Health Care Value SIG

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SIG Goals:

  • To support and recruit APA members who are working on issues relating to value (defined as health and healthcare outcomes/cost) in pediatric healthcare
  • To develop a national curriculum on healthcare value for pediatric trainees
  • To facilitate discussions and projects within the field of pediatrics surrounding the financial crisis affecting US healthcare

SIG Background:

Healthcare costs in the US are ~$3 trillion per year, comprising almost 20% of the GDP. Despite these substantial expenditures, which dwarf all other developed countries, outcomes such as life expectancy, infant mortality are suboptimal. Reduction of the rampant overtesting and overtreatment that are currently plaguing our system would increase value both by improving outcomes (through reduced harm) and by decreasing costs. Underuse of cost-effective care is also commonplace in pediatrics, which further reduces value. As pediatricians, we have a professional obligation to deliver high-value care that improves the health of children while reducing the financial harms borne by families and society.

Much of the current dialogue surrounding value and healthcare overuse occurs in the adult medicine world, but it is imperative that the field of pediatrics is similarly engaged. An APA SIG on Healthcare Value is an important step. This SIG will encourage and facilitate sharing of ideas and collaboration on projects relating to research, educational, quality, and policy for child health advocates around the country. An initial project, which would build on the APA’s long track record of supporting educational innovations, will be to form and house a national curriculum on healthcare value that could be disseminated to pediatric training programs around the country.

Other Links:

The Value of Stories contest for 2016 PAS in Baltimore
We are pleased to announce our first "The Value of Stories" submission contest. As part of our SIG session at the 2016 PAS meeting in Baltimore, trainees (students, residents, fellows) are invited to present case stories of patients who have received low-value care. This is a great opportunity to increase trainees’ exposure to the concept of value in healthcare (generally defined as outcomes/cost) and to deliver an oral presentation at a national conference.

Stories should include:

  • Presentation of case
  • Overview of the evidence supporting or refuting the decisions that were made
  • Description of some of the charges for the care that was provided, either from the patient's direct bill, the hospital 'chargemaster', or from sites such as
  • Discussion of the drivers of the low-value care that was provided, how the low-value care may have been prevented, and/or how costs or low-value care personally affected the patient, the family, or the trainee him/herself.

Examples of similar stories can be found at the Hospital Pediatrics Bending the Value Curve section (scroll to the Bending the Value Curve section for links to prior published essays: or the JAMA Internal Medicine Teachable Moments section: Historically, stories of underuse of healthcare services have dominated the media and driven physician behavior, policy change, and law suits, but these journal sections (and hopefully our SIG session) have been successful in bringing attention to overuse stories as well.

Additional details

  • Story should be submitted in narrative form in 600 words or less to Alan Schroeder ( no later than February 1, 2016.
  • Stories will be judged by 8 panelists, including 2 prominent non-MD authors who we are planning on having speak during the session.
  • Trainees whose stories are selected will be given 10 minutes for oral presentation followed by a 5 minute Q&A. Slides OK but not mandatory.
  • Goal will be to have as many oral presentations as possible, but will depend on # of submissions and total time allotted for the session. Trainees will be notified no later than March 1, 2016.
  • The top 2 submissions will be provided the opportunity to publish their story in the Hospital Pediatrics journal’s Bending the Value Curve section.

Please help us spread the word to trainees, and do not hesitate to contact us with additional questions.

SIG co-chairs
Alan Schroeder, MD
Ricardo Quinonez, MD
Adam Schickendanz, MD
Shannon Brownlee (Author, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer) and SVP, Lown Institute
Helen Haskell (Author, Case Studies in Patient Safety: Foundations for Core Competencies)
Shawn Ralston, MD
Jim Stallworth, MD
Dan Nicklas, MD

Annual Report

Co-chairs: Alan Schroeder, Stanford, term 3 years (2019), Ricardo Quinonez, Baylor College of Medicine, term 2 years (2018), Adam Schickedanz, UCLA, term 3 years (2019)

SIG purpose/mission: To highlight health care value within the activities of the Pediatric Academic Association and support academic pediatricians interested in promoting value-based care

Current SIG goals:
1. To increase awareness of barriers to and facilitators of healthcare value in pediatrics

2. To create a learning community within APA to support the growing interest among academic pediatricians in health care value

Annual summary:

Value Success Stories, Journal Editor Panel at Annual HCV SIG Session
Our second annual meeting of the HCV SIG at PAS built on the success of the first by focusing on community building through our second "Value of Stories" competition. This year, we chose to highlight not stories of low value pediatric care but stories of trainees and their teams improving care value at their institutions to increase quality and lower cost for pediatric patients and families. This national, peer-reviewed competition received dozens of entries for five oral story presentations during the annual meeting. Trainees were asked to describe the clinical value problem they tried to improve, the approach they took, and the human impact on patients and providers of their value improvements. They were also encouraged to speculate on factors that may have facilitated their success in achieving higher-value care. We received many exceptional stories, which were all evidence of the tremendous work being done nationally around pediatric value (especially at the residency level). The presentations from trainees were uniformly excellent and highly engaging for the packed-room audience.

We also hosted a panel discussion of journal editors from major academic journals in pediatrics and internal medicine with a focus on value. The editors provided thoughtful insight into everything from the definition of value in pediatrics to how academic publishing can further the value discussion in our field.

PedsValue Modules Publication
Another major initiative of the SIG this year continued to be pediatric value-based education and curricular resources. After the development and dissemination by HCV SIG members of a series of online, case-based educational modules (The PedsValue Modules) focused on preparing pediatric trainees to deliver high quality, cost-effective care in the management common pediatric diagnoses last year, SIG members this year co-authored a manuscript in Academic Pediatrics ( reviewing existing high value care curricula in pediatrics and describing the process leading to the development of these PedsValue Modules, which represent the first nationally-developed pediatric high value curriculum. Use and utility of the PedsValue modules continues to be tracked by their authors and members of the SIG, who have plans to evaluate their uptake and effectiveness in the coming year. The PedsValue Modules are available at

Other groups that work in your area of interest:

January 2016 Newsletter Article

This report from the Healthcare Value SIG provides updates on 2 SIG-related activities: one - the PedsValue modules, and two - the Value of Stories contest for the May 2016 PAS meeting in Baltimore.

PedsValue modules
Health care costs are expected to continue their meteoric rise in 2016, and pediatric care costs are rising faster than costs for patients of any other age. Many assume that the costs of care for children are negligible, but the average family now pays over $2,500 per child annually for health care, and that rate has increased by nearly $400 dollars in the last 5 years. This increased cost is straining the typical American family, whose real earnings have been stagnant for a decade. And what benefit does the average family see for paying this ballooning price tag? Improvements in pediatric health care quality have been very incremental and the change in health of children in this country on the whole has been almost imperceptible when compared to the escalating costs. Will the price of child health care become so steep for some families that the value isn't enough to justify the cost? There is already some evidence that many families feeling the economic pinch already cut back on health care use.

So, how do we stem the tide of growing costs in pediatrics? To start, pediatricians, faculty, and trainees can learn techniques to help them practice high value medicine, defined as the highest quality and most cost-effective care. Leaders of the APA's Health Care Value SIG have spearheaded the creation of a new series of learning modules on high value care in pediatrics -- the PedsValue Modules. These modules, supported by a generous grant from the UCSF Center for Health Care Value, have been authored by a team of pediatric experts in high value care across the country, with extensive peer-review solicited from the HCV SIG members. The modules will build learners' expertise in high value care concepts and prepare them for high value management of common specific pediatric conditions. The modules will be launched and freely accessible in the Spring of 2016. For details on how to access the PedsValue modules, stay tuned to the APA's Health Care Value SIG.

Value of Stories contest for PAS
We are excited for our first ever Health Care Value SIG session at PAS this year, which will feature talks by two prominent authors about patient and family perspectives on value followed by presentations from the Value of Stories contest. More details can be found about this contest on our SIG website. Briefly, trainees are encouraged to submit stories to Alan Schroeder ( by 2/1/15 detailing a story involving a pediatric patient who received low-value care - including discussion of the drivers and consequences of the low-value care and how such care can be prevented in the future. Top stories will be given the opportunity to present during the session and to publish their stories in the "Bending the Value Curve" section of Hospital Pediatrics.

Adam Schickedanz, MD
384 28th St
San Francisco, CA 94131
Phone: (314) 303-3309

Alan Schroeder, MD
891 La Para Ave
Palo Alto, CA 94306
Phone: (408) 885-3612

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Current SIG Co-Chairs:

Adam Schickedanz, MD
384 28th St
San Francisco, CA 94131
Phone: (314) 303-3309

Alan Schroeder, MD
780 Welch Road
Palo Alto, CA 94305
Phone: (650) 725-0551



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