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PubMedDate not supplied

A survey of perceived benefit and differences in therapy provided by credentialed and noncredentialed nutrition support dietitians.

BACKGROUND: Benefits of the certified nutrition support dietitian (CNSD) credential to clinicians, their patients, and healthcare administrators have not been defined. A study was designed to measure the difference in cost of therapy provided by credentialed and noncredentialed nutrition support dietitians and to measure the perceived value of the credential to those who hold it. METHODS: Using a modified Delphi technique, a questionnaire was developed to obtain demographic information, responses to statements of perceived benefit of the credential, and costs of therapy selected for patients in common clinical scenarios. RESULTS: Of the 691 questionnaires mailed, 314 (45%) were returned. For 8 of 10 statements of perceived benefit, mean response scores indicated agreement. Respondents did not agree that salary increases resulted from credentialing. There was no difference between groups in the type of monitoring selected or in the time to complete an initial assessment. Cost of therapy was significantly higher for credentialed versus noncredentialed dietitians (dollar 915.67 +/- dollar 241.73 versus dollar 851.78 +/- dollar 243.44; p = .035), although the survey was not designed to show that the most appropriate care was least expensive. CONCLUSIONS: The CNSD credential is of perceived benefit to practitioners except in obtaining salary increases. Credentialed dietitians selected more expensive therapy than noncredentialed dietitians, which would benefit healthcare administrators only if reduction of other costs resulted. More complex models are needed to fully assess the benefit of credentialed nutrition support dietitians to patients and healthcare administrators.

Certification↗
PubMedDate not supplied

Hospital credentialing for laparoscopic cholecystectomy: is stricter better?

OBJECTIVE: Hospital credentialing standards for laparoscopic cholecystectomy were established to improve surgical outcomes, but standards vary by hospital. We hypothesized that more stringent credentialing would result in better outcomes. DESIGN: Univariate and multivariate logistic analyses were performed using a 1996 survey on hospital credentialing practices. Surgical-outcome data were obtained from statewide hospital discharge abstracts and hospital chart reviews. Multivariate logistic analysis was used to calculate the effects of hospital credentialing stringency and nine credentialing practices on operative and postoperative outcomes (including death), controlling for patient and hospital characteristics. SETTING: Short-stay community hospitals performing laparoscopic cholecystectomy. PATIENTS: Statewide hospital discharge data included 1995 inpatient discharges for laparoscopic cholecystectomy. Medical-records review included 843 laparoscopic cholecystectomy patients selected from 14 North Carolina hospitals with widely different credentialing practices. RESULTS: Surgical complications from laparoscopic cholecystectomies appeared unrelated to stringency of the hospital credentialing environment. Important factors predicting complications included hospital volume and other hospital characteristics such as the number of registered nurses per patient day. CONCLUSIONS: Given current levels of training, performance, and credentialing standards, tightening of credentialing practices may not improve patient outcomes for laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed2006

Use of board certification and recertification of pediatricians in health plan credentialing policies.

CONTEXT: Health plans conduct credentialing processes to select and retain qualified physicians who will provide high-quality care to their subscribers. One of the tools available to health plans to help ensure physician competence is assessment of board certification status. OBJECTIVE: To determine the credentialing policies of health plans regarding the use of board certification and recertification for general pediatricians and pediatric subspecialists. DESIGN, SETTING, AND PARTICIPANTS: Telephone survey conducted February through July 2005 of credentialing personnel from a US national sample of 244 health plans stratified by enrollment size, Medicaid proportion, and for-profit or not-for-profit status. MAIN OUTCOME MEASURES: Proportion of health plans that require general or subspecialty board certification at initial contract or at any time during association with the plan and recertification to maintain credentialing or to bill as a specialist or subspecialist; percentage of physicians credentialed in each health plan and credentialing goals for each plan regarding the proportion of physicians to be board certified. RESULTS: Response rate was 193 of 244 (79%). Overall, 174 (90%) of the plans do not require general pediatricians to be board certified at the time of initial credentialing, and only 41% ever require a general pediatrician to become board certified. Similarly, only 80 (40%) ever require subspecialists to become board certified in their subspecialty. Although 80 of 192 (41%) report requiring recertification of general pediatricians, almost half do not have a time frame in which recertification must occur. Seventy-seven percent of plans allow physicians to bill as subspecialists with expired certificates. CONCLUSIONS: These findings, although specific to pediatrics, likely apply to other primary care disciplines and raise questions regarding the ability of plans to ensure initial or continued competence of their credentialed physicians. Growing public concern regarding patient safety, as well as demonstrated patient preferences for certified physicians, will likely result in greater emphasis on quality assessments in physician credentialing.

Certification↗
PubMed2000

Hospital credentialing and quality of care.

The purpose of this study was to evaluate the impact of hospital credentialing standards on surgical outcomes for selected procedures. The study used hospital credentialing practices from a 1996 survey of North Carolina community hospitals, with surgical outcomes derived from a statewide database of inpatient surgical discharges in 1995. Hospital mortality, complications and elevated lengths of stay were used as outcome indicators in an analysis of 6 surgical procedures. Multivariate logit analysis was used to calculate the effects of hospital credentialing stringency and nine credentialing practices on outcomes, controlling for patient demographic characteristics, type of admission, severity of illness and hospital characteristics. Teaching hospitals adopted more stringent credentialing practices, with almost no difference between metropolitan and nonmetropolitan nonteaching facilities in their use of various credentialing policies. Surgical outcomes typically were not related to stringency of the hospital credentialing environment. Generally, the effect of specific practices was inconsistent (associated with improved outcomes for certain procedures and significantly worse outcomes for others) or counterintuitive (showing worse outcomes for selected surgical procedures where effects were statistically significant). More stringent hospital credentialing does not appear likely to improve patient outcomes.

Adolescent↗
PubMed2002

Credentialing complementary and alternative medical providers.

Since the late 19th century, state legislatures and professional medical organizations have developed mechanisms to license physicians and other conventional nonphysician providers, establish standards of practice, and protect health care consumers by establishing standardized credentials as markers of competence. The popularity of complementary and alternative medical (CAM) therapies presents new challenges. This article describes the current status of, and central issues in, efforts to create models for health care credentialing of chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It also suggests a strategy of CAM provider credentialing for use by physicians, health care administrators, insurance companies, and national professional organizations. The credentialing debate reflects fundamental questions about who determines which providers and therapies will be accepted as safe, effective, appropriate, and reimbursable. More nationally uniform credentialing mechanisms are necessary to ensure high standards of care and more generalizable clinical research. However, the result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially. Furthermore, even credentialed providers can deliver ineffective therapy. The suggested framework balances the desire to protect the public from dangerous practices against the wish to grant patients access to reasonably safe and effective therapies.

Acupuncture↗
PubMed2006

Faculty credentialing: a survey of forty-six U.S. dental schools.

This study was undertaken in June of 2005 to evaluate the status of credentialing of clinical faculty in United States dental schools. A short survey on the process of credentialing was developed and emailed or mailed to all clinical deans. The survey contained a standard definition of health professional credentialing to which the respondent was to compare his or her school's procedures. Of the forty-six respondents, only 46 percent were conducting credentialing as defined on the survey. Recredentialing of clinical faculty was occurring in most of these schools; however, 23 percent did not report a process of recredentialing. Each institution required different items in its credentialing application: 95 percent required information on licensure; 86 percent, educational background; 67 percent, academic appointments; and 67 percent, specialty board status, among other items that were included at lower rates. Health status was only requested by 29 percent of the institutions. Only 34 percent of those institutions doing credentialing verified the data collected during the application process. Given the legal implications of adverse outcomes, prudent risk management calls for a strong credentialing program. Results of this survey indicate the need for an ongoing effort to standardize credentialing procedures among dental schools and to select appropriate data to be included in the process.

Credentialing↗
PubMed2004

Credentialing of surgeons as interventionalists for carotid artery stenting: experience from the lead-in phase of CREST.

BACKGROUND: Credentialing of vascular surgeons to perform carotid artery stenting (CAS) continues to be a major issue confronting the specialty of Vascular Surgery. Cannulation of aortic arch branches, and placement of carotid antiembolic devices and stents constitute the major technical challenges to vascular surgeons becoming credentialed to perform CAS. The multicenter Carotid Revascularization Endarterectomy vs Stenting Trial (CREST), supported by the National Institute of Neurological Disorders and Stroke, National Institute of Health, reviews credentials of interventionalists, including surgeons, for the trial's "lead-in" phase of CAS to treat symptomatic (>50% stenosis) and asymptomatic (>70% stenosis). METHODS: Vascular surgeons requesting participation in CREST must have achieved basic interventional credentialing criteria as recommended by the Society of Vascular Surgery. Each interventionalist is asked to submit notes and narrative summaries from a series of 10 to 30 CAS procedures for review by a multi-specialty review committee before being approved to participate in CREST. Thereafter, during the lead-in phase of CREST, each approved interventionalist is asked to perform CAS procedures using the study devices in as many as 20 patients. In this interim report from the CREST lead-phase, the association of specialty of operator (vascular surgeon, neurosurgeon, other specialist) and periprocedural stroke and death rate was examined in patients undergoing CAS. In addition, current enrollment volume in the lead-in phase by specialty of the principal investigator was examined. RESULTS: Thirty-two of 134 (23.9%) CREST-credentialed interventionalists are vascular surgeons (n = 22; 16.4%) or neurosurgeons (n = 10; 7.5%). For events monitored through March 31, 2004, 789 patients had undergone CAS procedures performed by these 134 specialists. Thirty-day stroke and death rate was 4.6%, and myocardial infarction was observed in 1.1% of patients. Serious adverse events have not been clustered at individual institutions, and no significant differences have been observed between vascular surgeons or neurosurgeons and other credentialed specialists. CONCLUSIONS: Vascular surgeons with basic catheter and guide wire skills, particularly those who have incorporated diagnostic cerebral angiography into their practice, can be credentialed to perform CAS. Individuals or groups should devote a number of cases (n = 10-30 per surgeon) to CAS to accomplish this goal. Pending US Food and Drug Administration approval of devices and Center for Medicaid and Medicare Services reimbursement, institutional financial support for the performance of these procedures must be secured. The learning curve for CAS should not be considered so formidable as to discourage surgeons from adding these techniques of CAS to their procedural inventory.

Angioplasty, Balloon↗
PubMed1983

Private credentialing of health care personnel: an antitrust perspective. Part Two.

Having argued in Part One against extensive judicial or regulatory interference with private personnel credentialing in the health care field, this Article now shifts its focus to emphasize the anticompetitive hazards inherent in credentialing as practiced by professional interests. Competitor-sponsored credentialing is shown to be a vital part of a larger cartel strategy to curb competition by standardizing personnel and services and controlling the flow of information to health care consumers. Instead of altering the conclusions reached in Part One, however, Part Two sets forth a new and hitherto unexplored agenda for antitrust enforcement, one that the authors believe will increase the quantity and quality of information available to consumers and offer a fairer competitive environment to individuals and groups disadvantaged by the denial of desirable credentials. The specific targets singled out for antitrust scrutiny are (1) the practice of "grandfathering," by which new candidates for credentials are required to meet tougher requirements than were met by existing credential holders; (2) agreements to standardize educational programs if they go beyond setting and applying accrediting standards and impair the freedom of institutions to decide independently whether to offer unaccredited training; (3) agreements by which independent certifying or accrediting bodies limit the nature or scope of competition among themselves; and (4) mergers and joint ventures in credentialing and accrediting. The legal theory supporting antitrust attacks in the latter two categories is strengthened by the apparently original insight that commercial information and opinion are themselves articles of commerce such that agreements and combinations restricting their nature and output can be characterized as restraints of trade. Among the many self-regulatory institutions in the health care field whose operation or sponsorship is called into question by the analysis herein are the leading medical specialty boards, the Liaison Committee on Medical Education, various accrediting and certifying bodies in the allied health occupations, and the Joint Commission on Accreditation of Hospitals.

Accreditation↗
PubMed1997

Managed care credentialing of advanced practice nurses.

The enormous and rapid changes taking place in health care delivery are forcing institutions, organizations, and individual providers of care to reexamine their relationships and create new methods of assuring both quality of care and safety for consumers. One result has been the emphasis on systematic methods of credentialing, privileging, and measuring and evaluating an individual's qualifications and actual performance. This article discusses the credentialing and privileging processes that are either in place or evolving for physicians in the managed care health care systems. With the continued evolution of managed care in this country, advanced practice nurses may need to expand their credentialing process. This article provides information on the evolutionary events leading to credentialing and privileging, current and anticipated credentialing measures, sources of measurements, medicolegal issues, and suggestions for expansion of nurse credentialing. A comprehensive credentialing system will provide additional evidence of the nursing profession's capacity to play a major role in the reformed health care system.

Credentialing↗
PubMed1995

The feasibility and desirability of public health credentialing: a survey of public health leaders.

OBJECTIVES: The goal of this study was to provide insight concerning the potential of credentialing public health workers through an exploratory examination of public health leaders' perceptions. METHODS: Qualitative and quantitative procedures were used. Credentialing issues were identified through the literature and through open-ended interviews with leaders and experts. A 74-item Likert-type survey was used to quantify perceptions. Key informants and survey participants were identified through pertinent organizations. RESULTS: The public health leaders leaned toward consensus on some benefits of and concerns about credentialing. There was no consensus related to a specific form of desired credentialing, although national certification was supported by a plurality. State licensing and an emphasis on the master's in public health (MPH) degree were opposed by large margins. Public health leadership survey results were similar to results of a survey of credentialing experts. CONCLUSIONS: The lack of consensus and the vehemence of some opposing positions indicate that movements toward credentialing should proceed cautiously. However, many of the response patterns indicate that the issue merits further exploration.

Credentialing↗
PubMed1998

Meet the new kids on the credentialing block.

The Washington, DC-based American Nurses Credentialing Center's nurse case manager credential continues to get a rocky reception. Following difficulties with last year's test and controversy over the credential's eligibility criteria, the number of applicants remains small. Meanwhile, the inaugural test for the Center for Case Management's new case management administrator certified credential took place on Oct. 24, 1998. While results are not yet available, officials at the South Natick, MA-based Center report that the diversity of candidates for the credential reflected the exam's cross-continuum focus. The Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations is still developing its upcoming "Diplomate of the Academy" credential, which will feature a formal curriculum and course work.

Case Management↗
PubMed1985

The PA credentialing process--the Bureau of Health Professions' role.

The widespread use of credentialing mechanisms has been an important trend among health professions in recent years. The PA profession is one of several that has undergone a multi-stage credentialing process designed to promote individual competence and relevance of the field. The goal was to establish a national credentialing program involving clearly delineated roles, competency requirements, and criterion-referenced examinations. Several organizations participated in the process to produce a variety of assessment tools and continuing competence models. The article discusses the role of these organizations (including that of the Bureau of Health Professions), examines the initial development of the credentialing process, and outlines the four major phases of the program. The author cites that while the entry-level competence of PAs can be assured through the credentialing process, the profession's continuing competency program remains the subject of controversy, partially because of the newness of the profession and its re-certification program. The author feels, however, that the experience gained in the initial credentialing process will assist in the resolution of this matter.

Credentialing↗
PubMedDate not supplied

[Credentialing for diagnostic and interventional nephrology].

UNLABELLED: It is necessary to define the credentialing process that allows the nephrologist to achieve certification and accreditation in the following essential procedures of diagnostic and interventional nephrology: renal echography; renal and bone biopsies; the creation of vascular (arteriovenous fistula [FAV], grafts) or peritoneal access for permanent dialysis; the management and treatment of possible complications; and the implantation of central venous catheters for temporary or definitive hemodialysis. BACKGROUND: The acquisition of credentials for the interventional nephrologist includes the completion of training programs, the identification of appraisal indices, certification, possible recertification, and accreditation. The specialist validation allows the nephrologist to act as a tutor and supply the credentials for the interventional procedures in nephrology. The use of echography has remarkably simplified the procedure of percutaneous renal biopsy, a technical diagnostic invasive technique, practiced exclusively by the nephrologist the ecography-guided technique has reduced the risks of greater complications to less than 0.5%. However, guidelines are lacking on the training required to accredit a nephrologist in this technique. The initial placement of a shunt, vascular or peritoneal, to carry out dialysis treatment is usually performed by the nephrologist, radiologist, or surgeon. However, the successful long-term management of the dialysis patient generally demands a multidisciplinary approach. The poor management of the dialysis shunt can contribute to reduced patient life expectancy and increased costs of care. Therefore, it is essential that those who perform such interventional procedures must be certified and accredited according to strict protocol guidelines. In Italy (as opposed to the United States) most peritoneal shunt placements are performed by the nephrologist. However, international scientific society guidelines on this procedure, where they exist, are generic, allowing for the adaptation of particular techniques by various nephrologic centers. The criteria for the acquisition of credentials in one particular procedure must be uniform, logical, consistent, and applicable, comprising of a recognition of the basic procedure and a course of appropriate practical training. The criteria for training and credentialing in diagnostic and interventional nephrology should encompass the following points: The establishment of guidelines for the performance of all procedures that ensures suitable and effective treatment, including during emergencies, and considering the hospital context in which the procedures are performed. The recognition that scientific society guidelines for one specialty or procedure may not be appropriate or applicable to credentialing in another specialty or procedure. The ability of guidelines to adapt to improvements in technique and new technologies. The stipulations of insurance coverage and legal counselling must be taken into consideration whenever accreditation criteria are developed. CONCLUSIONS: An adequately certified and accredited background improves the quality of care, reduces costs and waiting list time, and reduces those complications that could increase the length of hospitalization.

Biopsy↗
PubMed2004

Full time adult credential students' instructional preferences at California State University, Long Beach: pedagogy orandragogy?

This study investigated the instructional preferences of full time adult credential students after they took a live course called Principles of Adult Education at California State University, Long Beach (CSULB) in the fall semester of 2002. These full time adult credential students had been working on their adult teaching credentials to meet the competencies specified by the California Commission on Teacher Credentialing. The course introduced students to Andragogy developed by Malcolm Knowles out of the andragogical model developed by Lindeman (1926). The study used Principles of Adult Learning Scales (PALS), advanced by Gary Conti in 1983 to measure instructional preferences. Data were collected from 30 (100% of 30) full time adult credential students enrolled in a live course to determine their instructional preferences of helping adults learn. The results of the study showed in most cases these adult learning professionals taught adult students andragogically; in some cases they taught adult students pedagogically.

California↗
PubMed2006

Status of credentialing alternative providers within a subset of U.S. academic health centers.

BACKGROUND: Complementary and alternative medicine (CAM) clinical services are increasingly provided within conventional health care settings. OBJECTIVE: To determine how a subset of U.S. academic health centers is credentialing CAM providers. DESIGN: An electronic survey was created focusing on the credentialing method utilized for six specific types of CAM clinical practitioners within academic medical settings. METHODS: This survey was electronically distributed to 33 academic health centers in the United States during the summer 2004. RESULTS: Ninety-five percent (95%) of academic centers surveyed provide some CAM clinical care. Acupuncture and massage are most common, with naturopathy and homeopathy least common. State licensure requirements for CAM providers appear to not be well-understood. Most commonly, CAM professionals do not receive full medical staff credentials. LIMITATIONS: Results cannot be extrapolated to remaining academic health centers within the United States. Mind-body practitioners were not included in the survey. CONCLUSIONS: Credentialing and privileges are most commonly granted via indirect methods. Variability in state licensure compounds the challenge of credentialing CAM practitioners. Suggestions for beginning discussions on guiding principles for integrating CAM practitioners within conventional settings are proposed.

Academic Medical Centers↗
PubMed1998

Multidisciplinary credentialing and privileging: a unified approach.

A health care organization's thoughtful and rigorous credentialing and privileging process is not only required by state and federal regulations but is essential for building a quality professional staff. The addition of nonphysician providers has challenged organizations to articulate the appropriate credentialing process for these providers. Further, the credentialing process has been burdened by the redundancy created when providers require credentialing and privileging by multiple health care settings and managed care organizations. This paper describes a multidisciplinary credentialing and privileging system of the highest standard that minimizes effort and expense for both the provider and the organization.

Credentialing↗
PubMed2001

Credentialing for critical care in small hospitals.

OBJECTIVE: To assess credentialing practices for critical care admissions and procedures in smaller hospitals within the United States. METHODS: A questionnaire was sent to credentialing coordinators of 500 randomly selected American Hospital Association hospitals with fewer than 300 beds. MEASUREMENTS AND MAIN RESULTS: Most hospitals validate qualifications for intensive care unit (ICU) admitting and procedural privileges through recommendations only. Fewer (16%) require a specified prior number of procedures to have been performed, and 9% require prospective supervision before privileges are granted. Critical care subspecialists are present in 57% of these hospitals and tend to be in the larger facilities with more critical care beds. Criteria for ICU admission and procedure privileges appear to be inclusive, because family medicine, obstetrics-gynecology, orthopedic surgery, and neurology specialists are often credentialed. The presence of a critical care subspecialist is associated with fewer hospitals credentialing family medicine specialists for ICU admission and procedures but not obstetrician-gynecologists, orthopedic surgeons, or neurologists. CONCLUSIONS: This is a brief descriptive report of hospital policies that define which physicians are permitted to care for critically ill/injured patients in small U.S. hospitals. The presence of a critical care specialist appears to influence only slightly the ICU credentialing processes for other selected specialists.

Credentialing↗
PubMed2005

A survey of credentialing practices of gastrointestinal endoscopy centers in the United States.

BACKGROUND: Competence in gastrointestinal (GI) endoscopy correlates with the number of procedures performed by the endoscopist. For each GI endoscopic procedure, the American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend minimum numbers needed to assess competence. METHODS: We conducted an anonymous mail survey to determine whether GI endoscopy centers in the United States follow ASGE or other guidelines for granting and renewing endoscopic privileges. RESULTS: Completed surveys were received from 479 respondents in 46 states, Puerto Rico, and the District of Columbia. Most respondents were either the physician director (24%) or nurse manager (57%) of the endoscopy center. Most centers have more than 5 endoscopists (62%), and gastroenterologists performed procedures in the majority of the centers (89%). For initial endoscopic credentialing, few centers require a minimum number of procedures and only 10% meet ASGE criteria. To maintain credentials, less than one third require a minimum number and only 2% require more than 25 procedures/year. Although three fourths report periodic review of procedures, less than 5% review them more frequently than every 6 months. Only 20% of centers had ever denied endoscopic privileges (poor skills [80%], no references [27%], poor communication [7%], and excess complications [6%]) for which half faced litigation. CONCLUSIONS: Most GI endoscopy centers responding to this survey have no minimum standards for determining endoscopic competence and may credential GI endoscopists with suboptimal training. Only 10% adhere to ASGE guidelines. Moreover, there is lack of uniformity to application of these guidelines, and few centers use resulting data to deny or renew credentials. To guarantee high-quality endoscopic practice, more stringent, universal credentialing standards are required.

Clinical Competence↗