(1109) Addressing Challenges to High-Value Care Practice: A Curriculum for Senior Pediatric Residents

Introduction: United States healthcare costs are increasing at an unsustainable rate, with physicians contributing to overdiagnosis and overtreatment. ACGME requires residents to incorporate considerations of cost-awareness in patient care. Yet, providing high-value care (HVC) can be challenging for residents in complex training environments that include working on high acuity services, frequent use of consultants, and lack of cost transparency.

Methods: We designed a new HVC Academic Half Day (3.5 hour block conference) for a large pediatric residency program (n=94 residents). The curriculum consisted of four learning activities: an overview lecture of HVC principles; a small group case-based discussion utilizing an interactive cost dashboard to manage a child hospitalized in the pediatric intensive care unit (PICU); a small group case-based discussion working with consultants on a hospital medicine service; and a case competition focused on a cost-conscious diagnostic evaluation.

Evaluation consisted of an electronic retrospective post-survey accessed via QR code at the end of each of the two AHD blocks.

Results: 45 pediatric residents were scheduled to complete the curriculum. Survey results (response rate 67%) revealed 97% of residents were “much/somewhat more” likely to incorporate cost-awareness considerations after participating in the curriculum. Respondents were also much/somewhat more likely to apply HVC principles to patients in the PICU (90%) and with consultants (84%). Nearly all found the curricular components to be “extremely/moderately effective”. Themes from qualitative analysis included: greater consideration of HVC in developing plans, increased awareness and use of cost resources, heightened confidence in managing consultant recommendations, and appreciation for the case competition due to curriculum participation.

Conclusions: We successfully developed, implemented, and preliminarily evaluated a HVC curriculum uniquely focusing on low-value contexts, the PICU environment, working with consultants, and lack of cost transparency. Results highlight perceived planned changes in behavior to incorporate HVC principles. Next steps include evaluating the impact of this curriculum on senior resident practice in the clinical environments and designing a curriculum for pediatric interns.