Integrating Choosing Wisely, Value-Based Care Principles, Into Undergraduate Medical Education: A Pilot Study.

BACKGROUND: Healthcare spending represents a large portion of the GDP of the United States. Value-based care (VBC) seeks to decrease waste in health care spending, yet this concept is insufficiently taught to medical students. The Choosing Wisely Students and Trainees Advocating for Resource Stewardship (STARS) campaign promotes initiatives that integrate knowledge of VBC into undergraduate medical education (UME). This study sought to determine the most effective strategy to educate medical students on key principles of VBC as taught by the STARS campaign. METHODS: Choosing Wisely principles were incorporated into the UME curriculum of an academic medical institution via the creation of eight new learning objectives (LOs) for case-based learning (CBL) sessions and lectures. Medical students completed an annual 10-question survey from 2019 to 2022 and 10 formal examination questions during the preclinical (years 1 and 2) curriculum after exposure to varying quantities of LOs. Pearson correlation, chi-square, and logistic regression were employed to determine the association between increased LOs in the curriculum and (1) campaign awareness and (2) knowledge of VBC principles. RESULTS: A total of 700 survey responses over a four-year period (2019 to 2022) were analyzed. Student awareness of the campaign and knowledge of VBC principles increased year over year during the survey period (39% to 92% and 64% to 74%, respectively). There were significant associations between increased LOs in the curriculum and (1) campaign awareness (0.828, p<0.0001) and (2) knowledge of VBC principles (0.934, p<0.001). Students also performed well on formal examination questions related to VBC principles (mean: 81.5% and mean discrimination index: 0.18). CONCLUSION: Integration of VBC-focused LOs is significantly associated with awareness of the Choosing Wisely STARS campaign and knowledge of VBC principles taught by the campaign. Collaborative initiatives to increase exposure to VBC education may improve students' knowledge of these principles during medical school.

Evolution of Population Health Within US Schools of Medicine and Academic Medical Centers.

Schools of medicine are increasingly focusing on efforts beyond the immediate needs of individual patients and addressing the needs of whole populations. This study examined the characteristics of population health departments and related programs within, and affiliated with, schools of medicine and how these programs address the schools' educational, clinical care, research, and service missions. Structured reviews of school of medicine websites were used to identify population health departments and related programs. An on-line survey was distributed to a subset of these programs to capture details on their activities and organizational characteristics. The authors convened leaders of population health programs to elaborate on core themes. Of 154 school of medicine websites reviewed, 37 (24%) had affiliated population health programs, including 28 (18%) with distinct departments of population health. Departments reported a variety of teaching activities related to undergraduate medical education, graduate degree programs, and certificate programs addressing a variety of population health domains including public health, health administration, epidemiology, biostatistics, informatics, and research methods. Research was a core activity for most departments with significant support coming from federal funding, with many playing major roles in clinical and translational research institutes and cancer centers. Most departments had research, data sharing, and other collaborations with affiliated health systems. All departments engaged in community service activities, including activities supporting the response to the COVID-19 pandemic. Population health programs are playing an increasingly important role in the teaching, clinical care, research, and community service missions in schools of medicine and academic medical centers.

A judicious approach to ordering lab tests.

Following these guidelines to order fewer tests can improve health care quality and patient experience, while reducing wasteful costs.

A Framework and Curriculum for Training Residents in Population Health.

There is increasing imperative to train residents in population health. The Accreditation Council for Graduate Medical Education (ACGME) enhanced its mission with revised Common Program Requirements (CPRs), which were fully implemented on July 1, 2020. The revised CPRs state ACGME's mission: "The development of physicians in GME focused on excellence in delivery of safe, equitable, affordable, quality care; and the health of the populations they serve." The new CPRs clearly articulate the need for graduate medical education (GME) trainees to develop and understand population health concepts during their GME experience, including social determinants of health and community impact. However, currently there is no standardized and widely available curriculum for GME to implement these revised CPRs. This paper proposes a curriculum in population health management for GME, which was developed in 1 institution, using a blend of didactic and experiential learning.

Use of Postdischarge Emergency Medical Services to Reduce Hospital Readmissions: Does It Work and Is It Economically Feasible?

A new model of community health delivery has utilized emergency medical services (EMS) to manage care transitions and provide chronic care services in patients' homes. The authors performed a retrospective, case-controlled analysis of a quality improvement project that examined whether an EMS home visit to recently discharged inpatients from the zip code where EMS provides services can reduce 30-day unscheduled ED visits and hospital readmissions. Additionally, the financial impact from the perspective of the community-based EMS provider and the community hospital from which patients were discharged was examined. A total of 53 patients and 53 controls were matched on the following variables: readmission risk score, age, sex, insurance status, and case management intervention. Patients who received the intervention had a 44% relative reduction of 30-day ED visits (17% vs 24.5%, P = 0.3381) and a 28.4% relative reduction in 30-day readmissions (18.9% vs 26.4%, P = 0.3532) but neither achieved statistical significance. The intervention cost to EMS was $1937; the intervention led to a $3626 profit for the hospital compared to a loss of $9915 for the control group. Use of local EMS providers may lead to enhanced health care and financial outcomes for community hospitals but the study was underpowered to make a definitive conclusion. However, the results may allow health systems to assess whether collaboration with local EMS providers can improve outcomes at a lower cost.

Learning the oral and cutaneous signs of micronutrient deficiencies.

Wound healing is a complex process that is influenced by multiple systemic factors, including nutritional status. While nutritional support is commonly recognized as an important aspect of comprehensive wound management, the focus is typically on replacement of macronutrients, specifically calories and protein. Our experience strongly suggests that micronutrients are equally important, that micronutrient deficiencies are common, and that correction of these deficiencies frequently leads to wound healing when incorporated into a comprehensive wound management program. This article provides guidelines for assessment and management of micronutrient deficiencies.

Razones e indicaciones para la nutrición parenteral y enteral (Hiperalimentación)

Los pacientes que presentan enfermedades tales como pancreatitis, politraumatismo, etc.. las que impiden al enfermo alimentarse adecuadamente por vía oral durante períodos significativos de tiempo entre 7-10 días, o llega con una DNT previa debe recibir terapia nutricional.

Hiperalimentación parenteral: Seguridad y eficacia

No se debe permitir que un enfermo caiga en desnutrición clínica significativa mientras se halla hospitalizado. se evita esta situación con la administración de nutrición intravenosa prescrita por médicos preparados con vigilancia diaria en aquellas situaciones en las que la nutrición enteral no es posible.

Hiperalimentación enteral: Seguridad y eficacia

La nutrición enteral está indicada en cualquier paciente en que su tracto gastrointestinal funcione y el cual no pueda consumir alimentos voluntarios a través de la vía oral.