Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served.
-This paper presents an analysis of the views and ideas generated at a recent health policy discussion for doctors in training. This provides an illustration of the creativity and enthusiasm that trainees can bring to the policy sphere by providing unique insights and a fresh perspective.KEY WORDS: doctors in training, health policy, medical education, performance reporting, social determinants of health Introduction Doctors willing to involve themselves in the formulation of health policy have tended to be rare. Among doctors in training, this seems to be shifting. Clinical leadership schemes for trainees, emerging following a call in Lord Darzi's NHS Next Stage Review, 1 have proved popular. They have also provided an impetus for the development of a cadre of UK doctors eager to shape the future of the NHS.A recent event at the Royal College of Physicians (RCP) gathered together doctors in training from national leadership schemes for an evening of debate. Participants represented all major specialties and stages of training. Discussion centred around three policy areas, chosen to reflect recent developments and future medical practice, and attendees were challenged to generate policy recommendations. This paper presents the views expressed and ideas generated as an indicator of the trainee perspective. They demonstrate the valuable role doctors in training can play in health policy development, providing unique insights and fresh perspectives.
The role of doctors in the social determinants of healthEstimates suggest 10% of variations in health are determined by medical care and 15% by social factors. 2 Sir Michael Marmot's recent reports for the World Health Organization and the UK government have refocused attention on the social determinants of health. 3,4 Despite efforts to address social factors, inequalities within the UK remain profound. Life expectancy for those living in the most deprived boroughs of England is, on average, a decade shorter than for those in the most affluent boroughs. 4 Historically doctors have argued for societal reform to improve health. Given competing pressures on doctors today, what is their current role in addressing these social determinants of health?The term 'social determinants of health' requires clarification. Discussion at this event contrasted 'causes' of disease, such as smoking, and 'causes of the causes' , such as poor education. Most attendees felt that the medical profession should address the causes of disease, rather than merely treating the consequences. Whether the medical profession should routinely be addressing the 'causes of the causes' was more contentious. Some felt that doctors should focus their energy on areas where their influence alone is seen to be significant. Given time and financial constraints, others felt that involvement may perhaps be beyond the day-to-day remit of individual clinicians, but where time allows, evidence-based initiatives should be prioritised. Given the imperative to concentrate on cost-effective activities, attendee...
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