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The Article in Brief
Measuring Outcomes: Lessons From the World of Public Education
John W. Saultz , and colleagues
Background Quality and efficiency in American health care are increasingly measured using clinical and financial data. Similar performance management policies have been implemented in public education. In this article, 2 researchers, one with a background in education policy and the other in primary care, outline how outcomes measurement and public reporting of quality data in public education can serve as both a positive example and a cautionary tale for similar changes underway in health care.
What This Study Found Performance measurement techniques can be useful if properly applied, and, according to the authors, opposition will not cause such efforts to go away. They recommend that health policy leaders not discount the expertise of physicians as educational policy leaders have with teachers, focusing on a narrow list of outcomes; rather, policy leaders should recognize the limitations of business models in service sectors, reconnect with local communities, and more effectively listen to their voices. The unintended consequences of poorly implemented performance management in both education and health care include the narrowing of purpose, deprofessionalization, and a loss of community control.
Implications
Annals Journal Club
Jan/Feb 2017: Measuring Outcomes: Lessons From the World of Public Education
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion: Submit a comment.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
Saultz A, Saultz JW. Measuing outcomes: lessons from the world of public education. Ann Fam Med 2017;15(1):71-76..
Discussion Tips
Journal clubs are traditionally based on original research that focuses on diagnosis or treatment of a particular condition. The medical literature, however, has important articles and lessons that do not fit this mold. The special report by Saultz and Saultz investigates measurement and quality in the public education system and the relation to the health care system.
Discussion Questions
- What is the main point of this special report and why does it matter?
- Do you see cross-disciplinary learning as an important component of medical practice and/or medical research?
- The authors advocate for physicians to participate in "debates about the future of
public education in their own communities."
- Do you see this as a role you should take on?
- Do you feel prepared for this type of role?
- What would you advocate for in this role?
- Do you see quality improvement and/or measurement as an important component of medical practice?
- What are the positives and negatives of quality improvement and measurement in medical practice?2-4
- Do you think the parallel from the education system provides insight into measurement within the health care system?
- What do you see as critical components to measurement/quality in your practice? Cite examples.
- What opportunities do you see for teachers and primary care clinicians to work together on common advocacy (for those on the frontlines of caring for children and patients)?
- How could this special report be used to change practice? Policy? Education? Research?
- Do you see researchable or actionable questions that arise from this article?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.
- Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M. Effects of pay for performance on the quality of primary care in England. N Engl J Med . 2009;361(4):368-378.
- Berwick DM. Era 3 for medicine and health care. JAMA. 2016;315(13):1329-1330.
- Kerr EA, Hayward RA. Patient-centered performance management: enhancing value for patients and health care systems. JAMA. 2013;310(2):137-138.
