A Conceptual Framework for Continuing Medical Education and Population Health

Figures & data

Figure 1. Moore et al.’s expanded outcomes framework—levels 1 to 7 (adapted from Moore et al.⁵).

Table 1. From Moore et al.’s¹ outcomes measurement framework - population health (Level 7) is NOT included.

	Observed	Self-report
Patient Health Status Level 6	Patient health record Administrative records	Physician questionnaire Patient questionnaire
Performance Level 5	Patient health record Administrative records	Physician questionnaire Patient questionnaire
Competence Level 4	Observation during practice and feedback during learning activity OSCEs Scenarios with ARS Scenarios in small groups Standardized patients	Physician questionnaire Clinical scenarios (electronic) Clinical scenarios (print)

Table 3. Hazard ratios between opioid doses and overdose, data from Dunn et al.⁷

Opioid Dose	Patients Who Overdosed, n (%)	Person-Years	Overdose Rate (95% CI) per 100,000 Person-Years	Hazard Ratio for All Overdose Events (95% CI)
None	6 (12)	16 780	36 (13-70)	0.31 (0.12-0.80)
Any opioid use	45 (88)	17 582	256 (187-336)	5.16 (2.14-12.28)
1 to <20 mg/d	22 (43)	13 770	160 (100-233)	1.00
20 to <50 mg/d	6 (12)	2311	260 (95-505)	1.44 (0.57-3.62)
50 to <100 mg/d	6 (12)	886	677 (249-1317)	3.73 (1.47-9.50)
≥100 mg/d	11 (22)	614	1791 (894-2995)	8.87 (3.99-19.72)

Figure 2. Moore et al.’s⁵ needs assessment in the outcomes framework.

Table 2. Categorizing population health outcomes by specificity of the outcome and the scope of the population compared to the CME intervention.

		Specificity of outcome compared to intervention
		High specificity	Moderate specificity	Low specificity
Scope of population compared to intervention	Narrow scope	Opioid use in patients of CME participants^a	Opioid-related harms/benefits in patients of CME participants	Health-related quality of life or mortality in patients of CME participants
	Moderate scope	Opioid use in patients of clinical practices of CME participants	Opioid-related harms/benefits in patients of clinical practices of CME participants	Health-related quality of life or mortality in patients of clinical practices of CME participants
	Wide scope	Opioid use in entire jurisdiction	Opioid-related harms/benefits in entire jurisdiction	Health-related quality of life or mortality in entire jurisdiction^b

a Pure “aggregative” population health outcome (more patient/medical-like).

b Pure “distributive” population health outcome (more social-like).

Figure 3. Clinical population medicine, "numerators" and "denominators."

Figure 4. Population distribution of CHD deaths according to serum cholesterol (from Rose⁷).

Figure 5. Population distribution of opioid overdoses according to opioid dose (reinterpreted from Dunn et al.⁶⁴).

Moore DE, Jr., Chappell K, Sherman L, Vinayaga-Pavan M. A conceptual framework for planning and assessing learning in continuing education activities designed for clinicians in one profession and/or clinical teams. Med Teach. 2018;40(9):904–913. doi:10.1080/0142159X.2018.1483578.

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Moore DE, Jr., Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Contin Educ Health Prof. 2009;29(1):1–15. doi:10.1002/chp.20001.

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Rose GA, Khaw K-T, Marmot MG. Rose’s Strategy of Preventive Medicine: The Complete Original Text. New ed. Oxford: Oxford University Press; 2008.

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Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92. doi:10.7326/0003-4819-152-2-201001190-00006.

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