Innovative peer review model for rural physicians: system design and implementation.

CONTEXT: The peer review process in small rural hospitals is complicated by limited numbers of physicians, conflict of interest, issues related to appropriate utilization of new technology, possibility for conflicting recommendations, and need for external expertise. PURPOSE: The purpose of this project was to design, test, and implement a virtual peer review system for small rural hospitals in Texas. We sought to define the characteristics of a virtual peer review system in the context of rural health care, and to explore the benefits from peer review administration within a rural network supported by a university. METHODS: Physicians from small rural hospitals participated in pilot testing of the system. Policies and procedures reflecting the innovative character of the new peer review process were developed based on legal/regulatory requirements and desired educational focus of the process. An information technology system to support the virtual peer review was selected, tested, and deployed. FINDINGS: The system tests suggested feasibility of the procedures, reliability of the communication lines, and functional anonymity of the hospitals and physicians participating in the virtual peer review. Participating institutions and individual physicians expressed satisfaction with the reliability and user friendliness of the system as demonstrated during the pilot tests. CONCLUSIONS: Hospital licensing and accreditation require a process to monitor and evaluate the care of patients. Utilizing means of virtual communication is a viable option for small rural hospitals. This process is dependable, user-friendly and provides functional anonymity to participating hospitals and physicians. The peer review system has successfully functioned since 2004.

The role of public health nurses in bioterrorism preparedness.

BACKGROUND: Public health nurses have a central function in the public health system. Nurses conduct disease surveillance, which is an important first step in recognizing diseases caused by bioterrorist agents. Unfortunately, the current public health infrastructure and expectations for public health nurses are not clearly defined and therefore pose serious difficulties for conducting disease surveillance. Increased surveillance activities for bioterrorism preparedness add more responsibilities to the work of public health nurses. METHODS: A qualitative study on disease surveillance was conducted with public health officials at regional and local levels, working in a variety of urban and rural settings in one large public health region in Texas. Data analysis was supported by qualitative research software, The Ethnograph. RESULTS: The study found that the nurses working at the local level were extremely dedicated to serving their communities, had formed informal partnerships that are essential for disease surveillance, and effectively used informal communication channels to obtain critical surveillance information. The study revealed that nurses had unmet needs and experienced multiple barriers to conducting disease surveillance. CONCLUSIONS: The study's findings could have implications for public policy and nursing leadership. Defining the structure of the public health system and the scope of public health nurses' responsibilities will serve as the cornerstone for improvement of bioterrorism preparedness.

Lessons learned from a regional strategy for resource allocation.

Two qualitative case studies focus on the allocation of CDC funds distributed during 2002 for bioterrorism preparedness in two Texas public health regions (each as populous and complex as many states). Lessons learned are presented for public health officials and others who work to build essential public health services and security for our nation. The first lesson is that personal relationships are the cornerstone of preparedness. A major lesson is that a regional strategy to manage funds may be more effective than allocating funds on a per capita basis. One regional director required every local department to complete a strategic plan as a basis for proportional allocation of the funds. Control of communicable diseases was a central component of the planning. Some funds were kept at the regional level to provide epidemiology services, computer software, equipment, and training for the entire region. Confirmation of the value of this regional strategy was expressed by local public health and emergency management officials in a focus group 1 year after the strategy had been implemented. The group members also pointed out the need to streamline the planning process, provide up-to-date computer networks, and receive more than minimal communication. This regional strategy can be viewed from the perspective of adaptive leadership, defined as activities to bring about constructive change, which also can be used to analyze other difficult areas of preparedness.