The PRICE is Right: The Impact of the Pediatric Residents Improving Cost-Effectiveness (PRICE) Workshop

From the 2019 HVPAA National Conference

Dr. Risa Bochner (SUNY Downstate Medical Center/Kings County Hospital Center), Dr. Carol Duh-Leong (New York University), Dr. Anne Durstenfeld (University of California – San Francisco), Dr. Moriah Rabin (Children’s Hospital at Montefiore), Dr. Molly Broder (Children’s Hospital at Montefiore), Dr. Elizabeth Alderman (Children’s Hospital at Montefiore), Dr. Rhonda Acholonu (Children’s Hospital at Montefiore), Dr. Megan McCabe (Children’s Hospital at Montefiore), Dr. Priya Jain (Children’s Hospital at Montefiore)

Background

Healthcare spending in the United States is increasing. Education in high-value care (HVC) for resident physicians is essential to combat this trend.

Objectives

The objectives of our educational intervention were to examine resident baseline knowledge and attitudes about practicing HVC and to determine the impact of a single workshop on HVC knowledge and clinical decision making. Our target audience was pediatric residents.

Methods

This was a single arm pre-post study with a HVC workshop as the intervention. Study population was 73 pediatric residents who attended one of three identical workshops. A 28-question pre-survey, modeled after the survey by Rock et al, assessed prior HVC education, baseline knowledge, attitudes about practicing HVC, and ability to estimate medical costs. Three hypothetical clinical scenarios were given to test HVC decision making. The PRICE workshop adapted Woods et al’s 7 module longitudinal curriculum available on the MedEd portal into a 2.5-hour workshop consisting of a 2-hour interactive didactic session followed by a 30-minute clinical case exercise. The problem of healthcare spending was reviewed and a five-step model for practicing HVC was introduced. Residents then completed a 23-question post-survey. T-tests and chi-square tests compared pre- and post-survey responses. Qualitative data were collected on self-reported intentions to change practice.

Results

Forty-nine percent of residents reported no prior HVC education and 93% reported little to no knowledge of hospital finances. Eighty-nine percent were “somewhat” or “very” interested in learning about health care finances. Resident ability to estimate costs improved after the workshop (Table 1). The percentage of residents using HVC decision making improved in all three hypothetical clinical cases but was statistically significant only for bronchiolitis (Table 2). Ninety-eight percent of residents reported “moderate” or “significant” improvement in HVC knowledge after the workshop. Sixty-four percent of residents reported intentions to “usually” or “always” factor cost into future patient care. When asked about intentions to change practice, 29% of residents said they would apply general HVC principles such as asking how tests will change management and 59% of residents reported that they will think about value specifically when ordering laboratory tests.

Conclusions

After a 2.5-hour workshop, residents were better able to estimate costs, apply HVC concepts to hypothetical clinical cases, and planned to factor HVC into clinical practice.

Clinical Implications

Residents self-reported their intentions to practice HVC in the future. Next steps include examining the impact of our HVC workshop on actual ordering practices.

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