I. Wise-On Call Modules
Assessment:
End of Module Quiz
Abdominal Pain
Explain the differentiating
characteristics of common causes of abdominal pain.
Describe typical presenting
signs and symptoms and make
recommendations for assessment and diagnosis.
Acute Pain Management
Describe the common medications
used to manage acute pain, comparing the relative strengths, modes of
administration, side effects and contraindications.
Demonstrate how to safely manage
acute pain.
Certifying a death
Examine the responsibilities in
both pronouncing and certifying deaths.
Describe strategies for
management of the emotions associated with the passing of a loved one.
Chest pain
Formulate a differential
diagnosis of chest pain.
Understand the approach to early
diagnosis and management.
Documentation for Patient
Safety
Describe how to provide complete,
professional entries into the medical record.
Dyspnea
Formulate a differential
diagnosis of dyspnea.
Apply clinical skills to dyspnea
cases of various etiologies.
Fever and Sepsis
Explain the framework to assess
the febrile patient and to initiate management.
Discuss management of fever if
the underlying cause is thought to be sepsis.
Hypertension
Explain when and how to treat the
patient with urgent or emergent hypertension.
Hypotension
Explain the physiology of blood
pressure control.
Describe guidelines to
differentiating among the various types of shock and identifying the underlying
cause.
Recognize the importance of early
recognition and escalation to superiors.
Loss of Consciousness
Describe the underlying causes,
common diagnosis, and initial management of the patient who has experienced a
sudden loss of consciousness.
Lower Extremity pain
Formulate a differential
diagnosis of lower extremity pain.
Understand the approach to early
diagnosis and management including escalation of urgent cases.
Oliguria
Explain the pre renal, renal and
post renal causes and the appropriate bedside and laboratory measures that can
help determine the underlying cause.
Describe how a resident would
assess and manage a typical patient with oliguria.
II.
Emotional Intelligence
Assessment:
Self-Awareness Worksheet and Individual Energy Profile Worksheet
Define Emotional Intelligence and
the impact on professional practice.
Explain Self-Awareness and
Self-Management and their impacts on communication and patient care skills.
Discuss the impact of emotional
intelligence skills on team-based care.
Explain Social Awareness and
Social Skills and their impacts on communication and patient care skills.
Explore various resiliency
strategies for wellness and burnout prevention as a physician.
Utilize emotional intelligence
skills to enhance resilience skills.
III. Value-Based Care- Modules
and Discussion
Assessment:
Module completion and discussion session participation
MODULE 1: There’s A Better Way
Reflect on the causes of waste
and inefficiencies in health care.
Define 'value' for patients.
Define and identify the major
contributing components of healthcare waste.
Connect how the pursuit of
high-value care for patients supports the professionalism of clinicians.
Introduce the concept of health
care outcomes.
Examine a case that presents
strategies and tools for increasing value in health care.
Explore data to gain
understanding and appreciate the perspective of patients, individual clinicians,
and health systems as it pertains to value-based health care.
MODULE 2: Measuring What Matters
Appreciate and reflect on
outcomes that are meaningful to the patient.
Define the measurement of
‘patient outcomes’ as they relate to value-based health care.
Examine resources for choosing
and measuring validated patient outcomes.
Apply a measures framework to
evaluate the success of health care value programs from the perspective of
patient outcomes.
Describe different types of
measures and when they would be used.
Identify the reasons for
collecting ‘patient-reported outcomes.’
Appreciate and reflect on how
patient outcomes define physicians’ success.
MODULE 3: Understanding Costs In Health Care
Reflect on the impact of cost on
patient care and the overall value of provided health care.
Define terms used in discussing
health care costs.
Describe basic principles of
health care delivery, organization, and financing.
Evaluate various financial
methods used in health care.
Describe new methods for health
care cost accounting and value-based payments.
Study methods to measure and
evaluate the success of health care value programs.
Compare the application of
traditional and value-based costing methods in the course of a patient’s
treatment
MODULE 4: Coordinating Care For Patients
Reflect on the inefficiencies for
patients and clinicians coordinating care in the current system.
Identify how inefficiencies
contribute to harm to patients and clinicians.
Recognize the benefits of
team-based care interactions organized around patient circumstances or
conditions.
Define key components of
patient-centered medical homes (PCMHs).
Evaluate the purpose of PCMHs.
Define integrated practice units
(IPUs).
Evaluate the benefits and
limitations of IPU models.
Demonstrate ability to design
care models coordinated around the needs of patients.
MODULE 5: Bringing It All Together: Value Based Health Care Delivery
Analyze the features of a
high-functioning value-based health care delivery system
Recognize the benefits of
team-based care interactions organized around patient medical needs and
conditions
Reflect on the importance of
measurement focused on patient health outcomes
Recognize the benefits of
measuring and capturing actual costs of providing patient care
Reflect on the causes and impacts
of waste in health care
Explore methods to curb overuse
in health care
Describe reimbursement mechanisms
that support value of care provided across a full care cycle for medical
conditions
Explore examples of how health
information technology can be leveraged to help restructure care delivery and
accurately measure results
Describe key structures of a
delivery system focused on moving from volume to value
Review key components of
value-based health care
MODULE 6: ENHANCING AFFORDABILITY FOR PATIENTS THROUGH HIGH-VALUE Prescribing
Reflect on the impacts of high
medication costs on patients
Recognize the harms of
cost-related medication non-adherence
Define high-value prescribing
Explore the principles of
conservative prescribing
Articulate how to identify
patients who are having difficulty paying for their medications
Describe strategies to reduce
out-of-pocket drug costs for patients
Reflect on how Kaiser Permanente
has achieved better outcomes for patients through high rates of generic
prescribing and affordable medications
Practice methods for decreasing
the costs of necessary medications for a patient
MODULE 7: Introduction To High-Value Communication
Describe how miscommunications
can occur between the patient and clinician
Identify the challenges to
addressing misconceptions at the point-of-care
Suggest strategies for promoting
high-value, shared decisions
Develop an approach to discussing
optimal use of resources with colleagues, consultants, and supervisors
Discuss opportunities to improve
interprofessional communication to limit less helpful tests and treatments and
promote patient-centered, team-based care
Use tools that help patients
actively engage in their health
Reflect on the key principles of
the communication program developed at Cleveland Clinic
Apply high-value communication
techniques during a patient encounter
MODULE 8: Creating A High-Value Care Culture
Describe the ways ingrained
institutional cultures contributes to low-value care
Identify how organizational
culture influences the value of health care delivery
Define how culture can be
measured and analyzed
Analyze the key domains that
contribute to a high-value care culture
Characterize change management
strategies
Describe conditions that support
culture change related to overuse
Define ‘nudge’ strategies
Describe how nudge strategies can
used to minimize waste in health care
Recognize personal responsibility
in promoting cultural change
Apply nudge theories to advance
behavior change toward high-value care
Reflect upon your local
organizational culture in order to make a commitment to create change
MODULE 9: Shifting Payments From Volume To Value
Characterize the ways in which
low-value care is incentivized
Apply your knowledge of
reimbursement mechanisms
Describe the current predominant
fee-for-service payment model
Describe the drawbacks of the
pay-for-performance reimbursement model
Recognize the pros and cons of
bundled payment models
Explore the value of combining
elements of different reimbursement models
Define value-based insurance
design
Summarize the current evidence
supporting the VBID strategy
Discuss the CMS application of
the bundled payment model
Compare systems and policies for
clinical care reimbursement that maximize value and reduce costs
MODULE 10: LEADING VALUE IMPROVEMENT PROGRAMS ON THE FRONTLINES
Articulate the ways in which
issues can often have complex, system-ingrained causes
Describe common improvement
methodologies
Build an actionable foundation
for change implementation
Identify tools that can help grow
understanding of an issue
Evaluate the “COST” framework for
value improvement efforts
Utilize tools for change
measurement and tracking
Identify methods to measure and
evaluate the success of health care value programs
Evaluate examples of successful
value improvement projects and systems
Compare a lean health care system
approach to a problem in your local organization
Apply the concepts of change
implementation and/or change analysis in authentic situations
IV. Pain and Opioid Lecture
Assessment:
Quiz
Explain the
rationale for the development of the 2016 CDC Guidelines for the Management of
Chronic Pain
Summarize the
role of a clinical guideline
Summarize the
12 key points of the CDC guidelines
Utilizing the
CDC Guidelines for the Management of Chronic Pain, outline an appropriate
strategy to mitigate risk to patients if initiating opioids
Define
“morphine milligram equivalents” (MME) and calculate given an opioid dose
Summarize best
practices for opioid tapering and discontinuation.
Describe the
role of a prescription drug monitoring database
Explain how
urine drug testing can help in risk assessment and decision making when
prescribing opioids
V. EOL OSCE
The EOL OSCE has objectives which
the students are provided in advance:
1.
Assess a patient in
pain
-
Obtain a thorough
history
-
Demonstrate knowledge
of key principles of pain management with nonopiods and opiods, including
equianalgesic dosing and common side effects
-
Develop a management
plan for a patient’s pain
2.
Communicate serious
news to a patient
-
Apply the key steps in
delivering serious news
-
Demonstrate
patient-centered communication skills and strategies when giving serious news
3.
Discuss advance
directives with a patient
-
Define advance
directive
-
Describe a durable
power of attorney for healthcare
4.
Discuss hospice with a
patient
-
Demonstrate knowledge
of the philosophy of hospice
-
Define hospice
-
Demonstrate knowledge
of the services provided by a hospice program
-
Explore patient
understanding of illness, concerns, goals, and values that inform the plan of
care
-
Demonstrate basic
approaches to handling emotion in patients facing serious illness