The 2011 Putting the Charter into Practice grants will facilitate the development of innovative, emerging strategies to advance appropriate health care decision-making and the stewardship of health care resources, one of the commitments of Medical Professionalism in the New Millennium: A Physician Charter.

The 2011 Putting the Charter into Practice grantees are:

American College of Physicians (ACP) — The American College of Physicians Center for Ethics and Professionalism will develop case studies focusing on the professional considerations relevant to physician decisions about resource allocation and stewardship. The case studies will be available for CME credit and presented at educational sessions at future ACP annual meetings.

Costs of Care — Through this project, the Boston-based nonprofit's "Teaching Value" project team has created interactive, case-based video modules to facilitate reflective learning about stewardship of health care resources among medical students, residents and practicing physicians. The video modules, available at www.teachingvalue.org, center on the care of a fictional patient admitted to the emergency room. Each module explores reasons why clinicians commonly overuse medical tests and treatments, such as physician training, opaque pricing structures, redundant ordering and patient requests. Each scenario is coupled with a debriefing video that includes key teaching points, including how to communicate with patients about unnecessary care and reducing overused or misused tests and procedures. The modules are intended to engage trainees in graduate medical education programs, and will also be used for training both practicing physicians and residents in teaching hospitals, as well as students during third-year internal medicine clerkships.

Johns Hopkins Bayview Medical CenterJohns Hopkins Bayview will focus on reducing the overutilization of cardiac enzyme panels, a commonly ordered diagnostic test, by aligning physician ordering behavior with established guidelines for appropriate testing and changes in billing systems. Low performers will receive coaching; high performers will be interviewed to identify best practices. The project team will evaluate the effort based on cardiac enzyme test ordering pre- and post-intervention.

National Physicians Alliance (NPA) — This project builds on NPA’s 2009 Putting the Charter into Practice grant project, which convened workgroups to develop lists of how primary care physicians can be good stewards of resources. In this follow-up project, NPA will develop resources and train physicians to communicate with patients on tests and procedures where potential harm exceeds benefits based on recommended lists. It will showcase exemplar communication skills in clinical practices around the country by creating educational videos and other training materials.

Division of Pediatric Emergency Medicine, University of Minnesota — Through this project, the University of Minnesota's Division of Pediatric Emergency Medicine will develop and implement evidence-based practice guidelines and electronic clinical decision support tools for common causes of pediatric emergency room visits such as acute gastroenteritis and suspected appendicitis, two childhood conditions for which physicians commonly do not adhere to practice guidelines. This can result in overuse of laboratory testing and, in the case of suspected appendicitis, overuse of CT scans.