Assignments Week 1







Class Orientation (30')

Class (2 hrs)

VBHC: Mods 2 & 3

*Dive deep into Basics of Healthcare (M3.2) (2 hrs)

Class (2 hrs)

VBHC*: Mod 1 (1 hr)

CareZooming exploration* (30')

Mini Pres*: ICHOM

Click here for Dr. Matt Nielsen May 2020 recorded talk

Opt: Narrative Medicine Readings* (1 hr)

Mini Pres*: BOTM & Chargemaster

Weekly Reflection

Mini Pres*: TWDFNR

Opt: Equity & HVC *

*See Further Instructions & Resources

Further Instructions & Resources:

Note: Many of the associated online videos and readings derive from the Dell Modules. Students may view these resources on their own but the reason they are called out as "extra" assignments is to ensure that these specific materials are looked at by all students. Not every "extra" resource embedded in the Dell Modules will be listed in the syllabus.

  • VBHC Dell Modules:

    • Students access the Discovering Value-Based Medicine Interactive Module Series and create a free account. The program tracks module completion and offers the opportunity at the end of a "Course" to receive a Certificate (pending completion of the associated survey).

  • CareZooming exploration:

    • This site aggregates QI/HVC projects and may help inform students' final project. Use it to explore the interventions conducted at other institutions around the country. What were their successes? What pitfalls did they experience? What were their recommendations for follow-up work? Could your potential intervention be an expansion upon previous work?

  • Mini-Presentations

    • Things We Do For No Reason:

      • All students (1 hr): Go to the website and review a few TWDFNR.

      • Student Discussion Leaders (2 hrs): Present to the class a brief summary on a TWDFNR of your choice. (Preferably, clinical students will be assigned this such that they can include their own experiences into the presentation.) You should be prepared to explain why you chose this TWDFNR. The goal of this exercise is for presenters to convince the rest of the class that this truly is a TWDFNR. At a minimum, you must summarize the TWDFNR, hitting upon all or most of the entry's sections. Additionally, you must comment on whether you believe this to be a low-value practice. What are some downstream implications of this TWDFNR? Briefly consult the literature to support this assessment. You should also include any follow-up evidence on this recommendation. Were there studies of institutions changing their practice due to this TWDFNR? What do society guidelines suggest? Finally, what might be a way you'd want to publicize this information to attendings, residents, allied health, and patients?

    • ICHOM Exploration

      • All students (1 hr): Please peruse the available standard sets on the ICHOM website. Note that there are disease specific sets (i.e., diabetes) and general/population sets (i.e., older persons). Select one set to explore further. Download and explore the free reference guide for your standard set of choice. You will have to submit your name and e-mail to download the guide. Reflect on how these sets were made and the value of their utility. Potential questions you could ask of yourself include: Do you think it is comprehensive? Missing anything? What societies/physician groups were involved in the making of this standard set? If the standard set references another survey (i.e., PHQ-9) find the survey and prepare general comments. Do you feel that survey is comprehensive enough? Is it validated? How has it been validated? A student discussion leader will be investigating the ICHOM sets in detail and may ask you to voice your opinion on some questions regarding the sets (see below!)

      • Student Discussion Leaders (2 hrs): You will be leading a short discussion (~20 minutes) on ICHOM for your fellow classmates. You will need to schedule a 30 minute call/zoom with Elexis to go over some behind-the-scenes details that were obtained from an ICHOM representative. Look at the assignment description for all students so you know what knowledge they will be coming in with. It will be your job to spark and guide a conversation about the utility of ICHOM standard sets in clinical practice. Example questions you can ask of your classmates include: How realistic you think it is for an individual physician to integrate the use of this standard set into their practice. Should the onus be on the health system within which they operate (i.e., UNC Health)? Will you have time as a physician to evaluate these PROMs and perform process analysis formally or is it enough to simply utilize and evaluate these measures informally? Do you imagine that tracking process and outcome measures would actually hinder your ability to provide quality care as a physician? Are the surveys referenced in the standard set free? Do you feel like all of the measures in the standard set are already largely being addressed in the clinic? If so, what is the point of the ICHOM standard set?

    • Bill of the Month & Chargemaster

      • All Students (1 hr): Review the BOTM webpage and read through a few of the cases. Please attempt to find your institution's "Chargemaster."

      • Student Discussion Leaders (2 hrs): Pick a BOTM case that speaks to you and be prepared to present your choice to the class. Also, please search for "The Chargemaster" of three institutions (2 in your home state and 1 in a state of your choosing). In addition to giving us a brief summary of the case, some other prompts to consider:

        • 1) Why did you select this BOTM? Have you or someone else you know experienced something similar?

        • 2) What happened to this patient? What procedure or treatment did they receive and why? Whose fault is this? The doctor? The patient? The payor or the institution? What could have been done differently?

        • 3) How do the charges across selected institutions vary? Were you surprised? Why or why not? How do the charges compare with what the BOTM patient experienced?

  • Opt: Equity & HVC

    • Remember, HVC is patient-centric care. It's about understanding the totality of our patient's needs and the forces outside of them that might influence those needs (i.e., SDOH). In the wake of the George Floyd protests, legendary Prof. Emeritus at The IHI Don Berwick shares his take on how we can restructure our healthcare system. He presents some solutions for how we might create a system that transcends the "moral determinants of health," wherein we commit to the shared vision of "securing the health of communities." Only then, by adhering to a morality that first and foremost recognizes health care a human right -- can we begin to address the social determinants of health.

    • Another way to think about equity is to consider innovative approaches to guaranteeing healthcare for our most vulnerable patients. LA County Department of Housing Services worked with community, healthcare, and social services leaders to develop a comprehensive, collaborative program, "Housing for Health," for its homeless population. Built around the principle that ensuring housing first can lead to improved health outcomes, the Housing for Health program is a remarkable case study of an enormously diverse city's successful approach to addressing healthcare in its homeless population.

  • Follow-up Reading: A Patient's Viewpoint on a Current Controversy

    • This is the editorial mentioned in Dr. Nielsen's talk about the radiologist who received a seemingly benign imaging study which led to a cascade of unnecessary tests.

  • ACP Modules

    • Students have the opportunity to solidify content learned this past week. They must create a free online account with ACP.

  • Opt: Narrative Medicine readings:

    • Optionally take a short detour to the realm of medical humanities. These articles introduce "narrative medicine," and argue how it can and should shape the practice of medicine. Course facilitators can choose to bring this up into the next session, connecting how the principles of narrative medicine coincide with the objectives of the value-based medicine movement.

      • Readings (PDFs below):

        • Charon, R. (2004). Narrative and Medicine. N Engl J Med, 350(9), 862-864. (20')

        • Charon, R. and Wyer, P. (2008). The Art of Medicine: Narrative Evidence-Based Medicine. The Lancet, 371(9609), 295-297 (20')

        • Lewis, B. (2011). Narrative Medicine & Healthcare Reform. J Med Humanities, 32(9), 9-21 (50')

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