Teaching and Learning About the Health Care System. Financial Disclosures. Health Care Delivery. Health Policy. Health Care Economics

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1 Teaching and Learning About the Health Care System Nathan Moore PGY 1, Internal Medicine Washington University in St. Louis Financial Disclosures Co Author, The Health Care Handbook Training St. Jude Medical Devices Health Care Delivery Health Policy Health Care Economics 1

2 Survey of 93 Medical School Deans 94% of schools reported some form of policy education Average amount was 14 hours over 4 years 58% of deans reported that their school has too little health policy education. Only 30% of schools have a department or institute of health policy Mou, et al. The State of Health Policy Education in U.S. Medical Schools. Mou, et al. The State of Health Policy Education in U.S. Medical Schools AAMC Medical Student Questionnaire Do you believe that your instruction in the following areas was inadequate, appropriate, or excessive? Inadequate Appropriate Excessive Care of Hospitalized Patients Ethical Decision Making Patient Confidentiality and Privacy Health Policy Managed Care Law and Medicine Health Care Systems Medical Economics Medical Licensure/Regulation Mou, et al. The State of Health Policy Education in U.S. Medical Schools. 2

3 Survey of 770 U.S. Medical Students Most students demonstrated incomplete knowledge of the magnitude and demographics of [the uninsured], the performance of the U.S. health care system in comparison with other countries, and the financing of health care in the U.S. No appreciable difference in performance between firstand fourth year students 96% felt that understanding health policy was important to practicing medicine. Survey of 770 U.S. Medical Students 54% expressed dissatisfaction with medical school coursework related to health policy, health care delivery, and health care reform issues 89% wanted increased exposure to health policy, health care delivery, and options for health care reform. 67% wanted more required coursework 60% wanted more elective coursework 63% wanted more extracurricular experiences Agrawal, et al. Medical Students Knowledge of the U.S. Health Care System and Their Preferences for Curricular Change: A National Survey. Agrawal, et al. Medical Students Knowledge of the U.S. Health Care System and Their Preferences for Curricular Change: A National Survey. Why is it so hard? It s complicated 3

4 It s politically charged News and Blogs Popular Press 4

5 Scholarly Books It s boring (and it s not on Step 1 or 2) 5

6 Health Care Systems Education: Goals Don t get bogged down in details: Provide students with a basic level of competency 6

7 Health Care Systems Education: Goals Don t get bogged down in details: Provide students with a basic level of competency Integrate with clinical material: Students will care if you show them how it affects patients Health Care Systems Education: Goals Don t get bogged down in details: Provide students with a basic level of competency Integrate with clinical material: Students will care if you show them how it affects patients Be neutral: Present the range of opinions with an eye on the facts Health Care Systems Education: Goals Don t get bogged down in details: Provide students with a basic level of competency Integrate with clinical material: Students will care if you show them how it affects patients Be neutral: Present the range of opinions with an eye on the facts Demonstrate relevance to their careers: Once you mention salaries, people pay attention Health Care Systems Education: Goals Don t get bogged down in details: Provide students with a basic level of competency Integrate with clinical material: Students will care if you show them how it affects patients Be neutral: Present the range of opinions with an eye on the facts Demonstrate relevance to their careers: Once you mention salaries, people pay attention Reach across disciplines: Should be useful for all health professions students 7

8 Real World Examples University of Oklahoma Tulsa ACP s High Value Care Curriculum Khan Academy During ward rounds, the learners were asked 3 questions after presenting their patients: How could this admission have been prevented? During ward rounds, the learners were asked 3 questions after presenting their patients: How could this admission have been prevented? What might explain the fact that many in the community have the same health problem but are not receiving care at all? During ward rounds, the learners were asked 3 questions after presenting their patients: How could this admission have been prevented? What might explain the fact that many in the community have the same health problem but are not receiving care at all? What hospital or health system policies facilitate or hinder appropriate diagnosis and treatment of patients with this condition? 8

9 1. Each learner team selected a policy related problem to address. 2. Background research a. Literature search b. Patient data analysis c. Interviews with administrators and providers Outcomes were measured and monitored over time Daily updates during rounds Final results disseminated via , newsletter, grand rounds or presentation to hospital administration. 3. Action plan and discussion with faculty Problem: Patients requiring long stays in the hospital for social rather than clinical reasons. Social workers overworked and undermanned. Problem: Patients requiring long stays in the hospital for social rather than clinical reasons. Social workers overworked and undermanned. Analysis: 35 admissions 311 hospital days. 172 days for medical care 139 days for patients awaiting SNF/rehab placement Total cost to hospital: $147, 752 9

10 University of Oklahoma Tulsa Problem: Patients requiring long stays in the hospital for social rather than clinical reasons. Social workers overworked and undermanned. Analysis: 35 admissions 311 hospital days. 172 days for medical care 139 days for patients awaiting SNF/rehab placement Total cost to hospital: $147, 752 Intervention: Presentation to hospital and medical school leadership 2 additional social workers hired. Free lunch for residents and students. 10