Target Audience

Health care providers of all specialties including physicians, nurses, nurse practitioners and physician assistants.

Description

The ABIM Foundation, in partnership with Consumer Reports, has developed and implemented the highly successful "Choosing Wisely®" campaign. Medical specialty societies partnering in Choosing Wisely have published nearly 500 evidence-based recommendations that can be used as critical guideposts for conversations between patients and clinicians about avoiding inappropriate care and helping to create a culture of stewardship of healthcare resources. However, one must recognize that good stewardship of healthcare resources is not only a matter of making sure that clinicians understand evidence-based recommendations, but also a matter of helping clinicians learn how to deliver care differently.

Activity Overview

Focusing on avoiding overtreatment and providing patients and families with high-value care is a relatively new concept in most areas of medicine meaning health professionals may have varying levels of understanding and background for thinking about these issues. In the hospital it can be particularly challenging to navigate various hierarchies and different perspectives. Many of us can recall times where we had to respond to a supervisor who was asking us to do something for a patient that we did not necessarily agree with, or a situation where the supervisor’s motivation was unclear. There are a few communication strategies that can be used in these situations, along with a framework¹ for effective conflict resolution, advocacy, and mutual support so that we can all engage in conversations among the inter-professional team that ultimately help provide high-value care for our patients.

1. Pocket Guide: TeamSTEPPS. Content last reviewed January 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html. Accessed Dec 16, 2016

Learning Objectives

At the conclusion of this activity, participants will be able to:

1. Identify the challenges to addressing overuse at the point-of-care.
2. Develop an approach to discussing high-value care, including overtreatment and costs, with colleagues, consultants, and supervisors.
3. Discuss strategies for “managing up” and effectively starting conversations about high-value care with supervisors.

Additional References

• American Board of Internal Medicine Foundation. (2013). Choosing Wisely – American Academy of Pediatrics. http://www.choosingwisely.org/societies/american-academy-of-pediatrics.
• Berwick, D.M., & Hackbarth, A.D. (2012). Eliminating waste in US health care. JAMA. 307:14(1513-6).
• Kuppermann N, et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. Epub 2009 Sep 14. PubMed PMID: 19758692.

Faculty Information and Disclosures

Vineet Arora, MD, MAPP is the Education Director for Costs of Care, a non-profit that curates clinical insights that drive better care at lower cost. She is also Associate Professor of Medicine, Assistant Dean of Scholarship & Discovery at Pritzker School of Medicine, and Director of GME Clinical Learning Environment and Innovation at the University of Chicago Medicine. Dr Arora is also a Board of Directors member for the American Board of Internal Medicine.

Reshma Gupta, MD, MSHPM is the Outreach and Evaluation Director for Costs of Care. She oversees the joint Costs of Care/American Board of Internal Medicine Foundation Learning Network, which aims to support clinical innovators in scaling and sustaining best practices that improve value. She is the Medical Director for Quality and Value at the Offices of Accountable Care and Population Health at UCLA Faculty Practice Group.

Chris Moriates, MD is the Implementation Director for Costs of Care. He is also the Assistant Dean of Healthcare Value and an Associate Professor at the new Dell Medical School at UT Austin, and previously was an Assistant Professor at the University of California, San Francisco (UCSF), where he directed the center-wide Caring Wisely program and served as co-chair of the UCSF Division of Hospital Medicine High-Value Care Committee.

Danielle Moriates, RN is a nurse advisor for Costs of Care and has been working within the Advocacy platform to better engage nurses in delivering value-based healthcare. She is also a registered nurse who works in the neonatal intensive care unit at Seattle Children’s Hospital in Seattle, Washington.

Neel Shah, MD, MPP is the Founder and Executive Director of Costs of Care. He is also an Assistant Professor at Harvard Medical School and the Ariadne Labs for Health System Innovation. He maintains an active clinical practice as an ob/gyn that includes delivering babies, providing primary care, and performing surgery.

September Wallingford, RN, MSN is the Operations Director for Costs of Care. She currently oversees strategy, execution, and coordination of Costs of Care’s growing programs and works towards enhancing the visibility of the nursing profession in empowering patients and clinicians to deflate medical bills. She is also a registered nurse at Brigham & Women’s Hospital in Boston, Massachusetts.

The faculty have no conflicts of interest to disclose.

The faculty at Costs of Care and the staff of the Center for Continuing Medical Education have no financial relationships to disclose.

Accreditation and Credit Designation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Chicago Pritzker School of Medicine and Costs of Care. The University of Chicago Pritzker School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Chicago Pritzker School of Medicine designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This enduring material is approved for 2 years from the date of original release, March 22, 2017 thru March 21, 2019. To successfully earn credit, participants must complete the activity online during the valid credit period. To receive AMA PRA Category 1 Credits™, the participant must complete the activity evaluation and correctly answer all questions (100% pass rate) on the post-test. The test can be accessed by clicking on the appropriate certificate link at the top of this page. Upon successful completion, the participant may save or print their certificate (PDF).

Nurses and other healthcare professionals will receive a Certificate of Participation. For information on the applicability and acceptance of Certificates of Participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME, please consult your professional licensing board.

Fee

These activities are complimentary.

Contact

If you have any questions regarding this CME activity, please contact September Wallingford, Operations Director, Costs of Care: email september@costsofcare.org or Samantha Anderson, Research Specialist, Section of General Internal Medicine, University of Chicago: email sanderson7@medicine.bsd.uchicago.edu

Grant Funding

Funding for these modules was provided by the ABIM Foundation with support from Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of RWJF.

Disclosure(s) Declarations

As a provider accredited by the ACCME, The University of Chicago Pritzker School of Medicine asks everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. This includes any entity producing, marketing, re-selling, or distributing health care goods or services consumed by or used on patients. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months, including financial relationships of a spouse or life partner that could create a conflict of interest. Mechanisms are in place to identify and resolve any potential conflict of interest prior to the start of the activity.

Additionally, The University of Chicago Pritzker School of Medicine asks authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.

Disclaimer

The information presented in this activity is for continuing medical education purposes only. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of the University of Chicago Pritzker School of Medicine, the University of Chicago Medicine, or any Department or Section.