers is biostatistician, VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, and adjunct associate professor of medicine and sociology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. C. Moriates is assistant dean for healthcare value, associate chair of quality, safety and value, and associate professor, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, and director of implementation, Costs of Care, Boston, Massachusetts. S. Wali is chair, Department of Medicine at Olive View-UCLA Medical Center, and professor and executive vice chair of medicine for affiliated University of California, Los Angeles hospitals, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. C.H. Braddock III is vice dean for education, David Geffen School of Medicine, and professor, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. M. Ong is professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, and chief, Hospitalist Division, Greater Los Angeles VA Health Care System, Los Angeles, California.

出版信息

Acad Med. 2019 Sep;94(9):1347-1354. doi: 10.1097/ACM.0000000000002619.

DOI:10.1097/ACM.0000000000002619

PMID:31460932

Abstract

PURPOSE

Training in high-spending regions correlates with higher spending patterns among practicing physicians. This study aimed to evaluate whether trainees' exposure to a high-value care culture differed based on type of health system in which they trained.

METHOD

In 2016, 517 internal medicine residents at 12 California graduate medical education programs (university, community, and safety-net medical centers) completed a cross-sectional survey assessing perceptions of high-value care culture within their respective training program. The authors used multilevel linear regression to assess the relationship between type of medical center and High-Value Care Culture Survey (HVCCS) scores. The correlation between mean institutional HVCCS and Centers for Medicare and Medicaid Services' Value-Based Purchasing (VBP) scores was calculated using Spearman rank coefficients.

RESULTS

Of 517 residents, 306 (59.2%), 83 (16.1%), and 128 (24.8%) trained in university, community, and safety-net programs, respectively. Across all sites, the mean HVCCS score was 51.2 (standard deviation [SD] 11.8) on a 0-100 scale. Residents reported lower mean HVCCS scores if they were from safety-net-based training programs (β = -4.4; 95% confidence interval: -8.2, -0.6) with lower performance in the leadership and health system messaging domain (P < .001). Mean institutional HVCCS scores among university and community sites positively correlated with institutional VBP scores (Spearman r = 0.71; P < .05).

CONCLUSIONS

Safety-net trainees reported less exposure to aspects of high-value care culture within their training environments. Tactics to improve the training environment to foster high-value care culture include training, increasing access to data, and improving open communication about value.

摘要

目的

在高支出地区接受培训与执业医师的高支出模式相关。本研究旨在评估受训者接触高价值医疗文化的程度是否因他们接受培训的医疗体系类型而异。

方法

2016 年，12 个加利福尼亚研究生医学教育项目（大学、社区和医疗保障安全网医疗中心）的 517 名内科住院医师完成了一项横断面调查，评估他们各自培训项目内高价值医疗文化观念。作者使用多水平线性回归评估医疗中心类型与高价值医疗文化调查（HVCCS）评分之间的关系。使用 Spearman 秩相关系数计算机构平均 HVCCS 与医疗保险和医疗补助服务中心的基于价值的采购（VBP）评分之间的相关性。

结果

在 517 名住院医师中，分别有 306 名（59.2%）、83 名（16.1%）和 128 名（24.8%）在大学、社区和医疗保障安全网培训项目中接受培训。在所有站点，HVCCS 的平均得分为 51.2（标准差 [SD] 11.8），分值范围为 0-100。如果住院医师来自基于医疗保障安全网的培训项目，则报告的 HVCCS 平均得分较低（β=-4.4；95%置信区间：-8.2，-0.6），领导和医疗系统信息传递领域的表现也较低（P<.001）。大学和社区站点的机构平均 HVCCS 得分与机构 VBP 得分呈正相关（Spearman r=0.71；P<.05）。