New curriculum teaches internal medicine residents high value, cost-conscious care principles

The American College of Physicians (ACP) and the Alliance for Academic Internal Medicine (AAIM) today unveiled a high value, cost-conscious care curriculum to help train internal medicine residents about how to avoid overuse and misuse of tests and treatments that do not improve outcomes and may cause harms.

The free curriculum, available at www.highvaluecarecurriculum.org, is designed to engage residents and faculty in small group activities organized around actual patient cases that require careful analysis of the benefits, harms, costs, and use of evidence-based, shared decision making. The flexible curriculum consists of ten, one hour interactive sessions that can be incorporated into the existing conference structure of a program.

"Physicians receive little specific training about identifying and eliminating wasteful diagnostic and treatment options," said Cynthia D. Smith, MD, FACP, ACP's Senior Medical Associate for Content Development and the lead author of "Teaching High-Value Cost-Conscious Care to Residents: The AAIM-ACP Curriculum," published online in , ACP's flagship journal. "Residency training is an excellent time to introduce the concept of high value, cost-conscious care because the habits that residents learn during training have been shown to stay with them throughout their professional careers."

are projected to reach almost 20 percent of the United States' GDP by 2020. Many economists consider this spending rate unsustainable. Up to 30 percent, or $765 billion, of were identified as potentially avoidable -- with many of these costs attributed to unnecessary services.

The committee that developed the curriculum consisted of ACP-AAIM members and staff, program directors, associate program directors, a department chair, residency faculty, and internal medicine residents.

What is High Value, Cost-Conscious Care?

High value, cost-conscious care means that a test or treatment has benefits that make its potential harms and costs worthwhile. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests or treatments have low value because they do not provide enough benefit to justify even their low costs and may even be harmful.

Because misuse and overuse of medical interventions that do not improve patient health contribute significantly to the unsustainable growth of health care spending, ACP launched a High Value, Cost-Conscious Care initiative in 2010 to help physicians and patients understand the benefits, harms, and costs of tests and treatment options for common clinical issues.

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