Health Care Value SIG
- To support and recruit APA members who are working on issues relating to value (defined as health and healthcare outcomes/cost) in pediatric healthcare
- To develop a national curriculum on healthcare value for pediatric trainees
- To facilitate discussions and projects within the field of pediatrics surrounding the financial crisis affecting US healthcare
Healthcare costs in the US are ~$3 trillion per year, comprising almost 20% of the GDP. Despite these substantial expenditures, which dwarf all other developed countries, outcomes such as life expectancy, infant mortality are suboptimal. Reduction of the rampant overtesting and overtreatment that are currently plaguing our system would increase value both by improving outcomes (through reduced harm) and by decreasing costs. Underuse of cost-effective care is also commonplace in pediatrics, which further reduces value. As pediatricians, we have a professional obligation to deliver high-value care that improves the health of children while reducing the financial harms borne by families and society.
Much of the current dialogue surrounding value and healthcare overuse occurs in the adult medicine world, but it is imperative that the field of pediatrics is similarly engaged. An APA SIG on Healthcare Value is an important step. This SIG will encourage and facilitate sharing of ideas and collaboration on projects relating to research, educational, quality, and policy for child health advocates around the country. An initial project, which would build on the APA’s long track record of supporting educational innovations, will be to form and house a national curriculum on healthcare value that could be disseminated to pediatric training programs around the country.
- Value Curriculum (coming soon)
- CME/upcoming events:
- PAS workshop Monday April 27th (San Diego): "High value cost-conscious medicine: teaching trainees to safely do less"
- Lown Institute "Road to Right Care" conference, March 8-11, 2015 (San Diego): http://lowninstitute.org/take-action/come-to-an-event/
- Preventing Overdiagnosis 2015, 9/1 - 9/3/15, Washington DC: http://www.preventingoverdiagnosis.net/
- Recommended reading
- Understanding Value-Based Care, Chris Moriates, Vineet Arora, Neel Shah
- Overtreated, Shannon Brownlee
- Overdiagnosed, Gilbert Welch
- Less Medicine, More Health, Gilbert Welch
- The Treatment Trap, Rosemary Gibson, Jamardan Singh
- How We Do Harm, Otis Brawley
- Hippocrates Shadow, David Newman
- Evidence-Based Diagnosis, Thomas Newman, Michael Kohn
- Journal sections
- Bending the Value Curve, Hospital Pediatrics: http://www.hospitalpediatrics.org/content/4/4/261.full
- Too Much Medicine, British Medical Journal: http://www.bmj.com/too-much-medicine
- Teachable Moments, JAMA Internal Medicine: http://archinte.jamanetwork.com/article.aspx?articleid=1741887
- Recent journal articles/popular press
- Commentary on "safely doing less" in bronchiolitis care: http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3703.full.pdf+html
- Article on high value care in Medical Economics: http://medicaleconomics.modernmedicine.com/medical-economics/news/high-value-care-strategies?page=0,0
- James McCormack songs on value/EBM:
The Value of Stories contest for 2016 PAS in Baltimore
We are pleased to announce our first "The Value of Stories" submission contest. As part of our SIG session at the 2016 PAS meeting in Baltimore, trainees (students, residents, fellows) are invited to present case stories of patients who have received low-value care. This is a great opportunity to increase trainees’ exposure to the concept of value in healthcare (generally defined as outcomes/cost) and to deliver an oral presentation at a national conference.
Stories should include:
- Presentation of case
- Overview of the evidence supporting or refuting the decisions that were made
- Description of some of the charges for the care that was provided, either from the patient's direct bill, the hospital 'chargemaster', or from sites such as https://healthcarebluebook.com/.
- Discussion of the drivers of the low-value care that was provided, how the low-value care may have been prevented, and/or how costs or low-value care personally affected the patient, the family, or the trainee him/herself.
Examples of similar stories can be found at the Hospital Pediatrics Bending the Value Curve section (scroll to the Bending the Value Curve section for links to prior published essays: http://www.hospitalpediatrics.org/site/misc/Author_Guidelines-MASTER.pdf) or the JAMA Internal Medicine Teachable Moments section: http://archinte.jamanetwork.com/collection.aspx?categoryid=6017. Historically, stories of underuse of healthcare services have dominated the media and driven physician behavior, policy change, and law suits, but these journal sections (and hopefully our SIG session) have been successful in bringing attention to overuse stories as well.
- Story should be submitted in narrative form in 600 words or less to Alan Schroeder (email@example.com) no later than February 1, 2016.
- Stories will be judged by 8 panelists, including 2 prominent non-MD authors who we are planning on having speak during the session.
- Trainees whose stories are selected will be given 10 minutes for oral presentation followed by a 5 minute Q&A. Slides OK but not mandatory.
- Goal will be to have as many oral presentations as possible, but will depend on # of submissions and total time allotted for the session. Trainees will be notified no later than March 1, 2016.
- The top 2 submissions will be provided the opportunity to publish their story in the Hospital Pediatrics journal’s Bending the Value Curve section.
Please help us spread the word to trainees, and do not hesitate to contact us with additional questions.
Alan Schroeder, MD
Ricardo Quinonez, MD
Adam Schickendanz, MD
Shannon Brownlee (Author, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer) and SVP, Lown Institute
Helen Haskell (Author, Case Studies in Patient Safety: Foundations for Core Competencies)
Shawn Ralston, MD
Jim Stallworth, MD
Dan Nicklas, MD
Co-chairs: Alan Schroeder, Stanford, term 3 years (2019), Ricardo Quinonez, Baylor College of Medicine, term 2 years (2018), Adam Schickedanz, UCLA, term 3 years (2019)
SIG purpose/mission: To highlight health care value within the activities of the Pediatric Academic Association
Current SIG goals:
Increase awareness of issues such as overuse and underuse in pediatrics that negatively impact healthcare value
Create a networking community within APA for physicians with interest in health care value
Value of Stories
Our primary activity for this year as a new SIG primarily was focused around our first SIG meeting at the PAS meeting in which we incorporated a "Value of Stories" competition. The first PAS SIG session for the HCV SIG was highly successful. The session was dedicated to stories surrounding commission errors (errors where clinicians did excessive tests/treatments) involving children. The motivation for this session was the idea that omission errors (errors where clinicians failed to do the appropriate tests/treatments) tend to dominate the healthcare landscape. Increased attention to commission errors may improve healthcare value (HCV) by heightening awareness of the harms of overuse. We hosted a "Value of Stories" competition, and also hosted two renowned non-physician authors, Shannon Brownlee and Helen Haskell, who gave riveting accounts of overuse from the perspective of patients/parents. In the fall of 2015, announcements about the competition were sent to various listserves, including the APA, the American Academy of Pediatrics’ Section of Hospital Medicine, the Council on Medical Student Education in Pediatrics, and through distribution lists at the home institutions of SIG members. Trainees (medical students, residents, and fellows) were invited to submit a written story about low-value care. They were asked to describe: the details of the case, the evidence-base around the decisions that were made, and any harms that occurred to the patient and/or the family. They were also encouraged to speculate on factors that may have driven the low-value care and to provide relevant charges from either the hospital chargemaster or the "fair price" from healthcarebluebook.com.
A total of 21 essays were submitted. A panel of eight judges rated the essays. Eight trainees were invited to share their stories as ~10 minute (including questions and answers) oral presentations. The remaining contestants were encouraged to share their stories as posters.
Another major initiative of the SIG this year was the development and dissemination of a series of online, case-based educational modules focused on preparing pediatric trainees to deliver high quality, cost-effective care in the management common pediatric diagnoses. These modules, called the PedsValue Modules, were co-authored by academic pediatricians and members of the SIG from over a half dozen different pediatric teaching hospitals around the country and were peer reviewed by another dozen members of the SIG. A grant from the UCSF Center for HealthCare Value supported online publication of the modules through the American College of Physicians, which has launched other successful educational modules focused on value and had the platform to disseminate the modules widely. Use and utility of the modules will be evaluated by the authors in hopes of better understanding how to increase academic pediatricians’ awareness of educational materials for high-value pediatric care. The PedsValue Modules are available at https://www.acponline.org/clinical-information/high-value-care/resources-for-clinicians/high-value-care-pediatric-cases
Other groups that work in your area of interest:
- Lown Institute
- AAP - SOHM
- APA - EBM Sig
This report from the Healthcare Value SIG provides updates on 2 SIG-related activities: one - the PedsValue modules, and two - the Value of Stories contest for the May 2016 PAS meeting in Baltimore.
Health care costs are expected to continue their meteoric rise in 2016, and pediatric care costs are rising faster than costs for patients of any other age. Many assume that the costs of care for children are negligible, but the average family now pays over $2,500 per child annually for health care, and that rate has increased by nearly $400 dollars in the last 5 years. This increased cost is straining the typical American family, whose real earnings have been stagnant for a decade. And what benefit does the average family see for paying this ballooning price tag? Improvements in pediatric health care quality have been very incremental and the change in health of children in this country on the whole has been almost imperceptible when compared to the escalating costs. Will the price of child health care become so steep for some families that the value isn't enough to justify the cost? There is already some evidence that many families feeling the economic pinch already cut back on health care use.
So, how do we stem the tide of growing costs in pediatrics? To start, pediatricians, faculty, and trainees can learn techniques to help them practice high value medicine, defined as the highest quality and most cost-effective care. Leaders of the APA's Health Care Value SIG have spearheaded the creation of a new series of learning modules on high value care in pediatrics -- the PedsValue Modules. These modules, supported by a generous grant from the UCSF Center for Health Care Value, have been authored by a team of pediatric experts in high value care across the country, with extensive peer-review solicited from the HCV SIG members. The modules will build learners' expertise in high value care concepts and prepare them for high value management of common specific pediatric conditions. The modules will be launched and freely accessible in the Spring of 2016. For details on how to access the PedsValue modules, stay tuned to the APA's Health Care Value SIG.
Value of Stories contest for PAS
We are excited for our first ever Health Care Value SIG session at PAS this year, which will feature talks by two prominent authors about patient and family perspectives on value followed by presentations from the Value of Stories contest. More details can be found about this contest on our SIG website. Briefly, trainees are encouraged to submit stories to Alan Schroeder (firstname.lastname@example.org) by 2/1/15 detailing a story involving a pediatric patient who received low-value care - including discussion of the drivers and consequences of the low-value care and how such care can be prevented in the future. Top stories will be given the opportunity to present during the session and to publish their stories in the "Bending the Value Curve" section of Hospital Pediatrics.
Adam Schickedanz, MD
384 28th St
San Francisco, CA 94131
Phone: (314) 303-3309
Alan Schroeder, MD
891 La Para Ave
Palo Alto, CA 94306
Phone: (408) 885-3612
Current SIG Co-Chairs:
Adam Schickedanz, MD
384 28th St
San Francisco, CA 94131
Phone: (314) 303-3309
Alan Schroeder, MD
780 Welch Road
Palo Alto, CA 94305
Phone: (650) 725-0551