ABSTRACT
A national imperative to provide value-based care requires new strategies to teach clinicians about high-value care.
We developed a virtual online learning network aimed at disseminating emerging strategies in teaching value-based care.
The online Teaching Value in Health Care Learning Network includes monthly webinars that feature selected innovators, online discussion forums, and a repository for sharing tools. The learning network comprises clinician-educators and health system leaders across North America. We conducted a cross-sectional online survey of all webinar presenters and the active members of the network, and we assessed program feasibility.
Six months after the program launched, there were 277 learning community members in 22 US states. Of the 74 active members, 50 (68%) completed the evaluation. Active members represented independently practicing physicians and trainees in 7 specialties, nurses, educators, and health system leaders. Nearly all speakers reported that the learning network provided them with a unique opportunity to connect with a different audience and achieve greater recognition for their work. Of the members who were active in the learning network, most reported that strategies gleaned from the network were helpful, and some adopted or adapted these innovations at their home institutions. One year after the program launched, the learning network had grown to 364 total members.
The learning network helped participants share and implement innovations to promote high-value care. The model can help disseminate innovations in emerging areas of health care transformation, and is sustainable without ongoing support after a period of start-up funding.
Engaging clinicians in value-based care is a challenging undertaking critical to ensuring sustainability of the nation's health care system.
A virtual online learning network aimed at disseminating emerging strategies for teaching value-based care.
Small sample size, survey instrument lacks validity evidence, lack of data on actual impact of costs of care.
The learning network helped participants share and implement innovations to promote high-value care and is sustainable without ongoing support after start-up funding.
Introduction
With recent sweeping payment reforms and the rising cost of health care, the pressure on delivery systems to train providers to provide better care at lower costs has never been higher.1–6 Engaging clinicians in delivery system transformation, teaching value-based skills, and silos between delivery systems and training programs are challenging interventions whose failure will threaten this goal.7 While innovations in these areas exist, spreading such innovations is challenging.8
Learning collaboratives, like those sponsored by the Institute for Healthcare Improvement, can promote dissemination of health care innovations.9 We developed the Teaching Value in Health Care Learning Network, an online Google+ Community (Google Inc, Mountain View, CA), to create a free platform to disseminate innovations that promote high-value care to educators and system leaders. This article aims to evaluate the acceptability, implementation, and feasibility of this network.
Methods
We launched the Teaching Value in Health Care Learning Network in March 2015. While open to the public, members were also recruited from North America through e-mail solicitation from professional societies affiliated with the American Board of Internal Medicine (ABIM) Foundation Choosing Wisely campaign and the Costs of Care list host, including innovators who participated in Teaching Value Choosing Wisely Challenges, cosponsored by Costs of Care Inc and the ABIM Foundation.10 The network was also promoted on several social media networks such as Twitter and Facebook.
The learning network has 3 components: (1) 20- to 30-minute interactive webinar discussion(s) with diverse on-the-ground and national leaders; (2) an online discussion forum to facilitate sharing ideas; and (3) an online repository for disseminating materials related to value innovations. The learning network employed a private Google+ Community, an online social network platform that offers collaborative communication and storage, and utilized Google Hangouts.11–13 Google Hangouts on Air enables real-time YouTube broadcasting to a public audience from a “live” video chat session; it also enables remote learners to view an online panel of speakers in separate locations and post questions that can be moderated in real time. Sessions are automatically archived on YouTube, enabling asynchronous viewing.13,14
Ethical approval was waived by the University of California, Los Angeles Institutional Review Board.
In September 2015, we conducted a cross-sectional online survey via Qualtrics 2015 (Qualtrics, Provo, UT) of all speakers during the first 6 months of the program. To assess member experiences, we surveyed a subset of “active” learning network participants in March 2016. We defined active members as those who participated in at least 1 of the 3 learning network components in the first year. Both surveys were developed by 2 community participants and 2 content experts based on reviews of the literature to evaluate collaboratives and cognitive interviewing. We assessed participant comprehension, interpretation, readability, and perception of ambiguity of each item in the draft survey. We also measured feasibility by evaluating required personnel, online resources, webinar consistency, and viewing rates over time.
Results
In the first year, 12 webinars on value-based care were recorded and disseminated. A total of 4 clinical leads took turns moderating the learning network each month to update content and lead the monthly webinars with consistency in structure and quality. Over the first year, video webinars were each viewed an average of 77 times (range, 46–151; 0.3 average views per member; table 1). The learning network discussion board included 268 posts in the first year; 108 (40%) shared resources and events, and 165 (62%) shared questions and comments. Members uploaded PowerPoint presentations that addressed training, project descriptions, implementation guides, and relevant publications to the “Tools for Educators and System Leaders” section.
Initial implementation required 5 hours by a clinical lead to develop program content and 20 hours by 2 administrators to develop the website and recruit participants. Thereafter, the network required minimal resources to maintain (1 hour monthly by a clinical lead and 5 hours monthly by 2 administrators to edit webinar recordings). While the value-based care learning network development and implementation was supported by a $10,000 grant from the ABIM Foundation, it has been sustained for over 1 year without grant funding.
Six months after program launch, there were 277 learning community members, of which 74 (27%) were deemed active with at least 1 interaction (ie, these members either posted, commented, and/or watched a webinar). Of these active members, 50 (68%) completed an evaluation (table 2). After 1 year, the value-based care learning network consisted of 364 members, of which 153 (42%) were deemed active; 74 (20%) members had watched at least 1 live webinar.
Experiences of Webinar Presenters
All 6 webinar speakers (100%) reported that the learning network provided an opportunity to share parts of their work (ie, implementation) that they often did not have the opportunity to share. Five speakers (83%) reported that webinar discussions helped them to consider how to discuss their innovation in the future. All speakers reported that by participating, their innovation(s) achieved greater external recognition; overall, they felt that the webinar was a valuable experience.
Experiences of Learning Network Participants
Many respondents reported learning about new developments in the field of high-value care (35 of 50, 70%); networking and collaborating (19, 38%); gaining resources (7, 14%); and disseminating their work (3, 6%). Nearly two-thirds of respondents (31, 62%) reported that finding strategies shared on the learning network was helpful in meeting their individual goals, and roughly half (28, 56%) felt that content would be of interest to learners at their home institutions. Nearly one-third of respondents reported that as a result of the learning network, they implemented an innovation at their home institution. A total of 25 (50%) surveyed participants gained a sense of how to sustain high-value care innovations through the network.
Discussion
Over 1 year, the value-based care learning network brought together a diverse community and expanded membership by nearly 32%. Active members found content useful and implemented innovations from the network at their home institutions. We built capacity in value-based care training and delivery through consistent and sustained participation of community members in the learning network.
Compared with other large scale online learning communities (such as Academic Life in Emergency Medicine), the Teaching Value in Health Care Learning Network had similar numbers of webinar views and listening rates to podcasts per member and similar membership growth in a year.13,15 We found Google Hangouts to be a powerful tool to facilitate discussion and collaboration, bringing together a diverse group interested in health care–delivery improvement.13
Limitations include a small sample size, especially for trainee participants. We did not assess trainee knowledge or behaviors during or after residency, nor the actual impact on cost-effective care. Formal survey validation was not undertaken. Next steps could include a follow-up evaluation among a larger sample. Technical limitations included requirements for having camera-enabled devices and stable Internet connectivity, and the Google Hangout platform lacked survey functionality on new member enrollment. Participants reported challenges in viewing live webinars due to clinical schedules and different time zones, but asynchronous viewing enabled high viewing rates. Similar to other online communities, members requested shorter sessions,13 so video webinars16 and 15-minute podcasts are now offered.17 We are actively increasing participation from other professional organizations and are engaging a community of delivery system leaders to join our network.
Conclusion
The Teaching Value in Health Care Learning Network attracted a group of diverse health professionals. Speakers and members reported satisfaction with the format and usefulness of innovations shared. While the initial cost was supported by a grant, sustaining this network without ongoing dedicated resources appears feasible.
References
Author notes
Editor's Note: The online version of this article contains the schedule of topics and speakers in year 1 of the learning network webinars.
Funding: This work was supported by a grant from the American Board of Internal Medicine Foundation to Costs of Care Inc, a nonprofit organization with which all authors are affiliated.
Competing Interests
Conflict of interest: All authors are employed with Costs of Care Inc. Dr. Gupta is also supported by the Veterans Affairs (VA) Office of Academic Affiliations through the VA/Robert Wood Johnson Foundation Clinical Scholars Program. Drs. Shah, Moriates, and Arora receive royalties from McGraw-Hill and have received a grant from the ABIM Foundation.
The authors would like to thank Alison Brecher, Lisa Miller, and John Held, ABIM Foundation, for their administrative and technical support. The authors would also like to thank Daniel Wolfson and Leslie Tucker, ABIM Foundation, for their guidance and support through this endeavor.