title: U.S. Internal Medicine Residents' Knowledge and Practice of High-Value Care: A National Survey.
abstract: OBJECTIVE
  To determine U.S. internal medicine (IM) residents' knowledge of, attitudes toward, and self-reported practice of high-value care (HVC), or care that balances the benefits, harms, and costs of tests and treatments.
  
  
  METHODS
  The authors conducted a cross-sectional survey of U.S. IM residents who took the Internal Medicine In-Training Examination in October 2012. They used multivariable mixed-effects models to examine the relationships between self-reported knowledge and practice of HVC and both exposure to HVC teaching and the care intensity of the training hospital (based on a composite age-sex-race-illness standardized measure of hospital days and inpatient physician visits by Medicare recipients).
  
  
  RESULTS
  Of 21,617 residents who received the survey, 18,102 (83.7%) completed it. Self-reported HVC practices varied: 4,187 of 17,633 respondents (23.7%) agreed that they "share estimated costs of tests and treatments with patients"; 15,549 of 17,626 (88.2%) agreed that they "incorporate patients' values and concerns into clinical decisions." Discussions about balancing the benefits, harms, and costs of treatments with faculty during patient care at least a few times a week were reported by 7,103 of 17,704 respondents (40.1%) and were associated with all self-reported HVC practices. The training hospital's care intensity was inversely associated with self-reported incorporation of costs and patient values into clinical decisions but not with other self-reported behaviors.
  
  
  CONCLUSIONS
  U.S. IM residents reported varying HVC knowledge and practice. Faculty discussions of HVC during patient care correlated with such knowledge and practice and may represent an opportunity to improve residents' competency in providing value-based care.
authors.affiliation: K.L. Ryskina is general internal medicine fellow, Division of General Internal Medicine, and fellow, Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.C.D. Smith is director of clinical programs development and senior physician educator, American College of Physicians, Philadelphia, Pennsylvania.A. Weissman is research center director, American College of Physicians, Philadelphia, Pennsylvania.J. Post is assistant professor, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.C.J. Dine is assistant professor, Division of Pulmonary and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.K. Bollmann is assistant professor, Department of Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona.D. Korenstein is clinical member, Memorial Hospital at Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Kira L
authors.initials: KL
authors.lastname: Ryskina
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Smith
authors.forename: Arlene
authors.initials: A
authors.lastname: Weissman
authors.forename: Jason
authors.initials: J
authors.lastname: Post
authors.forename: C Jessica
authors.initials: CJ
authors.lastname: Dine
authors.forename: KeriLyn
authors.initials: K
authors.lastname: Bollmann
authors.forename: Deborah
authors.initials: D
authors.lastname: Korenstein
mesh_terms: D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States