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Christine K Cassel

Publications and source records attributed to Christine K Cassel.

At least 19 recordsLinked to original sources
PubMed2006

Who is maintaining certification in internal medicine--and why? A national survey 10 years after initial certification.

BACKGROUND: The American Board of Medical Specialties (ABMS) adopted a framework, called Maintenance of Certification (MOC), for all certifying boards to evaluate physicians' competence throughout their careers, with the goal of improving the quality of health care. The MOC participation rates of the American Board of Internal Medicine (ABIM) show that 23% of general internists and 14% of subspecialists choose not to renew their respective certificates. OBJECTIVE: To study U.S. internists' perceptions about the forces driving them to maintain certification. DESIGN: Mail survey. SETTING: A nationally representative sample of certified internists in the United States. PARTICIPANTS: Physicians originally certified in internal medicine, a subspecialty, or an area of added qualifications in 1990, 1991, or 1992. RESULTS: The overall rate of response to the survey was 51%. Although 91% of all participants are still working in internal medicine or its subspecialties, this percentage is notably lower among general internists (79%). Of those still working in the field of internal medicine or its subspecialties, approximately half report being required to maintain their specialty certificate by at least 1 employer, but only approximately one third of those who completed or enrolled in MOC report this requirement as a reason for participating. Those who completed or enrolled in MOC do so more for positive professional reasons than for monetary benefits or professional advancement. The most common reasons for not participating are the perceptions that it takes too much time, is too expensive, and is not required for employment. LIMITATIONS: Respondents were volunteers from an early cohort of diplomates entering the program, and those with less positive attitudes may have responded at higher rates. Results are based on self-reported data, and misconceptions about program requirements may have led to some inaccurate responses. CONCLUSIONS: The relatively large percentage of general internists who left internal medicine mostly to work in another medical field explains why rates of MOC participation for general internists seem lower than those for subspecialists (77% vs. 86%). Although positive professional reasons clearly have a compelling internal influence on program participation, it is less clear whether employers' requirements are an equally compelling external influence. Although half of all respondents report that MOC is required by 1 of their employers, only one third of those who participate in the program describe it as a reason for participating.

Attitude of Health Personnel↗
PubMed2004

The role of physician specialty board certification status in the quality movement.

The Institute of Medicine's reports and discussions on quality of medical care have focused on a systems-based approach to quality improvement. Our objective is to summarize evidence and theory about the role of a physician's current board certification status in quality improvement. The first body of evidence includes the validity of board certification demonstrated by the testing process, the relationship of examination scores with other measures of physician competence, and the relationship between certification status and clinical outcomes. The second body of evidence involves the adaptation of error prevention theory to medical care. Patient safety is enhanced when problem-solving uses readily accessed habits of behavior, the same behavior necessary to achieve board certification. The third body of evidence, obtained through a Gallup poll, demonstrates that certification and maintenance of certification are highly valued by the public. The majority of respondents thought it important for physicians to be reevaluated on their qualifications every few years and that physicians should do more to demonstrate ongoing competence than is currently required by the profession. We conclude that a physician's current certification status should be among the evidence-based measures used in the quality movement.

Physician's Role↗
PubMed2004

Using systems-based practice to integrate education and clinical services.

The authors describe one institution's strategies to implement the Accreditation Council for Graduate Medical Education's (ACGME) Outcomes Project requirements while simultaneously exploring and implementing standards of quality healthcare as endorsed by the Institute of Medicine's (IOM) Crossing the Quality Chasm (2001). Of real interest, application of the authors' institution's paradigm is identical to many of the parameters for system competence as recommended in the IOM's April 2003 report, Health Professions Education: A Bridge to Quality (2003).

Accreditation↗
PubMed2003

Professional organizations' position statements on physician-assisted suicide: a case for studied neutrality.

Position statements opposing legalization of physician-assisted suicide by organizations such as the American College of Physicians-American Society of Internal Medicine rightly emphasize that palliative care should be the standard of care for the dying, and that the inadequacies that exist in its delivery should be remedied. But such position statements generally understate the limitations of palliative care to alleviate some end-of-life suffering, and they do not provide adequate guidance about how physicians should approach patients with intractable suffering who are prepared to die. In this manuscript, we briefly present data about severe suffering before death for terminally ill patients, including those enrolled in hospice programs. We also review some of what is known about requests and responses for physician-assisted suicide in Oregon and in the rest of the United States. Preliminary data from Oregon suggest that legally sanctioned access to physician-assisted suicide is used by a very small number of patients and seems to be associated with improved delivery of hospice and palliative care. Physicians of good will, deep religious convictions, and considerable palliative care experience exist on both sides of the debate about legalization of physician-assisted suicide. In an effort to respect this diversity, and to encourage our profession to continue to struggle with the genuine dilemmas faced by some patients toward the end of their lives and by their families, we argue in favor of medical organizations' taking a position of studied neutrality on this contentious issue.

Depression↗
PubMed2003

Establishing national goals for quality improvement.

BACKGROUND: For a number of reasons, it has been difficult to garner public interest in the need to improve the quality of care delivered nationally. One possible reason for this is that the concept of quality has different meanings for different stakeholders. To make the problems of suboptimal quality more concrete and potential solutions more compelling, the Strategic Framework Board (SFB) recommended developing a set of national goals for quality improvement. OBJECTIVES: To describe the criteria by which national goals should be selected, illustrate the analytic methods that should be used to support the development of such goals, and describe and illustrate a process by which national goals could be formulated. RESEARCH DESIGN: Targeted review of literature and discussions among members of the SFB. FINDINGS: National goals have played a key role in making progress under the Healthy People 2000 and Health People 2010 initiatives. The recommended process will involve assembling key evidence as well as engaging in a consensus process. CONCLUSIONS: Developing a set of national goals for quality improvement is a key activity for a national quality measurement and reporting system to undertake. The steps outlined here represent a feasible and productive method for accomplishing this objective.

Adult↗
PubMed2002

Attitudes toward working on interdisciplinary healthcare teams: a comparison by discipline.

Interdisciplinary teams are important in providing care for older patients, but interdisciplinary teamwork is rarely a teaching focus, and little is known about trainees' attitudes towards it. To determine the attitudes of second-year post-graduate (PGY-2) internal medicine or family practice residents, advanced practice nursing (NP), and masters-level social work (MSW) students toward the value and efficiency of interdisciplinary teamwork and the physician's role on the team, a baseline survey was administered to 591 Geriatrics Interdisciplinary Team Training participants at eight U.S. academic medical centers from January 1997 to July 1999. Most students in each profession agreed that the interdisciplinary team approach benefits patients and is a productive use of time, but PGY-2s consistently rated their agreement lower than NP or MSW students. Interprofessional differences were greatest for beliefs about the physician's role; 73% of PGY-2s but only 44% to 47% of MSW and NP trainees agreed that a team's primary purpose was to assist physicians in achieving treatment goals for patients. Approximately 80% of PGY-2s but only 35% to 40% of MSW or NP trainees agreed that physicians have the right to alter patient care plans developed by the team. Although students from all three disciplines were positively inclined toward medical interdisciplinary teamwork, medical residents were the least so. Exposure to interdisciplinary teamwork may need to occur at an earlier point in medical training than residency. The question of who is ultimately responsible for the decisions of the team may be an "Achilles heel," interfering with shared decision-making.

Attitude of Health Personnel↗