Six Stewardship Innovations and Bright Ideas At Leading Teaching Hospitals Named Winners in Teaching Value and Choosing Wisely® Challenge

March 5, 2015 - Philadelphia, PA – Medical education teams at Penn State Milton S. Hershey Medical Center, Harvard Medical School, Case Western Reserve University, the Louis Stokes Cleveland VA Medical Center, the Medical College of Wisconsin, McGill University, The Mount Sinai Hospital, The University of Chicago and Brigham and Woman's Hospital were named winners of the Costs of Care and ABIM Foundation Teaching Value and Choosing Wisely Challenge. A new learning network to foster ideas and innovations to advance stewardship competencies in medical education and training was also announced.

Teaching Value and Choosing Wisely Challenge
The Challenge, now in its second year, sought to identify the most promising innovations and bright ideas for teaching high-value care and stewardship to medical students, trainees and faculty. A panel of experts reviewed 80 entries and judged them on their innovativeness, feasibility and relevance to the current training environment.

Winners were named in two categories-"Innovations" for projects that are either completed or underway-and "Bright Ideas" for proposed interventions that could be successfully implemented on a larger scale.

Innovations winners:

A team of medical educators, Drs. Eileen Moser and Susan Glod from Penn State Milton S. Hershey Medical Center; Drs. Sara Fazio and Grace Huang from Harvard Medical School; and Dr. Clifford Packer from Case Western Reserve University and the Louis Stokes Cleveland VA Medical Center, modified the traditional SOAP note template to include a discussion of value. By embedding value consideration into a routine practice, students reported greater comfort with initiating discussions about overuse with their clinical teams.

Drs. Marty Muntz, Jaren Thomas, Bipin Thapa and Michael Frank, and Kerrie Quirk, MEd, from the Medical College of Wisconsin, assigned third-year medical students on their internal medicine clerkship to roles as "High Value Care Officers." Students were prepared using a series of short podcasts and an iPad-based Choosing Wisely checklist before being asked to initiate conversations with colleagues on opportunities for improvement.

Drs. Todd Lee, Charles Frenette, Dev Jayaraman and Louise Pilote, from the Medicine and Microbiology departments at McGill University in Montreal, used trainee-led "time-outs" to optimize the use of antibiotics. Following one year of monthly education and audits, antibiotics were prescribed less frequently, leading to a 46 percent local cost reduction.

Bright Ideas winners:

A team of educators at The Mount Sinai Hospital that included Drs. Hyung (Harry) Cho, Tuyet-Trinh (Trini) Truong, Andrew Coyle, Andrew Dunn, Mather (Dilan) Jogendra, Karen Blanchard, and Deborah Korenstein, and Carlo Lutz, MS, and Shelley Greebel, LMSW, created the Overuse Clinical Case Morbidity (OCCAMs) conference named after Occam's razor, a problem-solving principle. The conference has a detailed rubric, including presentation of real-case and root-cause analysis of overuse. Conferences are paired with brainstorming sessions with trainees and faculty in the medicine department to develop improvement opportunities that will be translated into actionable solutions.

Drs. Jonas de Souza, Jeremy O'Connor, Chadi Nabhan, and Christopher Daugherty, and Aamir Hussain, MS, and Bonnie Yap, MS, from The University of Chicago, propose to help trainees become more comfortable discussing treatment costs with patients. Cancer patients will be screened for financial burden using a validated quality of life questionnaire and will then be interviewed by student and resident trainees under the supervision of a social worker and a psychologist.

Drs. Kei Ouchi, Jeremiah Schuur, Susan Block and Mara Schonberg, from Brigham and Women's Hospital, propose to ask emergency providers caring for elderly patients, "Would you be surprised if your patient died in the next 12 months?" Those who answer "no" will be given a structured conversation guide to facilitate improved end-of-life planning.

"Stewardship of resources is not a part of formal medical education in this country. But it needs to be and the response to the Teaching Value and Choosing Wisely Challenge demonstrates a willingness on the part of educators to develop innovative programs," said Neel Shah, MD, founder and executive director of Costs of Care. "We received 80 entries – showcasing the creativity, compassion and professionalism of physicians and health care teams in institutions in the United States and Canada. We'd like to offer our congratulations to the winners, and our sincere appreciation to all those who shared their ideas with us."

Challenge entries were judged by national leaders in medical education and included Darrell Kirch, MD, Association of American Medical Colleges President and CEO; Risa Lavizzo-Mourey, MD, Robert Wood Johnson Foundation President and CEO; Vivian Lee, MD, PhD, MBA, University of Utah Health Care CEO; and Amy Berman, RN, Hartford Foundation Senior Program Officer.

Four of the winners will be selected to present a "TED-style talk" at the 100th Annual American College of Physicians National Meeting.

Launch of the Teaching Value in Health Care Learning Network
Recognizing the groundswell of activity aimed at improving the clinical training environment, the ABIM Foundation and Costs of Care have launched the Teaching Value in Health Care Learning Network to highlight innovative ideas and best practices and facilitate spread and adoption.

"Efforts like the Foundation's Choosing Wisely campaign and the Teaching Value and Choosing Wisely Challenge conducted with Costs of Care demonstrate the opportunity to create positive change that comes from communities coalescing around a shared challenge in our health care system," said Daniel Wolfson, executive vice president and COO of the ABIM Foundation. "We hope to create a space where we can engage with one another to foster improvements in medical education and training, and I invite those with ideas to share or a desire to learn to join us."

The learning network is open to medical residents, students, faculty and others who are committed to advancing stewardship competencies and high value care. Participants will collaborate to develop learning strategies in medical education and training, focusing on the changing health care environment and the skills required of physicians.

The learning network will also feature monthly "Third Thursday" webinars with leaders in medical education. These will highlight implementation models and innovations in value-based training. The "Third Thursday" series kicks off on March 19 at 12 pm ET and will feature previous Teaching Value and Choosing Wisely Challenge winner Robert Fogerty, MD, assistant professor of medicine and academic hospitalist at Yale School of Medicine. Dr. Fogerty will discuss "I-CARE" (Interactive Cost-Awareness Resident Exercise), which he created to engage faculty and trainees in a friendly competition to create effective, lower cost care plans.

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit abimfoundation.org, read the Medical Professionalism Blog, connect with us on Facebook or follow us on Twitter.

About Costs of Care
Costs of Care is a nonprofit organization that is transforming American healthcare delivery using a combination of advocacy, education and technology to help caregivers deflate medical bills. Connect at CostsOfCare.org.