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Using a unique primary dataset for the UK, we estimate the effect of individual teachers on student outcomes, and the variability in teacher quality. This links 7,305 pupils to the individual teachers who taught them, in each of their compulsory subjects in the high‐stakes exams at age 16. We use point‐in‐time fixed effects and prior attainment to control for pupil heterogeneity. We find considerable variability in teacher effectiveness, a little higher than the estimates found in the few US studies. We also corroborate recent findings that observed teachers’ characteristics explain very little of the differences in estimated teacher effectiveness.

a b s t r a c tThis paper evaluates the impact of a performance-related pay scheme for teachers in England. Using data which matches individual pupils to individual teachers, and contains both test scores and value-added, we test whether the introduction of a payment scheme based on pupil attainment increased teacher effort. Our evaluation design controls for pupil effects, school effects and teacher effects, and adopts a difference-indifference methodology. We find that the scheme did improve test scores and value added increased on average by about 40% of a grade per pupil.

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The objectives of this study were to explore the existence of subgroups in a cohort with chronic low back pain (n = 294) based on the results of multimodal sensory testing and profile subgroups on demographic, psychological, lifestyle, and general health factors. Bedside (2-point discrimination, brush, vibration and pinprick perception, temporal summation on repeated monofilament stimulation) and laboratory (mechanical detection threshold, pressure, heat and cold pain thresholds, conditioned pain modulation) sensory testing were examined at wrist and lumbar sites. Data were entered into principal component analysis, and 5 component scores were entered into latent class analysis. Three clusters, with different sensory characteristics, were derived. Cluster 1 (31.9%) was characterised by average to high temperature and pressure pain sensitivity. Cluster 2 (52.0%) was characterised by average to high pressure pain sensitivity. Cluster 3 (16.0%) was characterised by low temperature and pressure pain sensitivity. Temporal summation occurred significantly more frequently in cluster 1. Subgroups were profiled on pain intensity, disability, depression, anxiety, stress, life events, fear avoidance, catastrophizing, perception of the low back region, comorbidities, body mass index, multiple pain sites, sleep, and activity levels. Clusters 1 and 2 had a significantly greater proportion of female participants and higher depression and sleep disturbance scores than cluster 3. The proportion of participants undertaking <300 minutes per week of moderate activity was significantly greater in cluster 1 than in clusters 2 and 3. Low back pain, therefore, does not appear to be homogeneous. Pain mechanisms relating to presentations of each subgroup were postulated. Future research may investigate prognoses and interventions tailored towards these subgroups.

Models of Care (MoCs) are increasingly recognised as a system-level enabler to translate evidence for 'what works' into policy and, ultimately, clinical practice. MoCs provide a platform for a reform agenda in health systems by describing not only what care to deliver but also how to deliver it. Given the enormous burden of disease associated with musculoskeletal (MSK) conditions, system-level (macro) reform is needed to drive downstream improvements in MSK healthcare - at the health service (meso) level and at the clinical interface (micro) level. A key challenge in achieving improvements in MSK healthcare is sustainable implementation of reform initiatives, whether they be macro, meso or micro level in scope. In this chapter, we introduce the special issue of the Journal dedicated to implementation of MSK MoCs. We provide a contextual background on MoCs, a synthesis of implementation approaches across care settings covered across the chapters in this themed issued, and perspectives on the evaluation of MoCs.

Conclusions: Clinicians and students encounter barriers to delivery of high-value OA care in clinical practice/training (micro-level); within service environments (meso-level); and within the health system (macro-level).

IntroductionDevelopment and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies’ aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.MethodsPolicies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0–14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.ResultsAfter removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies—all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).ConclusionRelative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.