Noah Hoffman, MD

I have always been interested in efficiency. As a medical student, I remember being fascinated by the volume of daily laboratory testing for every patient on the adult medicine service. I wondered if the resources we were using to monitor daily liver function tests and coagulation panels on every patient were being used efficiently. More importantly, I wondered if those resources were ultimately helping patients.

As I moved through residency and into fellowship, I developed a particular interest in this question as it relates to testing often done in the setting of failure to thrive. As my academic curiosities have continued to develop, I have been particularly excited by the evolving interest in providing “high-value” care in our institution. Economically speaking, value refers to the benefit received in exchange for the monetary cost of a good or service. While it is often difficult to precisely determine the costs of many of the tests, procedures, and treatments we prescribe, putting a monetary value on the benefit they provide is even more complicated. However, I believe that as physicians and stewards of medical resources, it is our responsibility to have an understanding of the personal, systemic, and societal costs of any given prescription and consider these relative to the potential benefit to the patient who sits in front of us. Whenever possible, and particularly in the case of commonly performed tests and procedures, I believe that these costs and benefits should be considered and researched systematically.

The American Board of Internal Medicine Foundation has given us one example of this systematic understanding with the Choosing Wisely Campaign, which considers the available evidence to encourage “physicians, patients, and other healthcare stakeholders to think and talk about medical tests and procedures that may be unnecessary.” Such a list has been published for pediatric hospital medicine, and to me, adding this systematic understanding to a thoughtful approach to each individual patient is the best way to provide high-value care. Electronic medical records and readily available clinical databases afford a tremendous opportunity to examine our practices and outcomes through a high-value lens. As a fellow, I am pursuing a master’s degree in Health Policy Research at the University of Pennsylvania. As a part of this degree and with mentorship from CHOP and Penn faculty, I hope that a part of my career will be dedicated to the development and assessment of data that drive high-value practice in pediatric gastroenterology.

References and Suggested Readings

Kuehn BM. Movement to promote good stewardship of medical resources gains momentum. JAMA. 2012;307(9):895-903.

Quinonez, RA, Garber, MD, Schroeder, AR, et al. Choosing wisely in pediatric hospital medicine: five opportunities for improved healthcare value. J. Hosp. Med. 2013;8:479–485.