Background: Healthcare expenditures in the United States have grown from 5% of the gross domestic product in 1960 to nearly 18% in 2015. Despite spending more for healthcare than any other industrialized country, healthcare outcomes are inferior. There are many factors identified for rising costs without an equivalent improvement in outcomes. This includes an estimated $700 million dollars of wasteful spending each year. High Value Care (HVC) is defined as providing quality patient care while simultaneously reducing unnecessary costs to the patient and healthcare system. It is suggested that clinicians ask themselves 5 key questions (KQs) prior to ordering diagnostic testing. A curriculum was developed at the University of New Mexico to empower internal medicine sub-interns to incorporate HVC principles into their emerging practice styles.
Methods: A survey was developed to gauge perceived frequency of asking the 5 KQs prior to testing. Students completed a pre-survey and two post-surveys (immediately after clerkship and prior to graduation). Residents completed pre-/post-rotation surveys and these were analyzed based on whether they had worked with a sub-intern.
Results: Seventeen sub-interns completed the curriculum and surveys (response rate 100%). Sub-interns had a statistically significant increase in their perceived frequency of asking KQ prior to testing that was sustained prior to graduation (p = 0.0007). Residents who worked with sub-interns (n=16) showed a statistically increased perceived frequency of asking KQs as compared to residents that did not work with sub-interns (n=14). Cronbach’s alpha for the KQs survey was 0.85 indicating good internal reliability.
Conclusions: Sub-interns exposed to the HVC curriculum expressed a perception that they were asking KQs prior to ordering tests that are recommendations for HVC. After working directly with these sub-interns, residents also reported asking these questions more frequently than their peers who did not. Sub-interns are not autonomous providers and have varying degrees of control over ordering practices. For GY2018 sub-interns, we plan to assess if these perceptions lead to changes in ordering patterns on their patients.