Pender Tyler, Boi Luca, Urbik Veronica M, Glasgow Robert, Smith Brigitte K
Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT.
University of Utah Hospital and Clinics, University of Utah, Salt Lake City, UT.
J Am Coll Surg. 2021 Jan;232(1):81-90. doi: 10.1016/j.jamcollsurg.2020.08.770. Epub 2020 Oct 3.
High value care (HVC), maximizing quality while minimizing cost, has become a major focus of surgical practice. Effective education in healthcare value concepts is critical during residency to ensure graduates are able to deliver high value surgical care and participate in interprofessional teams to improve the system.
An HVC curriculum was implemented at a single academic medical center. Sixty-six residents from general surgery, plastic surgery, otolaryngology, and urology completed the curriculum over 3 academic years (2016 to 2019). The 1-year curriculum taught residents the concepts of HVC before participating in a value improvement project the following year. Residents' knowledge of value was assessed pre- and post-participation using a validated assessment tool, the Quality Improvement Knowledge Application Tool Revised (QIKAT-R), and a curriculum-specific assessment tool. The overall success of the program was evaluated by assessing residents' skills in completing value improvement projects using a novel scoring rubric.
After completing the program, residents expressed improved confidence in their ability to complete a value improvement project. Residents also demonstrated improved knowledge on the curriculum-specific assessment (4.7/13 to 10.9/13) and the scenario assessment using the QIKAT-R tool (8.5/27 to 16.4/27). As the program underwent iterative improvements each year, the quality of the residents' projects also improved, as assessed by the novel scoring rubric.
Multimodal assessment demonstrated improvement in residents' objective knowledge of HVC principles, residents' ability to design and lead clinical value improvement projects, and residents' confidence they could use HVC principles in their current and future practice.
高价值医疗（HVC），即在成本最小化的同时实现质量最大化，已成为外科实践的主要关注点。在住院医师培训期间，对医疗价值概念进行有效的教育至关重要，以确保毕业生能够提供高价值的外科护理，并参与跨专业团队来改善医疗系统。
在一家学术医疗中心实施了一项高价值医疗课程。来自普通外科、整形外科、耳鼻喉科和泌尿外科的66名住院医师在3个学年（2016年至2019年）完成了该课程。为期1年的课程在住院医师参与次年的价值改进项目之前，教授他们高价值医疗的概念。使用经过验证的评估工具——修订后的质量改进知识应用工具（QIKAT-R）和特定课程评估工具，在参与前后评估住院医师的价值知识。通过使用一种新颖的评分标准评估住院医师完成价值改进项目的技能，来评估该项目的总体成功情况。
完成该项目后，住院医师对自己完成价值改进项目的能力表示更有信心。住院医师在特定课程评估（从4.7/13提高到10.9/13）和使用QIKAT-R工具的情景评估（从8.5/27提高到16.4/27）方面也表现出知识的提高。随着该项目每年进行迭代改进，根据新颖的评分标准评估，住院医师项目的质量也有所提高。
多模式评估表明，住院医师在高价值医疗原则的客观知识、设计和领导临床价值改进项目的能力以及他们在当前和未来实践中应用高价值医疗原则的信心方面都有所提高。
