Trends in High-Value Care as Reported by Internal Medicine Program Directors

Area of Science:

• Medical Education
• Health Services Research
• Quality Improvement

Background:

• High-value care, emphasizing cost-benefit-harm balance, is increasingly critical in healthcare.
• Program directors (PDs) offer insights into resident skills and institutional priorities for high-value care.

Purpose of the Study:

• To assess changes in PD-reported resident skills and institutional priorities related to high-value care from 2012 to 2014.
• To evaluate the evolution of high-value care education and practice in internal medicine residency programs.

Main Methods:

• Annual surveys of US internal medicine PDs were conducted from 2012 to 2014.
• Identical questions regarding high-value care were used to track changes over time.
• Survey development involved the American College of Physicians and the Alliance for Academic Internal Medicine.

Main Results:

• A majority of PDs reported high-value care as a teaching priority, subject of didactics, discussed by residents, and emphasized by leadership.
• Approximately one-third of PDs noted persistent unnecessary test ordering.
• A statistically significant increase (P=.002) was observed in PDs reporting residents ordering fewer unnecessary tests in 2014 compared to 2012 (42.5% vs. 28.1%).

Conclusions:

• Internal medicine residency programs demonstrated strong institutional commitment to teaching high-value care between 2012 and 2014.
• Evidence suggests improvement in trainees' ability to avoid unnecessary diagnostic testing over the study period.