Pahwa Amit K, Eaton Kevin, Apfel Ariella, Bertram Amanda, Ridell Rebecca, Cayea Danelle
Division of Hospital Medicine, Division of General Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
Divsion of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 806, Baltimore, MD, 21287, USA.
BMC Med Educ. 2020 Oct 15;20(1):365. doi: 10.1186/s12909-020-02303-1.
With almost 20% unnecessary spending on healthcare, there has been increasing interest in high value care defined as the best care for the patient, with the optimal result for the circumstances, delivered at the right price. The American Association of Medical Colleges recommend that medical students are proficient in concepts of cost-effective clinical practice by graduation, thus leading to curricula on high value care. However little is published on the effectiveness of these curricula on medical students' ability to practice high value care.
In addition to the standard curriculum, the intervention group received two classroom sessions and three virtual patients focused on the concepts of high value care. The primary outcome was number of tests and charges for tests on standardized patients.
136 students enrolled in the Core Clerkship in Internal Medicine and 70 completed the high value care curriculum. There were no significant differences in ordering of appropriate tests (3.1 vs. 3.2 tests/students, p = 0.55) and inappropriate tests (1.8 vs. 2.2, p = 0.13) between the intervention and control. Students in the intervention group had significantly lower median Medicare charges ($287.59 vs. $500.86, p = 0.04) and felt their education in high value care was appropriate (81% vs. 56%, p = 0.02).
This is the first study to describe the impact of a high value care curriculum on medical students' ordering practices. While number of inappropriate tests was not significantly different, students in the intervention group refrained from ordering expensive tests.
医疗保健领域存在近20%的不必要支出，人们对高价值医疗的兴趣与日俱增。高价值医疗被定义为以合适的价格为患者提供最佳护理，并在具体情况下取得最优结果。美国医学院协会建议医学生在毕业时精通具有成本效益的临床实践概念，因此催生了高价值医疗课程。然而，关于这些课程对医学生实践高价值医疗能力的有效性的研究报道甚少。
除标准课程外，干预组还接受了两节关于高价值医疗概念的课堂教学和三个虚拟病例。主要结局指标是标准化病人的检查项目数量和检查费用。
136名学生参加了内科核心实习课程，70名完成了高价值医疗课程。干预组和对照组在开具适当检查项目（3.1项/学生对3.2项/学生，p = 0.55）和不适当检查项目（1.8项对2.2项，p = 0.13）方面没有显著差异。干预组学生的医疗保险费用中位数显著较低（287.59美元对500.86美元，p = 0.04），并且认为他们在高价值医疗方面的教育是合适的（81%对56%，p = 0.02）。
这是第一项描述高价值医疗课程对医学生检查项目开具行为影响的研究。虽然不适当检查项目的数量没有显著差异，但干预组学生避免开具昂贵的检查项目。
