Appreciating the Value in High Value Care

By Giffin Daughtridge

The timing of the email I received announcing the Teaching Value Choosing Wisely competition could not have been better.  One week earlier, I had met with Dr. Richard Shannon, then the Chair of Medicine at Penn and now the Executive Vice President of Health Affairs at the University of Virginia, to discuss a common interest we shared in generating high-value health care.  We agreed that physician decision-making represented a powerful lever to improve value, and that decision-making skills were most malleable early in a clinician’s training.  As such, we decided to develop a course for medical students to bring awareness to the impact of physician decision-making on both costs and quality of care.

Following that meeting, I wrote a rough draft of a one-week didactic portion of the course, which featured a series of lectures based on the American College of Physicians’ high-value care curriculum.  Three days later, I received the email about the Teaching Value Choosing Wisely competition.  The “Bright Ideas” section seemed like a perfect opportunity to promote our curriculum, and both Dr. Shannon and I were intrigued, but we needed to expand our course beyond didactics if we wanted to truly develop an innovative idea.   To accomplish this, we developed a value exercise that would allow the students be matched up with a patient and then observe first-hand how their actual clinical care deviates from recognized care plans for common conditions.

As designed, the exercise will run for one week and will be offered for both residents and fourth-year medical students (post-clinical). On Monday, the students will be paired with a patient admitted within the last 24 hours for a condition that has been featured in the ABIM Choosing Wisely^® lists to ensure that there is a sufficient level of evidence-based research on care plans for these conditions.  Options include but are not limited to pulmonary embolism, CHF, pneumonia, CVA, CAD, valve replacement, and malignant HTN.  Once matched with their patient, the students will be responsible for three projects:

• Design an ideal care plan that outlines both the diagnostic and treatment approach using standardized algorithms of care for that patient’s presentation
• Follow the patient for a week and report the actual care that they receive
• Work with the hospital billing department to calculate the cost of the ideal and actual care plan and write a report for the class presenting the patient, the two care plans and their costs, and identify what was responsible for the difference

Through these projects, we hope to bring awareness to how much care plans deviate from standardized care strategies, and the impact on both the quality of care and cost that these deviations incur.  By bringing awareness to this situation early in the students’ training, we hope they will develop high-value clinical habits that will serve them, their patients, and the health care system throughout their careers.

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Giffin Daughtridge is a second-year medical student at the Perelman School of Medicine at the University of Pennsylvania and am from Charleston, South Carolina.  Following graduation in 2011 from the University of North Carolina at Chapel Hill, he spent a year living in Bogotá, Colombia as a Fulbright Scholar working on a project to vaccinate sex workers against Hepatitis B. In the future, he hopes to pursue a career that will allow him to balance his interests in both clinical medicine and health policy.