Credentialing in hospitals is the first line of defense for improving patient safety and reducing medical errors by verifying a physician's medical knowledge and skills. There is no single set of standards for physician credentialing followed by all hospitals in the United States. Using May's normalization process theory, the purpose of this quantitative study was to survey medical services professionals (MSPs) to determine which physician credentialing standards were being used, the sources being used, and the frequency of standards used. The dependent variables in this study were the 13 ideal credentialing standards developed by the National Association of Medical Staff Services (NAMSS). The independent variables were the methods MSPs use to satisfy the credentialing standard, or the way in which a hospital performs this function. The independent variables were measured using Likert-scale responses (always, almost always, sometimes, almost never, and never) and the dependent variables were measured by frequency of responses to each standard. A questionnaire was sent to 5,634 members of NAMSS. Findings from 364 responses indicated every facility had at least 1% of MSPs who almost never or never performed a particular standard in accordance with the ideal credentialing standards. A distribution table was used to measure the results, both individually and percentages of the total. To determine if there was a difference in credentialing standards based on hospital size or geographic location, a chi square was used. The results of this study demonstrated there are areas for improvement in physician credentialing. Results may be used to safeguard the public from fraudulent representation through implementation of a national credentialing standard.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21032号 / 社医博第86号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 川上 浩司, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

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The objective of this study was to describe hospital-community relations in Rural County, Mississippi and to discover those factors which were related to the choice of a hospital by the respondents. Data for the study came largely from personal interviews with 150 rural white housewives. Additional data were obtained from interviews with the physicians, hospital administrator, board or trustees, and hospital auxiliary. The study began with a description of the hospital situation in the county, this included the acceptance of the county hospital by the community, and the satisfaction expressed concerning the services of the hospital. The major part of the thesis involved an effort to determine the factors which were related to the choice of one of two hospitals in the community, although persons who would choose a hospital outside the county were given consideration. To discover these factors, both quantitative and nonquantitative variables were tested to discover their relation to the choice made by the respondents. The findings revealed that those persons who had had contact with the county hospital, either through personal use or through some member of the family, ranked high on the acceptance index. Those persons who had this contact with the county hospital were generally highly satisfied with its services. It was also found that choice of a hospital could not satisfactorally be accounted for by the objective characteristics of the respondents. It was found that four nonquantitative factors were highly related to the choice of a hospital. These were: (1) loyalty to the physician, (2) past experience with the hospital, (3) the better facilities of a hospital, and (4) the recommendation of a physician. It was concluded that hospital-community relations between the county hospital and the rural areas of the county were fairly weak. This was due to a later start of the county hospital, and also because of the great amount of loyalty to the physicians of the older hospital.

Mistrust in the medical field can be generated through experiences of racism and discrimination during interactions with members of the medical community. Black and African American individuals find themselves facing increased rates of morbidity including heart disease, and diabetes, and increased rates of mortality as compared to White individuals yet are treated less frequently and to a lesser extent. This thesis examines the mistrust black people have towards the medical field, as well as differences within the black community in terms of experiences with medical racism. In order to collect this information, I created a survey that enquires about race and ethnicity and the types of encounters that individuals have had with medical professionals. I analyzed the responses and found that a majority of those surveyed believe that medical racism does exist. Although the production of medical mistrust is evident, it is a difficult task to eliminate it. Therefore, this thesis recommends that more emphasis be placed on the sociological aspects of medicine.

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In 2015, participating US Emergency Departments (EDs) reported approximately 2.8 million visits related to skin and soft tissue infections (SSTIs). Studies indicate that there may be disparities by patient sex in physician treatment guideline adherence rates as a result of a gender bias during physician-patient interactions; however, only two epidemiologic studies have investigated the role of patient sex in guideline adherence rates for SSTIs. These prior studies were limited in size and covariate assessment. Thus, the magnitude and direction of the effect of patient sex is uncertain, warranting further research. Therefore, we conducted a large prospective study to elucidate the role that patient sex plays in guideline adherence rates among physicians for non-purulent cellulitis at two UMass Memorial Health Care Group EDs in 2017. Data on treatment and sex was abstracted from electronic medical records. Compliance with treatment guidelines was based on 2014 Infectious Disease Society of America (IDSA) guidelines. Adjusted multinomial regressions indicated that female patient sex was associated with lower prevalence of overtreatment (POR=0.72, 95%CI: 0.57-0.92). In contrast, female physician sex was significantly associated with higher prevalence of overtreatment (POR=1.48, 95%CI: 1.16-1.87), but did not affect the relationship of patient sex with overtreatment (P-interaction=0.80). Awareness of differential treatment by patient sex may improve physician adherence to guidelines. This study contributes to a growing body of literature elucidating the role of sex in medical decision making and is the first to account for both patient and physician sex as well as relevant covariates in studies regarding cellulitis treatment.

BACKGROUND: Nationally, 85% of general surgery graduates pursue fellowships reducing the incoming general surgical workforce with a predicted shortage of 41,000 general surgeons by 2025. In recent studies, the lack of confidence appears to be a major factor contributing to resident decision to pursue fellowship. The aim of the study was to determine if a hybrid academic/community program contributes to early autonomy and the decision to pursue fellowship in general surgery graduates. METHODS: We evaluated the level of confidence, level of autonomy, and decision to pursue fellowship at a hybrid academic/community program that historically graduates 70% of their residents into general surgery practice through an anonymous survey. Participants responded using Likert scales along with simple polar questions. RESULTS: Most current residents (90%) reported, upon graduation, that they feel very confident (45%) or fairly confident (45%) performing major cases independently. Most attendings (64%) reported that during their third year of residency, they began performing the majority (more than 75%) of their major cases as surgeon junior while current residents (55%) reported they were performing the majority as a second-year resident. Fifty-five percent of residents felt that confidence played a role in the decision to pursue fellowship. Thirty-three percent of our current chief residents and only 34% of the total general surgery residents plan to pursue fellowships. Conclusions: Our study showed that our residents appear to have earlier levels of autonomy than that experienced by our practicing surgeons when they were residents. Confidence continues to play a role in the decision to pursue fellowship and overall our residents are confident in technical skills at graduation. Our unique program continues to graduate the majority of our surgical residents into successful general surgery practice.

Few organizational communication studies examine the organizational aspects influencing career satisfaction specifically among non-white cultures in the medical physician population. This study examines minority physicians' perceptions of extrinsically controlled work environment factors in comparison to their white counterparts. Three research questions were analyzed from a 17-question survey tool to measure: physician satisfaction levels with autonomy over medical decision-making; autonomy over non-medical workplace decisions; and hospital cost containment efforts. These organizational variables have served as major points of discourse within the healthcare arena and they relate to the enigmatic nature of career satisfaction. Determined by the volume of respondents representing each race and ethnicity, five categories were selected for comparison: Asian/Pacific Islander, Indian/Pakistani, White/Non-Hispanic, Hispanic, and Black/African American. Participants that were surveyed included all physicians listed on the medical staff roster of a Southeastern, not-for-profit hospital group, regardless of status and medical specialty. The primary findings indicate that substantial variance exists among racial and ethnic subgroups regarding satisfaction with the dependent measures. Due to low numbers of minority health care physicians, previous studies have commonly measured physician job satisfaction aggregately, failing to differentiate cultural groups. Interestingly, when minority and non-minority groups were aggregately juxtaposed, no significant differences were reported in the data. However, when satisfaction was measured contrasting minority subgroupings with that of non-minority physicians, significant variations emerged from the data set. This study contributes to understanding better the organizational experiences of minority physicians in healthcare and the body of knowledge concerning minority health research as a whole.