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Wang Y, Ram SS, Scahill S. Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis. J Patient Saf 2024; 20:e18-e28. [PMID: 38506483 DOI: 10.1097/pts.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Pharmacists constitute a crucial component of the healthcare system, significantly influencing the provision of medication services and ensuring patient safety. This study aims to understand the characteristics and risk factors for complaints against pharmacists through Health and Disability Commissioner (HDC) published decisions. METHODS This study adopts a retrospective, qualitative approach. An inductive content analysis technique was used to analyze 37 complaints against pharmacists published decisions from the New Zealand Health and Disability Commissioner website to investigate a range of underlying risk factors contributing to the occurrence of complaints against pharmacists. RESULTS A set of 20 categories of risk factors emerged through the content analysis and were subsequently grouped into five overarching themes: pharmacist individual factors, organizational factors, system factors, medication-specific factors, and external environmental factors. CONCLUSIONS The findings of this study provide valuable insights that expand the understanding of risk management in pharmacist practice, serving as a valuable resource for regulatory bodies, policymakers, educators, and practitioners. It is recommended not only to focus solely on individual pharmacists but also to consider integrating their environment and individual behaviors to proactively address situations prone to errors and subsequent complaints.
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Affiliation(s)
- Yufeng Wang
- From the School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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2
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Wang Y, Ram S(S, Scahill S. Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review. Int J Qual Health Care 2024; 36:mzad114. [PMID: 38155372 PMCID: PMC10791111 DOI: 10.1093/intqhc/mzad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/26/2023] [Indexed: 12/30/2023] Open
Abstract
Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.
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Affiliation(s)
- Yufeng Wang
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Sanyogita (Sanya) Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Shane Scahill
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
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De Jong A, Penne C, Kapandji N, Touaibia M, Laatar C, Penne M, Carr J, Pouzeratte Y, Jaber S. Determinants of information provided by anaesthesiologists to relatives of patients during surgical procedures. BJA OPEN 2023; 7:100205. [PMID: 37638078 PMCID: PMC10457491 DOI: 10.1016/j.bjao.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023]
Abstract
Background Data and interventions are lacking for family-centred perioperative care in adults. Perioperative information given to relatives by nurses or surgeons is associated with improved satisfaction and fewer symptoms of anxiety for relatives and the patient themselves. However, the frequency of the provision of information by anaesthesiologists to patients' relatives during surgery has never been reported. Methods A cross-sectional survey was sent to French anaesthesiologists in October 2020 to inquire how often they provided information to patients' family members during surgery and what factors led to them providing information frequently (i.e. in more than half of cases). Results Among 607 anaesthesiologists, 53% (319/607) were male, with median age 47 (36-60) yr and nearly half (43%, 260/607) reported more than 20 years of clinical experience; most responders (96%, 580/607) mainly treated adults. Forty-nine (8%) anaesthesiologists declared that they frequently provide information to relatives during surgery. After multivariate analysis, age >50 yr, female gender, and paediatric practice were associated with providing information more frequently. Reasons for not providing information included a lack of time and dedicated space to talk to relatives. Urgent surgery or surgery lasting >2 h were identified as factors associated with provision of information to relatives. Conclusions Giving information to relatives during surgery is not a common practice among anaesthesiologists. It depends on individual anaesthesiologists' personal characteristics and practice. Information during surgery could be provided systematically in situations identified as being the most important by anaesthesiologists in our survey. By creating new pathways of information, we could reduce stress and anxiety of patients and relatives.
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Affiliation(s)
- Audrey De Jong
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, France
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Clara Penne
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Natacha Kapandji
- GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Maha Touaibia
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Chahir Laatar
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Michaela Penne
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Julie Carr
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Yvan Pouzeratte
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Samir Jaber
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, France
- Département d’Anesthésie-Réanimation, Hôpital Saint-Eloi, Montpellier, France
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Zhu D, Wong A, Shah PP, Pomeranz HD. Neuro-ophthalmology malpractice: A review of the Westlaw Database. Med Leg J 2022; 90:200-205. [PMID: 36189929 DOI: 10.1177/00258172221109731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Neuro-ophthalmologic conditions are at a higher risk of misdiagnosis compared to other ophthalmic conditions. Increased awareness of the most common diagnostic errors in neuro-ophthalmology that lead to malpractice claims can allow ophthalmologists to further improve their diagnostic workup to reduce delays in diagnosis and management, while also mitigating the risk of litigation. METHODS Malpractice trials in the Westlaw Legal Database that involved cases of neuro-ophthalmologic diagnostic errors or failures by ophthalmologists were included in this study. RESULTS A total of 43 cases were included, all citing failure to diagnose as the main reason for litigation. The most common diagnoses missed were cerebrovascular pathologies (30.2%), intracranial tumours (27.9%) and giant cell arteritis (25.6%). The majority of verdicts were in favour of the defendants (48.8%). After adjusting for inflation, the average amount awarded was $1,952,154. CONCLUSION Nearly half of the cases resulted in a defendant verdict. Settlement and plaintiff verdicts were costly, with average awards of approximately two million inflation-adjusted dollars. Failure to diagnose cerebrovascular pathologies was the most common diagnostic error followed by failure to diagnose intracranial tumours and giant cell arteritis. It is crucial for ophthalmologists to be aware of the most common pitfalls that lead to misdiagnosis or delays in diagnosis of neuro-ophthalmologic conditions.
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Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Amanda Wong
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Paras P Shah
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Howard D Pomeranz
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
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5
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Bali J, Bali O, Sahu A, Boramani J, Senthil T, Deori N. State of the nation survey on cataract surgery in India. Indian J Ophthalmol 2022; 70:3812-3817. [PMID: 36308101 PMCID: PMC9907269 DOI: 10.4103/ijo.ijo_1151_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To study the knowledge, attitudes, and practices of the ophthalmologists in India regarding cataract extraction practices. Methods A prospective, online, descriptive study was conducted from January 2022 to April 2022 using a self-developed validated questionnaire attached which was administered through a generated link. Results The mean age of these 153 respondents was 47.02 (SD = 11.53) years with a male preponderance (70.59%). The majority (52.9%) had completed a fellowship after their post-graduation, and 56.20% provided sub-specialty services. Comprehensive ophthalmology (69.93%) and anterior segment (50.32%) practice were the most popular. Although 76.47% of respondents used a mix of techniques, 11.11% surgeons used only phaco-emulsification and 9.8% used only manual small-incision cataract surgery (MSICS) as the lone cataract treatment modality. Roughly 38% felt that outcomes were comparable for phaco-emulsification and MSICS, whereas about 44% opined that the outcomes of phaco-emulsification were better. MSICS outcomes were reported to be better by approximately 15%. The frown incision (53.59%), the straight incision (19.60%), and the straight incision with back cuts (10.45%) were popular. The majority (71.24%) of the respondents were willing to train fellow ophthalmologists and youngsters in MSICS. Standalone practices and family practices (42.48%), private eye institutes (10.45%), medical colleges (12.41%), and government non-teaching hospitals (11.11%) were the major service providers. 4% were working in rural hinterland. Conclusion The majority of the surgeons use a mix of cataract extraction operative techniques. A large, willing talent pool of manual small-incision cataract surgeons exists. India can be a global hub for MSICS delivery and training.
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Affiliation(s)
- Jatinder Bali
- Department of Ophthalmology, Narela Polyclinic, North Delhi Municipal Corporation, Delhi, India,Correspondence to: Dr. Jatinder Bali, 55-D, Third Floor, DDA FLATS, Kalidas Road, Gulabibagh, Delhi - 110 007, India. E-mail:
| | - Ojasvini Bali
- Department of Medicine, Maulana Azad Medical College, Delhi, India
| | - Amulya Sahu
- Department of Ophthalmology, Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
| | - Jagannath Boramani
- Department of Ophthalmology, Surya Netralaya, Navi Mumbai, Maharashtra, India,MGM’s New Bombay Hospital, Navi Mumbai, Maharashtra, India
| | - Tamilarasan Senthil
- Department of Ophthalmology, Pranav Eye Care Centre, Chennai, Tamil Nadu, India
| | - Nilutparna Deori
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Patient Complaints in Orthopedic Surgery: An Analysis Utilizing a Large National Database. Orthop Clin North Am 2022; 53:491-497. [PMID: 36208891 DOI: 10.1016/j.ocl.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Unsolicited patient complaints (UPCs) about surgeons correlate with surgical complications and malpractice claims. Analysis of UPCs in orthopedics is limited. METHODS Patient complaint reports recorded at 36 medical centers between January 1, 2015 and December 31, 2018 were coded using a previously validated coding algorithm Patient Advocacy Reporting System. RESULTS A total of 33,174 physicians had 4 consecutive years of data across the 36 participating medical centers and met other inclusion criteria. CONCLUSIONS Orthopedists with high numbers of UPCs may benefit from being made aware of their elevated risk status in ways that invite reflection on underlying causes.
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Ajmi SC, Aase K. Physicians' clinical experience and its association with healthcare quality: a systematised review. BMJ Open Qual 2021; 10:e001545. [PMID: 34740896 PMCID: PMC8573657 DOI: 10.1136/bmjoq-2021-001545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE There is conflicting evidence regarding whether physicians' clinical experience affects healthcare quality. Knowing whether an association exists and which dimensions of quality might be affected can help healthcare services close quality gaps by tailoring improvement initiatives according to physicians' clinical experience. Here, we present a systematised review that aims to assess the potential association between physicians' clinical experience and different dimensions of healthcare quality. METHODS We conducted a systematised literature review, including the databases MEDLINE, Embase, PsycINFO and PubMed. The search strategy involved combining predefined terms that describe physicians' clinical experience with terms that describe different dimensions of healthcare quality (ie, safety, clinical effectiveness, patient-centredness, timeliness, efficiency and equity). We included relevant, original research published from June 2004 to November 2020. RESULTS Fifty-two studies reporting 63 evaluations of the association between physicians' clinical experience and healthcare quality were included in the final analysis. Overall, 27 (43%) evaluations found a positive or partially positive association between physicians' clinical experience and healthcare quality; 22 (35%) found no association; and 14 (22%) evaluations reported a negative or partially negative association. We found a proportional association between physicians' clinical experience and quality regarding outcome measures that reflect safety, particularly in the surgical fields. For other dimensions of quality, no firm evidence was found. CONCLUSION We found no clear evidence of an association between measures of physicians' clinical experience and overall healthcare quality. For outcome measures related to safety, we found that physicians' clinical experience was proportional with safer care, particularly in surgical fields. Our findings support efforts to secure adequate training and supervision for early-career physicians regarding safety outcomes. Further research is needed to reveal the potential subgroups in which gaps in quality due to physicians' clinical experience might exist.
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Affiliation(s)
- Soffien Chadli Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Ronald AA, Sadda V, Rabah NM, Steinmetz MP. Patient complaints in the postoperative period following spine surgery. J Neurosurg Spine 2021:1-8. [PMID: 34653968 DOI: 10.3171/2021.6.spine21637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient complaints are associated with a number of surgical and medical outcomes. Despite high rates of patient complaints regarding spine surgeons and efforts to study patient complaints across medicine and surgery, few studies have analyzed the complaints of patients undergoing spinal surgery. The authors present a retrospective analysis that, to their knowledge, is the first study to directly investigate the complaints of spine surgery patients in the postoperative period. METHODS Institutional records were reviewed over a 5-year period (2015-2019) to identify patients who underwent spine surgery and submitted a complaint to the institution's ombudsman's office within 1 year of their surgery. A control group, comprising patients who underwent spine surgery without filing a complaint, was matched to the group that filed complaints by admission diagnosis and procedure codes through propensity score matching. Patient demographic and clinical data were obtained by medical record review and compared between the two groups. Patient complaints were reviewed and categorized using a previously established taxonomy. RESULTS A total of 52 patients were identified who submitted a complaint after their spine surgery. There were 56 total complaints identified (4 patients submitted 2 each) that reported on 82 specific issues. Patient complaints were most often related to the quality of care received and communication breakdown between the healthcare team and the patient. Patients who submitted complaints were more likely to be Black or African American, have worse baseline health status, and have had prior spine surgery. After their surgery, these patients were also more likely to have longer hospital stays, experience postoperative complications, and require reoperation. CONCLUSIONS Complaints were most often related to the quality of care received and communication breakdown. A number of patient-level demographic and clinical characteristics were associated with an increased likelihood of a complaint being filed after spine surgery, and patients who filed complaints were more likely to experience postoperative complications. Improving communication with patients could play a key role in working to address and reduce postoperative complaints. Further study is needed to better understand patient complaints after spine surgery and investigate ways to optimize the care of patients with risks for postoperative complaints.
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Affiliation(s)
- Andrew A Ronald
- 1Case Western Reserve University School of Medicine, Cleveland; and.,2Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vineeth Sadda
- 1Case Western Reserve University School of Medicine, Cleveland; and.,2Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas M Rabah
- 1Case Western Reserve University School of Medicine, Cleveland; and.,2Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio
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Austin EE, Do V, Nullwala R, Fajardo Pulido D, Hibbert PD, Braithwaite J, Arnolda G, Wiles LK, Theodorou T, Tran Y, Lystad RP, Hatem S, Long JC, Rapport F, Pantle A, Clay-Williams R. Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance. BMJ Open 2021; 11:e050377. [PMID: 34429317 PMCID: PMC8386219 DOI: 10.1136/bmjopen-2021-050377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. DESIGN Systematic review. DATA SOURCES Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. RESULTS Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. CONCLUSIONS It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor's risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42020182045.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Vu Do
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tahlia Theodorou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Annette Pantle
- Medical Council of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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10
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The complaints culture. Eye (Lond) 2021; 35:3181-3182. [PMID: 34239086 DOI: 10.1038/s41433-021-01667-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/08/2022] Open
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Dambrino RJ, Zuckerman SL, Guidry BS, Domenico HJ, Thompson RC, Galloway MB, Pichert JW, Cooper WO. Do neurosurgeons receive more patient complaints than other physicians? Describing who is most at risk and how we can improve. J Neurosurg 2021; 134:1990-1997. [DOI: 10.3171/2020.4.jns20870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individual neurosurgeon characteristics, and 3) describe the types of UPCs made about neurosurgeons.
METHODS
Patient and family complaint reports among 36,265 physicians, including 423 neurosurgeons, 8292 other surgeons, and 27,550 nonsurgeons who practiced at 33 medical centers (22 academic and 11 regional) from January 1, 2014, to December 31, 2017, were coded with a previously validated Patient Advocacy Reporting System (PARS) algorithm.
RESULTS
Among 423 neurosurgeons, 93% were male, and most (71%) practiced in academic medical centers. Neurosurgical subspecialties included general practice (25%), spine (25%), tumor (16%), vascular (13%), functional (10%), and pediatrics (10%). Neurosurgeons had more average total UPCs per physician (8.68; 95% CI 7.68–9.67) than nonsurgeons (3.40; 95% CI 3.33–3.47) and other surgeons (5.01; 95% CI 4.85–5.17; p < 0.001). In addition, a significantly higher percentage of neurosurgeons received at least one UPC (71.6%; 95% CI 67.3%–75.9%) than did nonsurgeons (50.2%; 95% CI 49.6%–50.8%) and other surgeons (58.2%; 95% CI 57.1%–59.3%; p < 0.001). Factors most associated with increased average UPCs were younger age, measured as median medical school graduation year (1990.5 in the 0-UPC group vs 1993 in the 14+-UPC group, p = 0.009) and spine subspecialty (13.4 mean UPCs in spine vs 7.9 mean UPCs in other specialties, 95% CI 2.3–8.5, p < 0.001). No difference in complaints was seen in those who graduated from non-US versus US medical schools (p = 0.605). The most common complaint types were related to issues surrounding care and treatment, communication, and accessibility, each of which was significantly more common for neurosurgeons than other surgical specialties (p < 0.001).
CONCLUSIONS
Neurosurgeons were more likely to generate UPCs than other surgical specialties, and almost 3 out of 4 neurosurgeons (71.6%) had at least one UPC during the study period. Prior studies have shown that feedback to physicians about behavior can result in fewer UPCs. These results suggest that neurosurgeons have opportunities to reduce complaints and potentially improve the overall quality of care delivered.
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Affiliation(s)
| | | | | | | | | | | | | | - William O. Cooper
- 4Center for Patient and Professional Advocacy, and
- 5Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Kalavar M, Watane A, Sridhar J, Cavuoto KM. Surgeon demographic and surgical volume trends in adult strabismus surgery in the United States. J AAPOS 2021; 25:78.e1-78.e5. [PMID: 33711430 DOI: 10.1016/j.jaapos.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/18/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore the influence of career stage, gender, and age on procedural trends of surgeons performing strabismus surgery. METHODS Data on ophthalmologists who performed strabismus surgery and on the Medicare beneficiaries who underwent surgery between 2012 and 2017 was retrieved from Medicare Provider Utilization and Payment Data. RESULTS A total of 133 strabismus surgeons (78.9% male and 21.1% female) were reimbursed by Centers for Medicare and Medicaid Services for 10,598 strabismus procedures during the study period. The overall number of strabismus surgeries increased (P = 0.039) over time. Most surgeons were 50-59 years of age (n = 45 [33.8%]), with an average age of 54.5 ± 9.5 years. The number of services per physician did not differ by gender (85 ± 97 procedures/male surgeon and 60 ± 149 procedures/female surgeon [P = 0.13]). There was no difference in the gender proportion of physicians, with 0-9 post-fellowship years of experience (P = 0.32), but there were significantly more men with 10-19 (P = 0.003), 20-29 (P < 0.001), and 30-39 (P < 0.001) years of post-fellowship experience. There was no difference in the number of procedures performed between women and men 30-39 (P = 0.83) or 60-69 (P = 0.48) years of age; however, women 40-49 (P = 0.009) and 50-59 (P < 0.001) years of age performed significantly fewer procedures per surgeon than men. CONCLUSIONS Women performed significantly fewer surgeries midcareer compared to their male counterparts.
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Affiliation(s)
- Meghana Kalavar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Arjun Watane
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Kara M Cavuoto
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida.
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Raldow A, Adefres B, Warso M, Shinohara E, Anand S, Domenico HJ, Galloway MB, Pichert JW, Cooper WO. Unsolicited patient complaints among radiation, medical, and surgical oncologists. Cancer 2021; 127:2350-2357. [PMID: 33724453 DOI: 10.1002/cncr.33513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs. METHODS This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Average total UPCs were compared by specialty in addition to sex, medical school graduation year, degree, medical school location, residency location, practice setting, and practice region. For continuous variables, linear regression was used to test for an association with total complaints. RESULTS The study included 1576 physicians: 318 ROs, 1020 MOs, and 238 SOs. The average number of UPCs per physician was different and depended on the oncologic specialty: ROs had significantly fewer complaints (1.28; 95% confidence interval [CI], 1.02-1.54) than MOs (3.81; 95% CI, 3.52-4.10) and SOs (6.89; 95% CI, 5.99-7.79; P < .0001). In a multivariable analysis, oncologic specialty, recency of graduation, and academic practice were predictive of higher total UPCs (P < .05). UPCs described concerns with care and treatment (42.8%), communication (26.4%), accessibility (17.5%), concern for patient (10.3%), and billing (2.9%). CONCLUSIONS ROs had significantly fewer complaints than MOs and SOs and may have a lower risk of malpractice claims as a group. In addition to oncologic specialty, a more recent year of medical school graduation and working at an academic center were independent risk factors for UPCs. Further research is needed to clarify the reasons underlying these associations and to identify interventions that decrease UPCs and associated risks. LAY SUMMARY This study of 1576 oncologists found that radiation oncologists had significantly fewer complaints than medical oncologists, who in turn had significantly fewer complaints than surgical oncologists. Other characteristics associated with more patient complaints included recency of medical school graduation and practice in an academic setting. Oncologists' patient complaints provide information that may have practical applications for patient safety and risk management. Understanding and addressing the characteristics that increase the risk for complaints could improve patients' experiences and outcomes.
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Affiliation(s)
- Ann Raldow
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Bethel Adefres
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Michael Warso
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Eric Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sidharth Anand
- Department of Medical Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | | | - Mitchell B Galloway
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Martinez KA, Keenan K, Rastogi R, Roufael J, Fletcher A, Rood MN, Rothberg MB. The Association Between Physician Race/Ethnicity and Patient Satisfaction: an Exploration in Direct to Consumer Telemedicine. J Gen Intern Med 2020; 35:2600-2606. [PMID: 32632788 PMCID: PMC7459065 DOI: 10.1007/s11606-020-06005-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient satisfaction measures have important implications for physicians. Patient bias against non-White physicians may impact physician satisfaction ratings, but this has not been widely studied. OBJECTIVE To assess differences in patient satisfaction by physician race/ethnicity. DESIGN A cross-sectional observational study. PARTICIPANTS Patients seeking care on a large nationwide direct to consumer telemedicine platform between July 2016 and July 2018 and their physicians. MAIN MEASURES Patient satisfaction was ascertained immediately following the encounter on scales of 1 to 5 stars and scored two ways: (1) top-box satisfaction (5 stars versus fewer) and (2) dissatisfaction (2 or fewer stars versus 3 or more). To approximate the information patients would use to make assumptions about physician race/ethnicity, four reviewers classified physicians into categories based on physician name and photo. These included White American, Black American, South Asian, Middle Eastern, Hispanic, and East Asian. Mixed effects logistic regression was used to assess differences in patient top-box satisfaction and patient dissatisfaction by physician race/ethnicity, controlling for patient characteristics, prescription receipt, physician specialty, and whether the physician trained in the USA versus internationally. KEY RESULTS The sample included 119,016 encounters with 390 physicians. Sixty percent were White American, 14% South Asian, 7% Black American, 7% Hispanic, 6% Middle Eastern, and 6% East Asian. Encounters with South Asian physicians (aOR 0.70; 95% CI 0.54-0.91) and East Asian physicians (aOR 0.72; 95% CI 0.53-0.99) were significantly less likely than those with White American physicians to result in top-box satisfaction. Compared to encounters with White American physicians, those with Black American physicians (aOR 1.72; 95% CI 1.12-2.64), South Asian physicians (aOR 1.77; 95% CI 1.23-2.56), and East Asian physicians (aOR 2.10; 95% CI 1.38-3.20) were more likely to result in patient dissatisfaction. CONCLUSIONS In our study, patients reported lower satisfaction with some groups of non-White American physicians, which may have implications for their compensation, professional reputation, and job satisfaction.
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Affiliation(s)
- Kathryn A Martinez
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH, 44195, USA.
| | - Kaitlin Keenan
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Joud Roufael
- Kent State University College of Public Health, Kent, OH, USA
| | - Adrianne Fletcher
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Mark N Rood
- Department of Family Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH, 44195, USA
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15
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Cooper WO, Spain DA, Guillamondegui O, Kelz RR, Domenico HJ, Hopkins J, Sullivan P, Moore IN, Pichert JW, Catron TF, Webb LE, Dmochowski RR, Hickson GB. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg 2020; 154:828-834. [PMID: 31215973 DOI: 10.1001/jamasurg.2019.1738] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance For surgical teams, high reliability and optimal performance depend on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may undermine a culture of safety, threaten teamwork, and thereby increase the risk for medical errors and surgical complications. Objective To test the hypothesis that patients of surgeons with higher numbers of reports from coworkers about unprofessional behaviors are at greater risk for postoperative complications than patients whose surgeons generate fewer coworker reports. Design, Setting, and Participants This retrospective cohort study assessed data from 2 geographically diverse academic medical centers that participated in the National Surgical Quality Improvement Program (NSQIP) and recorded and acted on electronic reports of safety events from coworkers describing unprofessional behavior by surgeons. Patients included in the NSQIP database who underwent inpatient or outpatient operations at 1 of the 2 participating sites from January 1, 2012, through December 31, 2016, were eligible. Patients were excluded if they were younger than 18 years on the date of the operation or if the attending surgeon had less than 36 months of monitoring for coworker reports preceding the date of the operation. Data were analyzed from August 8, 2018, through April 9, 2019. Exposures Coworker reports about unprofessional behavior by the surgeon in the 36 months preceding the date of the operation. Main Outcomes and Measures Postoperative surgical or medical complications, as defined by the NSQIP, within 30 days of the operation. Results Among 13 653 patients in the cohort (54.0% [7368 ] female; mean [SD] age, 57 [16] years) who underwent operations performed by 202 surgeons (70.8% [143] male), 1583 (11.6%) experienced a complication, including 825 surgical (6.0%) and 1070 medical (7.8%) complications. Patients whose surgeons had more coworker reports were significantly more likely to experience any complication (0 reports, 954 of 8916 [10.7%]; ≥4 reports, 294 of 2087 [14.1%]; P < .001), any surgical complication (0 reports, 516 of 8916 [5.8%]; ≥4 reports, 159 of 2087 [7.6%]; P < .01), or any medical complication (0 reports, 634 of 8916 [7.1%]; ≥4 reports, 196 of 2087 [9.4%]; P < .001). The adjusted complication rate was 14.3% higher for patients whose surgeons had 1 to 3 reports and 11.9% higher for patients whose surgeons had 4 or more reports compared with patients whose surgeons had no coworker reports (P = .05). Conclusions and Relevance Patients whose surgeons had higher numbers of coworker reports about unprofessional behavior in the 36 months before the patient's operation appeared to be at increased risk of surgical and medical complications. These findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients' risk for adverse outcomes.
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Affiliation(s)
- William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California
| | - Oscar Guillamondegui
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Hopkins
- Department of Medicine, Stanford University, Stanford, California
| | - Patricia Sullivan
- Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia
| | - Ilene N Moore
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas F Catron
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn E Webb
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
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16
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van Dael J, Reader TW, Gillespie A, Neves AL, Darzi A, Mayer EK. Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights. BMJ Qual Saf 2020; 29:684-695. [PMID: 32019824 PMCID: PMC7398301 DOI: 10.1136/bmjqs-2019-009704] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
Abstract
Introduction A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. Aim To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement. Method Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances. Results A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture. Discussion If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.
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Affiliation(s)
- Jackie van Dael
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Alex Gillespie
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Ana Luisa Neves
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik K Mayer
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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17
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Bressler NM. JAMA Ophthalmology—The Year in Review, 2018. JAMA Ophthalmol 2019; 137:481-482. [DOI: 10.1001/jamaophthalmol.2019.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Neil M. Bressler
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
- Editor, JAMA Ophthalmology
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18
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Nassiri AM, Pichert JW, Domenico HJ, Galloway MB, Cooper WO, Bennett ML. Unsolicited Patient Complaints among Otolaryngologists. Otolaryngol Head Neck Surg 2019; 160:810-817. [DOI: 10.1177/0194599818823706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To analyze unsolicited patient complaints (UPCs) among otolaryngologists, identify risk factors for UPCs, and determine the impact of physician feedback on subsequent UPCs. Methods This retrospective study reviewed UPCs associated with US otolaryngologists from 140 medical practices from 2014 to 2017. A subset of otolaryngologists with high UPCs received peer-comparative feedback and was monitored for changes. Results The study included 29,778 physicians, of whom 548 were otolaryngologists. UPCs described concerns with treatment (45%), communication (19%), accessibility (18%), concern for patients and families (10%), and billing (8%). Twenty-nine (5.3%) otolaryngologists were associated with 848 of 3659 (23.2%) total UPCs. Male sex and graduation from a US medical school were statistically significantly associated with an increased number of UPCs ( P = .0070 and P = .0036, respectively). Twenty-nine otolaryngologists with UPCs at or above the 95th percentile received peer-comparative feedback. The intervention led to an overall decrease in the number of UPCs following intervention ( P = .049). Twenty otolaryngologists (69%) categorized as “responders” reduced the number of complaints an average of 45% in the first 2 years following intervention. Discussion Physician demographic data can be used to identify otolaryngologists with a greater number of UPCs. Most commonly, UPCs expressed concern regarding treatment. Peer-delivered, comparative feedback can be effective in reducing UPCs in high-risk otolaryngologists. Implications for Practice Systematic monitoring and respectful sharing of peer-comparative patient complaint data offers an intervention associated with UPCs and concomitant malpractice risk reduction. Collegial feedback over time increases the response rate, but a small proportion of physicians will require directive interventions.
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Affiliation(s)
| | | | | | | | | | - Marc L. Bennett
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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19
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Correction for Discussion Section. JAMA Ophthalmol 2018; 136:1432. [PMID: 30383166 DOI: 10.1001/jamaophthalmol.2018.5518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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20
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Stevenson D, Sinclair N. Complaints About Hospice Care in the United States, 2005–2015. J Palliat Med 2018; 21:1580-1587. [DOI: 10.1089/jpm.2018.0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- David Stevenson
- Department of Health Policy, Vanderbilt School of Medicine, Nashville, Tennessee
| | - Nicholas Sinclair
- Department of Health Policy, Vanderbilt School of Medicine, Nashville, Tennessee
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21
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Cooper WO, Martinez W, Domenico HJ, Callahan ST, Kirkby BP, Finlayson AJR, Foster JJ, Johnson TM, Longo FM, Merrill DG, Jacobs ML, Pichert JW, Catron TF, Moore IN, Webb LE, Karrass J, Hickson GB. Unsolicited Patient Complaints Identify Physicians with Evidence of Neurocognitive Disorders. Am J Geriatr Psychiatry 2018; 26:927-936. [PMID: 30146001 DOI: 10.1016/j.jagp.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Determine whether words contained in unsolicited patient complaints differentiate physicians with and without neurocognitive disorders (NCD). METHODS We conducted a nested case-control study using data from 144 healthcare organizations that participate in the Patient Advocacy Reporting System program. Cases (physicians with probable or possible NCD) and two comparison groups of 60 physicians each (matched for age/sex and site/number of unsolicited patient complaints) were identified from 33,814 physicians practicing at study sites. We compared the frequency of words in patient complaints related to an NCD diagnostic domain between cases and our two comparison groups. RESULTS Individual words were all statistically more likely to appear in patient complaints for cases (73% of cases had at least one such word) compared to age/sex matched (8%, p < 0.001 using Pearson's χ2 test, χ2 = 30.21, df = 1) and site/complaint matched comparisons (18%, p < 0.001 using Pearson's χ2 test, χ2 = 17.51, df = 1). Cases were significantly more likely to have at least one complaint with any word describing NCD than the two comparison groups combined (conditional logistic model adjusted odds ratio 20.0 [95% confidence interval 4.9-81.7]). CONCLUSIONS Analysis of words in unsolicited patient complaints found that descriptions of interactions with physicians with NCD were significantly more likely to include words from one of the diagnostic domains for NCD than were two different comparison groups. Further research is needed to understand whether patients might provide information for healthcare organizations interested in identifying professionals with evidence of cognitive impairment.
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Affiliation(s)
- William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
| | - William Martinez
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - S Todd Callahan
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Brian P Kirkby
- Department of Surgery, Launceston General Hospital, Australia
| | | | - Jody J Foster
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Theodore M Johnson
- Birmingham/Atlanta VA GRECC and the Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Frank M Longo
- Department of Neurology, Stanford University, Stanford, CA
| | | | - Monica L Jacobs
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas F Catron
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Ilene N Moore
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Lynn E Webb
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Jan Karrass
- Department of Psychology, University of Maryland University College Europe, Kaiserslautern, Germany
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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