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PubMed1998

Trends in health care practitioner credentialing.

Once a risk management process limited to hospitals, the practice of practitioner credentialing has expanded to include many other health care organizations, including insurers, health maintenance organizations, preferred provider organizations, management services organizations, medical groups, and independent practice associations. Standards set by recognized accreditation bodies, including the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), National Committee for Quality Assurance (NCQA), and American Accreditation Health Care Commission/Utilization Review Accreditation Committee mandate a substantial effort to properly evaluate the credentials of health care practitioners. A sector of commerce called the credentials verification organization (CVO) industry has undertaken the mission to make the process of practitioner credentialing more consistent and efficient, faster, and less expensive.

Cost-Benefit Analysis↗
PubMed1990

Credentials and clinical activities of internship supervisors in neuropsychology: a comparison of VA and non-VA training sites.

Surveyed 69 VA and 101 non-VA internships to (a) delineate the credentials and activities of supervisors in clinical neuropsychology, and (b) compare the credentials and activities of the two groups. Questionnaires were returned by 83% of VA and 62% of non-VA internships. A majority of each group was trained in clinical psychology. The proportions of supervisors with board certification and relevant coursework and/or training experiences (e.g., postdoctoral fellowship) were the same for both groups. Similarities were noted in time devoted to research and training, number of interns supervised, preferred assessment tools, and favored approach to clinical evaluation. Conversely, VA instructors devoted more time to clinical practice, while non-VA personnel claimed more publications. The majority of VA supervisors were trained in VA settings, while most non-VA respondents interned at university medical centers or state hospitals. The training and credentials of both groups evidenced wide ranging competencies. The need for improved training and credentialing of practitioners and supervisors was discussed.

Journal Article↗
PubMed1994

Effectiveness of strict credentialing and proctoring guidelines on outcomes of laparoscopic cholecystectomy in a community hospital.

UNLABELLED: Strict credentialing and proctoring guidelines were set up prior to initiating a program of laparoscopic cholecystectomy at the Good Samaritan Hospital in Downers Grove, Illinois. This is a private 386-bed community hospital. At the inception of the program, there were 15 general surgeons who were going to participate in this program. In 1992, there were 20 general surgeons performing the laparoscopic cholecystectomy (LC). The following guidelines were approved by the Credentials Committee and authorized by the Executive Committee: A. Training: A SAGES-approved or equivalent course in LC, meeting or exceeding SAGES guidelines. B. Proctoring: Proctoring of 10 LC cases, prior to operating independently. C. Prevention of injuries: Two surgeons credentialed in LC to operate as a surgeon-cosurgeon team. D. EVALUATION: 100% concurrent review of all LC cases.

Cholecystectomy, Laparoscopic↗
PubMed2001

A prospective analysis of 13,580 colonoscopies. Reevaluation of credentialing guidelines.

BACKGROUND: The aims of this study were to assess the safety and efficacy of surgeons performing colonoscopy, and to use the results to reevaluate currently available credentialing guidelines. METHODS: A prospective outcomes study was designed to include all members of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES). End points were related to the efficacy and safety of colonoscopy. Credentialing guidelines were reviewed. RESULTS: Between April 1998 and September 1999 13,580 colonoscopies were prospectively entered into a database. The most common indications were rectal bleeding, colonic polyps, and change in bowel habits. The colonoscopy was normal or revealed only diverticulosis or nonspecific inflammation in 8,473 (62.4%), lower gastrointestinal bleeding in 4 (0.03%), polyps in 4,645 (34.2%), and tumors in 458 (3.4%) patients. The most common biopsy methods for polyps or tumors were the snare (n = 1,728; 34%), the hot (n = 1,600; 31%), and the cold (n = 1,340; 22%) procedures. The colonoscopy was complete in 12,495 cases (92%), requiring a mean procedure time of 22.7 min (range, 1-170 min). Intraprocedural complications included arrhythmia (n = 14; 0.1%), bradycardia (n = 115; 0.8%), hypotension (n = 171; 1.2%), and hypoxia (n = 806; 5.6%). Postprocedural complications were seen in 27 patients (0.2%). Bleeding (n = 10; 0.07%) was managed by observation alone (n = 9; 0.06%) and repeat colonoscopy with transfusion (n = 1; 0.01%). Perforation (n = 10; 0.07%) was treated successfully by observation with conservative management (n = 5; 0.05%) and surgery (n = 5; 0.05%); severe abdominal pain (n = 4; 0.03%) was managed by observation and conservative therapy; and bronchospasm (n = 2; 0.015%) was managed by observation and supportive care. One single mortality (0.007%) was that of a 70-year-old man with a massive lower gastrointestinal hemorrhage who had a cardiac arrest in the recovery room following colonoscopy. The complication rate was not significantly associated statistically with either the level of experience or the number of prior or annual colonoscopies. However, prior colonoscopic experience did have an impact on the completion rate (p < 0.001) and was inversely proportional to the time to completion (p < 0.001). Similarly, the number of annual colonoscopies affected the completion rate and was inversely correlated with the time to completion (p < 0.001). CONCLUSIONS: This large prospective outcomes study showed that colonoscopy performed by surgeons can be rapidly and successfully done with acceptably low morbidity and mortality. There was no association between experience and complications. However, a minimum of 50 prior colonoscopies and 100 annual colonoscopies were associated with a significant improvement in the rate of completion. There was also a significant correlation between both prior and ongoing annual experience and the time required for the examination. No minimum number of cases can be mandated for credentialing to perform "safe" colonoscopies.

Clinical Competence↗
PubMedDate not supplied

Credentialing certified nurse-midwives.

As the U. S. health care system struggles to respond to demands for accessible, quality, sensitive, and cost-effective care, the contribution of nurse-midwives is receiving renewed attention. Many institutions are seeking assistance as they move to credential certified nurse-midwives for the first time or as they reassess their credentialing policies and procedures. This article provides an extensive review of multiple issues relating to credentialing nurse-midwives including nurse-midwifery education, licensure, scope of practice, professional liability, relationship with physicians, and delineation of privileges. The article also reviews Medicare Hospital Conditions of Participation and Joint Commission on Accreditation of Healthcare Organizations requirements as they relate to nurse-midwifery practice.

Credentialing↗
PubMedDate not supplied

Recent developments in professional midwifery education and credentialing.

The American College of Nurse-Midwives, (ACNM), as a membership organization, and the ACNM Certification Council (ACC), as a credentialing agency, pursue independent but allied missions of expanding access to education for the practice of midwifery, while adhering to established standard of quality for education and clinical practice. The following recent actions taken by these agencies are presented for the information of the membership. 1) The Assured Equivalency Option, a mechanism through which nurse-midwives educated in countries other than the United States can demonstrate their competency and, as needed, acquire additional requisite didactic knowledge or clinical skills, leading to eligibility for national certification examination, is detailed. 2) The rationale for adoption of the multiple-choice format for the criterion-referenced national certification examination in nurse-midwifery and the methods used to determine the validity and reliability of the examination are described. 3) The award of a time-limited credential to those newly certified is offered as a policy statement of the ACC. 4) Deliberations and decisions leading to development of guidelines for the accreditation of non-nurse-midwifery education programs and credentialing as a professional midwife are recounted.

Clinical Competence↗
PubMed1995

The demographics of inpatient pediatric anesthesia: implications for credentialing policy.

STUDY OBJECTIVE: To examine the demographics of inpatient anesthesia care for infants and children in a specific region to determine if there were sufficient numbers of procedures to permit credentialing to take place, as a first step in understanding the consequences of implementing credentialing policies based on caseload. DESIGN: Retrospective computerized review of discharge abstracts. SETTING: All hospitals in northern California. MEASUREMENTS AND MAIN RESULTS: Surgical procedures and date of surgery were linked to create "procedure-days." Each procedure-day counted as one anesthesia case. Annual hospital caseloads (procedure-days) were tabulated for three separate age subgroups under six years of age. The proximity of hospitals with smaller surgical volumes to those with larger volumes was determined. Of the 205 hospitals in the region, 162 had at least one procedure-day for children less than 6 years of age for a total of 14,435 procedure-days (anesthesia cases). For each of three age groups studied--0 to 6 months, 7 to 24 months, and 25 to 72 months--85%, 90%, and 81%, respectively, of hospitals had caseloads of 1 to 50 per year. When procedure days from all three age groups were totalled, 59% of hospitals had less than 20 cases per year and 72% of hospitals had less than 50 cases per year; 86% of hospitals had less than 100 cases per year. Of hospitals with less than 100 cases per year, 75% were within 50 miles of a hospital with more than 100 cases. CONCLUSIONS: Performance based credentialing for pediatric anesthesia based on caseload may be problematic for many hospitals due to the distribution of cases: a majority of hospitals care for a few children, and most children are cared for in a few hospitals.

Anesthesia↗
PubMed2001

The new credential: advanced diabetes management.

A new multidisciplinary credential, the advanced diabetes manager, has been developed by the American Association of Diabetes Educators (AADE) and the American Nurses Credentialing Center (ANCC), in collaboration with the American Dietetic Association, the American Diabetes Association, and the American Pharmaceutical Association (APhA). The credential, designated as BC-ADM, is conferred upon successful completion of an exam to registered dietitians, registered nurses and registered pharmacists who hold advanced degrees and meet experience requirements. The exam is based on the scope and standards of practice approved by the governing agencies of the sponsoring organizations and defines advanced diabetes management knowledge and skills associated with improved outcomes. Information related to the test content outline, application process, suggested exam preparation, test sites, etc., is available from www.aadenet.org or www.nursingworld.org/ancc.

Accreditation↗
PubMed2000

Credentialing issues with sentinel lymph node staging for breast cancer.

Sentinel lymphadenectomy (SL) is a minimally invasive approach for staging patients with breast cancer. SL, when performed in lieu of axillary dissection, is associated with less morbidity and is potentially more cost effective and more accurate than the historical axillary dissection in the detection of regional nodal metastases. The credentialing and privileging of SL, as with any surgical procedure, is by the policies of the local hospital or institution. The suggested credentialing criteria for local hospitals has been an area of controversy. Herein the authors outline the credentialing controversy and suggest criteria for the implementation of sentinel lymph node staging for breast cancer.

Breast↗
PubMed1997

Credentialing issues in emergency ultrasonography.

The use of ultrasonography, traditionally performed by radiologists, is becoming increasingly widespread in emergency medicine. Consequently, much debate has evolved over whether emergency medicine physicians are qualified to provide this service, and the criteria by which training and credentialing can be achieved. This article discusses training and credentialing guidelines, paths to becoming credentialed in emergency sonography, and quality assurance issues. Also, strategies are proposed for emergency departments seeking to perform emergency sonography.

Credentialing↗
PubMed2001

A system of credentialing physicians in advanced gynecologic endoscopy.

STUDY OBJECTIVE: To develop criteria for credentialing physicians in advanced gynecologic endoscopy. DESIGN: Descriptive study (Canadian Task Force classification III). SETTING: University-affiliated community hospital. Patients. None. INTERVENTION: Criteria for credentialing physicians were tested. MEASUREMENTS AND MAIN RESULTS: Physicians were granted universal privileges in advanced gynecologic laparoscopy or hysteroscopy when they were certified by the Accreditation Council for Gynecologic Endoscopy (ACGE). Alternatively, they received category-specific privileges in any one of six categories when they provided documentation of having satisfactorily performed 10 cases in four categories or 5 cases in the remaining two. Required cases included those performed during residency or with a proctor. Completion of an approved residency, board certification or eligibility, and good standing were other requirements. Proof of continuing medical education in endoscopy was also considered. Of 31 physicians in the department, 3 had ACGE certification: 1 in laparoscopy, 2 in laparoscopy and hysteroscopy. Three physicians gained privileges under the alternative system. One received category 1, one received categories 1 and 2, and the third received categories 1, 2, and 6 privileges. Twenty-five physicians were granted standard endoscopy privileges, including six who applied for advanced endoscopy privileges. These applications are pending case documentation and proctorship. CONCLUSION: A system for credentialing physicians in advanced gynecologic endoscopy, using two alternative pathways, was implemented.

Chicago↗
PubMed1988

Falsification of clinical credentials by physicians applying for ambulatory-staff privileges.

As part of a quality-assurance program, we reviewed the clinical credentials listed on applications from 773 physicians applying for clinical positions in the Humana MedFirst national ambulatory care program between March 1 and December 31, 1986. In 39 applications (5.0 percent), physicians presented false clinical credentials: 27 physicians (3.5 percent) gave false information about their residency, 10 (1.3 percent) falsely reported board certification, and 2 (0.3 percent) provided false information about both residency and board certification. There was no significant difference between the falsification rates among graduates of U.S. medical schools and those among graduates of foreign medical schools, or among those in the various medical specialties. Falsification was more common among physicians recruited locally than among those recruited nationally, and was significantly more common among applicants who graduated before 1970. Because of this sample included only applicants for ambulatory privileges within a single organization, the findings may be of uncertain generalizability to groups of physicians applying for other classes of privileges in other institutions. We conclude that in applying for some clinical privileges, physicians present inaccurate clinical credentials more frequently than might be expected.

Certification↗
PubMed1998

Providing credentials to our graduates.

Provision of meaningful professional credentials to Poultry Science graduates requires the sharing of expertise among a number of departments. Increased access to specialized poultry courses will assist in assuring that all graduates have excellent technical credentials. Greater access could be brought about through distance learning materials developed on a regional basis. Professional credentials will protect the marketability of our graduates in a changing industry and provide them a starting point for continued professional development. All departments, large and small, can claim an essential niche in the instruction and examination process. Another benefit is that to maintain their professional status, graduates would periodically participate in seminars and short courses and be encouraged to maintain active memberships in associations such as the Poultry Science Association.

Agriculture↗
PubMed1990

Credentialing protocols used by internal medicine residency programs in New York State.

In the fall of 1988, the Association of Program Directors in Internal Medicine established a New York State (NYS) Task Force to assess the impact of the "Report of the New York State Ad Hoc Advisory Committee on Emergency Services--Supervision and Residents' Working Conditions." Fifty-eight of the 62 NYS internal medicine residencies were surveyed in 1989 and 21 provided copies of their credentialing protocols. Analysis of these protocols identified eight essentials of a viable credentialing protocol, including five present in a majority of the examined protocols. The study produced a master list of procedures with a corresponding range of certification criteria and confirmed most programs had undergone parallel development of remarkably similar protocols, suggesting that a uniform credentialing system was possible and warranted further study.

Credentialing↗
PubMed1996

Legal forum. Economic credentialing of physicians. New criteria and evaluation of physicians.

As managed care and integrated health care delivery systems have developed, the credentialing of physicians, historically a function of the medical profession, has moved to other organizations and individuals. The criteria for credentialing and appointment to hospital staffs and care provider panels has been expanded to include economics and care providers' use of hospital or health organization resources. The rights, responsibilities, and liabilities of those in this enhanced credentialing process are now being played out.

Credentialing↗
PubMed1999

Credentialing and privileging of advanced practice nurses.

Credentialing and privileging are increasingly common administrative processes that advanced practice nurses must complete. With the intention of assuring the public of safe health care provided by qualified personnel, several federal and state organizations have developed criteria that licensed practitioners must meet. Managed care organizations are also creating credentialing and privileging guidelines for practitioners who are applying to their provider panels. Understanding the requirements of these processes is essential to advanced practice nurses establishing themselves in practice. This article explains the guidelines from federal, state, and institutional agencies and offers recommendations to practitioners as they prepare for the credentialing process. Also included are sample forms for establishing a practice agreement and a privilege-delineation request.

Contract Services↗
PubMed2001

The credentialing of a population-based health profession: lessons learned from health education certification.

This article summarizes research and issues related to health education certification. Health education's experience with certification provides valuable insight for other public health professions because of the credential's population-based emphasis, its recent development, and its broadly defined cross-cutting skill set. Although data are still emerging on the outcomes of health education certification, most studies indicate that it has had a positive impact across multiple dimensions. Critical to this success has been providing profession-wide opportunities for input, communicating with key stakeholders, establishing an independent credentialing agency, and basing the credential on scientifically and legally defensible competencies that are linked to job responsibilities.

Certification↗
PubMed2001

Competency-based credentialing of public health administrators in Illinois.

This article describes an initiative to develop and implement a competency-based credentialing program for public health managers and administrators that is linked with practice performance standards for local public health systems. The Illinois Public Health Administration Certification Board represents an innovative model for credentialing public health workers, placing equal value on competencies secured through education and training and those demonstrated in practice. Competency-based credentialing of public health administrators may have applicability for other segments of the public health workforce.

Administrative Personnel↗