Innovative Peer Review Model for Rural Physicians: System Design and Implementation

ABSTRACT:  Context: The peer review process in small rural hospitals is complicated by limited numbers of physicians, conflict of interest, issues related to appropriate utilization of new technology, possibility for conflicting recommendations, and need for external expertise. Purpose: The purpose of this project was to design, test, and implement a virtual peer review system for small rural hospitals in Texas. We sought to define the characteristics of a virtual peer review system in the context of rural health care, and to explore the benefits from peer review administration within a rural network supported by a university. Methods: Physicians from small rural hospitals participated in pilot testing of the system. Policies and procedures reflecting the innovative character of the new peer review process were developed based on legal/regulatory requirements and desired educational focus of the process. An information technology system to support the virtual peer review was selected, tested, and deployed. Findings: The system tests suggested feasibility of the procedures, reliability of the communication lines, and functional anonymity of the hospitals and physicians participating in the virtual peer review. Participating institutions and individual physicians expressed satisfaction with the reliability and user friendliness of the system as demonstrated during the pilot tests. Conclusions: Hospital licensing and accreditation require a process to monitor and evaluate the care of patients. Utilizing means of virtual communication is a viable option for small rural hospitals. This process is dependable, user-friendly and provides functional anonymity to participating hospitals and physicians. The peer review system has successfully functioned since 2004.     

American Cancer Society Colorectal Cancer Survivorship Care Guidelines

Answer questions and earn CME/CNE Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two‐thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short‐term and long‐term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long‐term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk‐based health care for CRC survivors who have completed active therapy. CA Cancer J Clin 2015;65:427–455 . © 2015 American Cancer Society.     

Customer Convergence

This article explores the interrelationships between three categories of service quality in healthcare delivery organizations: patient, employee, and physician satisfaction. Using the largest and most representative national databases available, the study compares the evaluations of hospital care by more than 2 million patients, 150,000 employees, and 40,000 physicians. The results confirm the relationship connecting employees' satisfaction and loyalty to their patients' satisfaction and loyalty. Patients' satisfaction and loyalty were also strongly associated with medical staff physicians' evaluations of overall satisfaction and loyalty to the hospital. Similarly, hospital employees' satisfaction and loyalty were related to the medical staff physicians' satisfaction with and loyalty to the hospital. Based upon the strength of the interrelationships, individual measures and subscales can serve as leverage points for improving linked outcomes. Patients, physicians, and employees, the three co—creators of health, agree on the evaluation of the quality of that service experience. The results demonstrate that promoting patient—centeredness, enhancing medical staff relations, and improving the satisfaction and loyalty of employees are not necessarily three separate activities in competition for hospital resources and marketing leadership attention.     

The challenge of change

This article provides the Risk Manager with a framework for dealing with today's challenging times and how much uncertainty an organization is willing to accept. The frame work is ERM: Enterprise Risk Management. An argument is made that by applying an established ERM decision‐making framework, Risk Managers can integrate governance, risk management, compliance, quality performance, and technology which allows organizations to explore, evaluate, predict, mitigate, and even prevent adverse events from occurring in the first place.     

Back to basics—just how much should a risk manager know about risk financing?

Whether directly involved in development and implementation of the organization's risk financing program or not, risk management professionals, at the very least, need to be familiar with and understand the various risk financing strategies available to address all areas of exposure. This article addresses the types of coverages and risk financing options that should be considered when developing a comprehensive risk‐financing program, and why it is important for risk management professionals to have some knowledge about these products, in order for their true value to be fully appreciated.     

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency,Causes, and Costs

OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long‐ and short‐stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on‐site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long‐term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.