BACKGROUND: Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. OBJECTIVE: To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). DESIGN: The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. SETTING: U.S. IM residency programs. PARTICIPANTS: 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. MEASUREMENTS: Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. RESULTS: The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. LIMITATION: Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. CONCLUSION: Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. PRIMARY FUNDING SOURCE: None.
BACKGROUND: Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. OBJECTIVE: To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). DESIGN: The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. SETTING: U.S. IM residency programs. PARTICIPANTS: 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. MEASUREMENTS: Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. RESULTS: The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. LIMITATION: Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. CONCLUSION: Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. PRIMARY FUNDING SOURCE: None.
Authors: Kira L Ryskina; Cynthia D Smith; Vineet M Arora; Aimee K Zaas; Andrew J Halvorsen; Arlene Weissman; Sandhya Wahi-Gururaj Journal: Acad Med Date: 2018-10 Impact factor: 6.893
Authors: Serge B R Mordang; Karen D Könings; Andrea N Leep Hunderfund; Aggie T G Paulus; Frank W J M Smeenk; Laurents P S Stassen Journal: BMC Health Serv Res Date: 2020-03-02 Impact factor: 2.655