Rigotti, Nancy Ann

Rubenstein, Lisa V.

Journal of General Internal Medicine

Harvard University - DASH 

 The SGIM Policy Analysis: Supporting the Generalist Voice forParticipation in Policymaking  (Article begins on next page)The Harvard community has made this article openly available.Please share how this access benefits you. Your story matters.Citation Rubenstein, Lisa V., and Nancy A. Rigotti. 2009. The SGIMPolicy Analysis: Supporting the Generalist Voice forParticipation in Policymaking. Journal of General InternalMedicine 24(7): 888-889.Published Version doi://10.1007/s11606-009-1025-6Accessed February 19, 2015 7:45:14 AM ESTCitable Link http://nrs.harvard.edu/urn-3:HUL.InstRepos:5346651Terms of Use This article was downloaded from Harvard University's DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth athttp://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAAThe SGIM Policy Analysis: Supporting the Generalist Voicefor Participation in PolicymakingLisa V. Rubenstein, MD, MSPH1,2,3 and Nancy A. Rigotti, MD41Department of Medicine, Veterans Administration Greater Los Angeles, Los Angeles, CA, USA;2UCLA David Geffen School of Medicine andSchool of Public Health, Los Angeles, CA, USA;3RAND, Santa Monica, CA, USA;4Division of General Medicine, Massachusetts General Hospitaland Harvard Medical School, Boston, MA, USA.J Gen Intern Med 24(7):888–9DOI: 10.1007/s11606-009-1025-6© Society of General Internal Medicine 2009Th i si s s u eo fJGIM contains an article entitled “HighQuality Care and Ethical Pay-for-Performance: A Societyof General Internal Medicine Policy Analysis” by Wharam andcolleagues1. The importance of this topic is addressed in anaccompanying thought-provoking editorial by Dr. Matt Wynia.This second editorial has a different purpose. We highlight theWharam article as SGIM’s first full example of an officiallysanctioned SGIM policy analysis.While SGIM has always developed position papers on keyissues of relevance to our members, the Society has notpreviously used a systematic process to publish in-depthanalyses of its positions in JGIM. Because the product is newfor SGIM, this editorial outlines how it developed from an ideato a finished product, focusing on how the preparation andreview of the document differs from the typical journal article.By doing so, we hope to inspire SGIM members, committees,interest groups, and task forces to create other policy analysesaddressing the critical issues facing general internal medicinepractice, education, and research.SGIM’s Council and Health Policy Committee have longwrestled with the challenge of how best to articulate the viewsof SGIM members on problems and issues facing generalinternal medicine. This is a critical role for our Society, andone that has become more pressing recently as the prospectsfor major health-care reform escalate. The central role ofprimary care appears to be poised for recognition at the sametime that the declining workforce threatens the future of ourfield.At this critical juncture, how can SGIM make its voiceheard? We believe that as an organization, SGIM is wellpositioned to exert influence. SGIM represents a broad-basedgeneralist point of view. We have strong connections toacademic medicine and to the trainees who represent thefuture of our field. Among medical societies, SGIM has gainedcredibility by establishing its independence from for-profitpharmaceutical and other industries involved in health-caredelivery. These are among the qualities that lead other societiesand political entities to request SGIM’s participation orsupport. Yet our member-supported financing, our supportfor research, education, and quality improvement activities,and our reliance primarily on volunteer labor limit the numberof policy issues in which our governing bodies can effectivelyengage.A solution to this dilemma is to engage SGIM committeesand interest groups in creating a broad set of policy analysesthat our members can use to participate more effectively inlocal, regional, and national policy venues. In this way, SGIMcan support but also extend the reach of individual members.A policy analysis will differ from the product of SGIM individualmembers by having a defined process of review and input fromthe SGIM Council and Health Policy Committee. We envisionpublished SGIM policy analyses as a subset of those posted onthe SGIM web pages. Published policies would be salient, highquality, peer-reviewed products of general interest to ourmembers. These published analyses would represent collabo-rative effort among the authors working with the SGIMCouncil, Health Policy Committee, and the JGIM editorialteam. The Wharam article represents a collaboration of thissort. It is an example of the kind of thoughtful policy analysiswe hope to support. We would therefore like to highlight someof the article’s key features from the point of view of SGIMgovernance.First, the analysis was produced by one of SGIM’s formallyidentified committees (Ethics). Analyses by individual SGIMmembers and others on policy issues can be very valuable, butwould not be considered SGIM policy analyses. The path to anSGIM policy analysis (or SGIM issue brief, a shorter documentfor the website) begins with submission of a synopsis to anappropriate SGIM official committee.Second, the authors systematically incorporated the viewsof a broader group of SGIM members beyond the EthicsCommittee. Besides reviewing the literature, the authorscarried out in-depth interviews with key informants, focusgroups with SGIM members at regional meetings, and openforums at SGIM national meetings. The ideas in the paperevolved substantially as the authors interacted with clin-icians, educators, and researchers across the country. Thefinal paper speaks with the authority of the many voices itintegrates.Third, the SGIM Council actively participated in producingthe document. Initially, the Council supported the initiation ofthe project by involving regional and national meeting atten-dees. Later, the Council reviewed and approved the initial draftof the policy analysis paper. Finally, the Council re-reviewedand commented on the final policy analysis draft. Thestatement thus represents an official SGIM viewpoint and canbe used by SGIM Committees and interest groups for referenceand dissemination. Published online June 5, 2009888Fourth, the SGIM Health Policy Committee contributed byhelping the paper’s authors and the Council develop a focusedpolicy statement at the paper’sc o r e .T y p i c a lm e d i c a lj o u r n a lpapers present data and appropriately avoid taking positions.Like traditional publications, policy analyses rely on evidence,theory, and literature review as foundations. Policy analyses likethis one, however, when carried out in support of a society likeSGIM, also represent a defined stance that can be used to takeaction. Many Health Policy Committee members are highlyexperienced policy experts. Their expertise enabled the authorsof this paper to hone their conclusions into action statements.Finally, the published paper benefited from the expertise ofJGIM editors, reviewers, and editorial staff. The Council hadapproved the initial draft of the paper submitted to JGIM. Theformat and quality review criteria for JGIM policy analyses,however, had not yet been established. JGIM worked with theauthors to develop an effective format. The final paper containsthe same basic information as the initial draft, but it issubstantially more readable, shorter, and better supportedthan the initial draft, thanks to JGIM’s editing and review.The overall process produced a strong work that is a creditto its authors and to the many other SGIM individuals andgroups who contributed. It was also a pilot test for the processof developing SGIM policy analyses for JGIM and as suchidentified potential issues for the future. First, in order tofoster the development of future policy analyses from SGIM’scommittees and interest groups, the policy pathway needs tobe more broadly accessible. Methods for integrating healthpolicy and core committee expertise into such analysesbeginning from an early stage, for example, are critical.Second, standard publication formats and quality stan-dards for SGIM policy analyses are needed to support thepolicy analysis development and review process. Templatescould be created to make it easier for authors to prepare policyanalyses for publication. Quality guidelines could assist theCouncil and reviewers in moving policy analyses forward. Inthis paper, for example, no formal qualitative analysis of focusgroup or interview results is documented in the paper, and nosurveys or consensus panels were undertaken. SGIM needs toconsider what types of methods for assessing membershipviews on specific subjects are acceptable, and how muchexploration of broader views is necessary to assure reasonableconsensus.Finally, because policy analysis is action-oriented, tradeoffsbetween completeness of preparation and review must beweighed against the effects of delay in the publication timeline.Some issues may be enduring and lend themselves to a morecomprehensive approach, while others may be more time-limited and require a method for rapid progression into print.SGIM expects that the Wharam paper will be used by SGIMcommittees and members as a starting point for local, regional,and national action. Members who disagree with the paper willstill be able to utilize its systematic review of pay for performanceissues. Health-care reform activities will inevitably focus atten-tion on how to incentivize quality and will surely demandaccountability from providers. We expect that by anticipatingpotential unintended consequences, and framing them in ethicalterms, SGIM members can help shape performance incentivesthat truly benefit the health of the public.Corresponding Author: Lisa V. Rubenstein, MD, MSPH, VA GreaterLos Angeles at Sepulveda, 16111 Plummer St. (152), North Hills, CA91343, USA (e-mail: Lisar@rand.org).REFERENCE1. Wharam JF, Paasche-Orlow MK, Farber MJ, et al. High quality care andethical pay-for-performance: a society of general internal medicine policyanalysis. J Gen Intern Med. 2009;24 doi:10.1007/s11606-009-0947-3.889 Rubenstein and Rigotti: The SGIM Policy Analysis: Supporting the Generalist Voice for Participation in Policymaking JGIM

The SGIM Policy Analysis: Supporting the Generalist Voice for Participation in Policymaking

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The SGIM Policy Analysis: Supporting the Generalist Voice for Participation in Policymaking

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