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Biomedical subjects

N Hershey

Publications and source records attributed to N Hershey.

At least 19 recordsLinked to original sources
PubMed1990

Assessing peer review in the quest for improved medical services: Part II.

The first part of this article explored the flaws in the operation of peer review in two contexts: selection of articles for journal publication and decision-making in the award of research grants. There it was suggested that, to the extent these flaws had adverse effects on the information available to medical practitioners and those who conduct peer review of medical practice, the quest for improving the quality of health services is hampered. In this part of the article, medical peer review is defined, its practitioners noted, and the distinction between medical peer review and certain other activities and processes directed toward improving the quality of medical performance in hospitals illustrated.

Evaluation Studies as Topic↗
PubMed1990

Assessing peer review in the quest for improved medical services: Part III.

Part I of this article explored flaws in the operation of peer review in the selection of articles for journal publication and decision-making in the award of research grants, and Part II described medical peer review, its practitioners, and the distinctions between medical peer review and other activities and processes aimed at improving the quality of medical performance in hospitals. This part of the article directs attention to how the courts respond when a physician, aggrieved by an adverse determination with regard to appointment, reappointment, or clinical privileges (credentialing) by the hospital based on medical peer review, seeks redress in the courts.

Clinical Competence↗
PubMed1990

Assessing peer review in the quest for improved medical services and the implications for education in quality assessment: Part IV.

Three court decisions reviewing medical peer review conducted in hospitals were discussed at length in part III of this article. In their opinions the courts gave at least tacit approval to the procedures followed in the hospitals, and they accepted that an evidentiary basis for adverse action against the physicians was present. But not all medical peer review in hospitals resulting in adverse actions is found satisfactory when challenged in court, and the most prominent litigation in the decade of the 1980s concerning medical peer review, Patrick v. Burget (1), is testimony to the potential for its perversion. Part II adverted to the potential for bias or lack of objectivity in assessing physician performance. Part I mentioned the problem of bias in the context of peer review of articles for publication and of research grant proposals. The objectives of Part IV are: (1) to examine the concern about bias in medical peer review and to indicate how it may be lessened, if not eliminated; (2) to address further the difficulty created by the relative lack of valid criteria to employ in medical peer review; (3) to review the extent of protection from liability afforded to participants in medical peer review; and (4) to describe the changes that should be anticipated in review of medical services in the future. Before addressing these subjects it is essential to remind the reader that medical peer review is not conducted primarily for disciplinary purposes; rather, its purpose is to evaluate the quality of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Bias↗
PubMed1989

Assessing peer review in the quest for improved medical services.

The increased concern about the quality of medical services evidenced by, inter alia, the growing attention to quality of Peer Review Organizations. The purchasing and implementation of sophisticated medical data systems by hospitals, and the growing clamor from private health insurers and employers about the rapidly rising costs of health services has made determining the effectiveness of medical interventions a priority subject for many authorities in the field of medical care assessment. At the risk of oversimplification, the view that a greater focus on quality of health services is overdue has begun to energize healthcare institutions, the health professions, payers, and the general public. The objective of this paper and those that will follow is to examine medical peer review. Medical peer review involves peer appraisal in at least two stages: in criteria and standard setting (1, 2), and in determining whether criteria and standards have been met by practitioners in the rendering of services (2). This first article describes some difficulties with the information available to facilitate effective medical peer review, and examines the processes that provide the knowledge base upon which medical peer review depends.

Peer Review↗
PubMed1982

Putting the lamentations of epidemiologists in perspective.

Epidemiologists have expressed concern about constraints upon the conduct of epidemiological research imposed by Institutional Review Boards (IRBs), attorneys, and both institutional and individual health services providers. The epidemiologists assert that these constraints, not necessarily required by law or sound policy, will deprive society of the benefits such research can yield. It is suggested that the complex of law and regulation, resulting from increased awareness of privacy and confidentiality interests, can often be dealt with if there is clearer understanding of the roles of attorneys, and flexibility shown by both epidemiologists and health services administrators and practitioners in the structuring and review of epidemiological research protocols.

Epidemiology↗
PubMed1975

Health law in 1985--implications for the optometric profession.

In conclusion, I believe that you should seek to expand the scope of optometry into areas now regarded as exclusively medical practice, and devote less time and effort to protecting your rear from the encroachment of the opticians. I suggest this because it follows a seemingly natural process of expanding upward that one finds in other professions and occupations in the health field. Second, I have suggested that, to achieve an expanded scope of optometry, there may have to be some sacrifice of the concept of the independent, entrepreneurial practitioner in optometry. Even the medical profession is recognizing that the individual entrepreneurial physician is becoming less of a factor than he was before, and the future is not particularly bright for him further down the road. Third, to the extent you can influence the forum where the struggle over the expanded practice of optometry takes place, you may increase the likelihood that the expanded role will be recognized by law sooner. I have already alluded to the idea that costs of health services and funding mechanisms are intimately tied to the law related to optometric practice in the future. As you know from the legislative struggles in many states over inclusion of optometric services within state Medicaid programs, and freedom of choice legislation that required an insurer to pay any legally recognized practitioner who could provide the service, rather than physicians exclusively, the optometric profession is well aware how closely the success of a profession is linked to access to third party payment.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Services Accessibility↗