ArticleBMC health services research2020
A new instrument to measure high value, cost-conscious care attitudes among healthcare stakeholders: development of the MHAQ.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review.Frontiers in public health · 2021Pooled it
- Evaluating a targeted educational intervention to promote high-value, cost-conscious care among medical students.Medical education online · 2026Article
- Educator perspectives on costs and cost-conscious decision-making in health professions education: a Q-Method study.Advances in health sciences education : theory and practice · 2026Article
- Factors influencing cost awareness in hospitals: a scoping review.BMC health services research · 2025Article
- Medical Students' Observations of High Value and Potentially Wasteful Care Behaviors Modeled During Clinical Rotations.Journal of general internal medicine · 2025Article
- Curriculum Innovations: Teaching Residents About Guideline Development and Cost-Conscious Care: A Mixed-Method Evaluation Study.Neurology. Education · 2025Article
- Integrating High-Value Cost-Conscious Care into an Existing Medical School Curriculum.MedEdPORTAL : the journal of teaching and learning resources · 2025Article
- Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study.Journal of general internal medicine · 2025Article
- A decade of change towards Value-Based Health Care at a Dutch University Hospital: a complexity-informed process study.Health research policy and systems · 2024Article
- Implementing high-value, cost-conscious care: experiences of Irish doctors and the role of education in facilitating this approach.BMC medical education · 2024Article
- High-Value, Cost-Conscious Care Attitudes in the Graduate Medical Education Learning Environment: Various Stakeholder Attitudes That Residents Misjudge.Journal of general internal medicine · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundResidents have to learn to provide high value, cost-conscious care (HVCCC) to counter the trend of excessive healthcare costs. Their learning is impacted by individuals from different stakeholder groups within the workplace environment. These individuals' attitudes toward HVCCC may influence how and what residents learn. This study was carried out to develop an instrument to reliably measure HVCCC attitudes among residents, staff physicians, administrators, and patients. The instrument can be used to assess the residency-training environment.
methodThe Maastricht HVCCC Attitude Questionnaire (MHAQ) was developed in four phases. First, we conducted exploratory factor analyses using original data from a previously published survey. Next, we added nine items to strengthen subscales and tested the new questionnaire among the four stakeholder groups. We used exploratory factor analysis and Cronbach's alphas to define subscales, after which the final version of the MHAQ was constructed. Finally, we used generalizability theory to determine the number of respondents (residents or staff physicians) needed to reliably measure a specialty attitude score.
resultsInitial factor analysis identified three subscales. Thereafter, 301 residents, 297 staff physicians, 53 administrators and 792 patients completed the new questionnaire between June 2017 and July 2018. The best fitting subscale composition was a three-factor model. Subscales were defined as high-value care, cost incorporation, and perceived drawbacks. Cronbach's alphas were between 0.61 and 0.82 for all stakeholders on all subscales. Sufficient reliability for assessing national specialty attitude (G-coefficient > 0.6) could be achieved from 14 respondents.
conclusionsThe MHAQ reliably measures individual attitudes toward HVCCC in different stakeholders in health care contexts. It addresses key dimensions of HVCCC, providing content validity evidence. The MHAQ can be used to identify frontrunners of HVCCC, pinpoint aspects of residency training that need improvement, and benchmark and compare across specialties, hospitals and regions.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.