A Joint Quality Improvement and High-Value Care Curriculum in a Limited-Resource Setting

Since the release of the Institute of Medicine's To Err Is Human, there has been an increased focus on quality improvement (QI). QI training is now a requirement monitored via ACGME's clinical learning environment review committees. Given the significant cost of health care waste, teaching physicians to incorporate costs and value into medical decision making is crucial. Increasing information is available on methods to teach high-value care (HVC), but there is little information on combining HVC with QI. As these topics are intimately linked in efforts to provide effective, efficient care, a joint curriculum is a feasible solution.

We adapted material from two online resources-(1) Institute of Healthcare Improvement Open School and (2) American College of Physicians High Value Cost-Conscious Care Curriculum-to create a combined curriculum for use in a limited-resource setting. Our curriculum is divided into 10 seminars, each including both QI techniques and HVC theories, which are reinforced using a series of patient scenarios. Residents apply their knowledge in self-directed projects presented in the final seminar. Evaluation includes a pre-/postexposure QI knowledge application test, survey of self-assessed knowledge, and anonymous course feedback.

For the 46 residents who completed the series, a statistically significant improvement in both tests was measured, and feedback was positive overall. Tailoring our in-seminar patient scenarios allowed residents to demonstrate their HVC knowledge acquisition.

This seminar-based curriculum can be adapted to the time availability in any residency program and transfer to other disciplines with modification of the patient scenarios.