Unsolicited Patient Complaints Identify Physicians with Evidence of Neurocognitive Disorders

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.

Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications

Importance

Unsolicited patient observations are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves.

Objective

To examine whether patients of surgeons with a history of higher numbers of unsolicited patient observations are at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations.

Design, Setting, and Participants

This retrospective cohort study used data from 7 academic medical centers participating in the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System from January 1, 2011, to December 31, 2013. Patients older than 18 years included in the National Surgical Quality Improvement Program who underwent inpatient or outpatient operations at 1 of the participating sites during the study period were included. Patients were excluded if the attending surgeon had less than 24 months of data in the Vanderbilt Patient Advocacy Reporting System preceding the date of the operation. Data analysis was conducted from June 1, 2015, to October 20, 2016.

Exposures

Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation.

Main Outcomes and Measures

Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest.

Results

Among the 32 125 patients in the cohort (13 230 men, 18 895 women; mean [SD] age, 55.8 [15.8] years), 3501 (10.9%) experienced a complication, including 1754 (5.5%) surgical and 2422 (7.5%) medical complications. Prior unsolicited patient observations for a surgeon were significantly associated with the risk of a patient having any complication (odds ratio, 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complication (odds ratio, 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complication (odds ratio, 1.0079; 95% CI, 1.0009-1.0148; P = .03), and being readmitted (odds ratio, 1.0088, 95% CI, 1.0024-1.0151; P = .007). The adjusted rate of complications was 13.9% higher for patients whose surgeon was in the highest quartile of unsolicited patient observations compared with patients whose surgeon was in the lowest quartile.

Conclusions and Relevance

Patients whose surgeons have large numbers of unsolicited patient observations in the 24 months prior to the patient's operation are at increased risk of surgical and medical complications. Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals.

Triaging Patient Complaints: Monte Carlo Cross-Validation of Six Machine Learning Classifiers

Background

Unsolicited patient complaints can be a useful service recovery tool for health care organizations. Some patient complaints contain information that may necessitate further action on the part of the health care organization and/or the health care professional. Current approaches depend on the manual processing of patient complaints, which can be costly, slow, and challenging in terms of scalability.

Objective

The aim of this study was to evaluate automatic patient triage, which can potentially improve response time and provide much-needed scale, thereby enhancing opportunities to encourage physicians to self-regulate.

Methods

We implemented a comparison of several well-known machine learning classifiers to detect whether a complaint was associated with a physician or his/her medical practice. We compared these classifiers using a real-life dataset containing 14,335 patient complaints associated with 768 physicians that was extracted from patient complaints collected by the Patient Advocacy Reporting System developed at Vanderbilt University and associated institutions. We conducted a 10-splits Monte Carlo cross-validation to validate our results.

Results

We achieved an accuracy of 82% and F-score of 81% in correctly classifying patient complaints with sensitivity and specificity of 0.76 and 0.87, respectively.

Conclusions

We demonstrate that natural language processing methods based on modeling patient complaint text can be effective in identifying those patient complaints requiring physician action.

Infant negative emotionality and attachment: Implications for preschool intelligence

This longitudinal study examined the extent to which dimensions of infant negative temperament in the first year predicted IQ at age 3, and whether these associations depended on the quality of the infant–mother attachment relationship. In a sample of 63 infant–mother dyads, mothers completed Rothbart’s (1981) IBQ when infants were 4 and 12 months, mothers and infants participated in Ainsworth and Wittig’s (1969) Strange Situation at 12 months, and children completed the Stanford-Binet (Thorndike, Hagen, & Sattler, 1986) when they were 36 months of age. Hierarchical multiple regression analyses indicated that 4- or 12-month distress to limitations was not predictive of later IQ, but infants with greater distress to novelty at 4 months had higher IQs at 36 months. Furthermore, greater distress to novelty at 12 months predicted higher IQs but only for infants whose attachment was insecure. Differential implications of temperamental fear versus anger for social influences on cognitive development are discussed.

An intervention model that promotes accountability: peer messengers and patient/family complaints

BACKGROUND

Patients and their families are well positioned to partner with health care organizations to help identify unsafe and dissatisfying behaviors and performance. A peer messenger process was designed by the Center for Professional and Patient Advocacy at Vanderbilt University Medical Center (Nashville, Tennessee) to address "high-risk" physicians identified through analysis of unsolicited patient complaints, a proxy for risk of lawsuits.

METHODS

This retrospective, descriptive study used peer messenger debriefing results from data-driven interventions at 16 geographically disparate community (n = 7) and academic (n = 9) medical centers in the United States. Some 178 physicians served as peer messengers, conducting interventions from 2005, through 2009 on 373 physicians identified as high risk.

RESULTS

Most (97%) of the high-risk physicians received the feedback professionally, and 64% were "Responders." Responders' risk scores improved at least 15%, where Nonresponders' scores worsened (17%) or remained unchanged (19%) (p < or = .001). Responders were more often physicians practicing in medicine and surgery than emergency medicine physicians, had longer organizational tenures, and engaged in lengthier first-time intervention meetings with messengers. Years to achieve responder status correlated positively with initial communication-related complaints (r = .32, p < .001), but all complaint categories were equally likely to change over time.

CONCLUSIONS

Peer messengers, recognized by leaders and appropriately supported with ongoing training, high-quality data, and evidence of positive outcomes, are willing to intervene with colleagues over an extended period of time. The physician peer messenger process reduces patient complaints and is adaptable to addressing unnecessary variation in other quality/safety metrics.

Spontaneous regulation of emotions in preschool children who stutter: preliminary findings

PURPOSE

Emotional regulation of preschool children who stutter (CWS) and children who do not stutter (CWNS) was assessed through use of a disappointing gift (DG) procedure (P. M. Cole, 1986; C. Saarni, 1984, 1992).

METHOD

Participants consisted of 16 CWS and CWNS (11 boys and 5 girls in each talker group) who were 3 to 5 years of age. After assessing each child's knowledge of display rules about socially appropriate expression of emotions, the authors asked the children to participate in a DG procedure. The children received a desirable gift preceding the first free-play task and a disappointing gift preceding a second free-play task. Dependent variables consisted of participants' positive and negative expressive nonverbal behaviors exhibited during receipt of a desirable gift and disappointing gift as well as conversational speech disfluencies exhibited following receipt of each gift.

RESULTS

Findings indicated that CWS and CWNS exhibited no significant differences in amount of positive emotional expressions after receiving the desired gift; however, CWS--when compared with CWNS--exhibited more negative emotional expressions after receiving the undesirable gift. Furthermore, CWS were more disfluent after receiving the desired gift than after receiving the disappointing gift. Ancillary findings also indicated that CWS and CWNS had equivalent knowledge of display rules.

CONCLUSION

Findings suggest that efforts to concurrently regulate emotional behaviors and that speech disfluencies may be problematic for preschool-age CWS.

Spontaneous regulation of emotions in preschool children who stutter: preliminary findings

PURPOSE

Emotional regulation of preschool children who stutter (CWS) and children who do not stutter (CWNS) was assessed through use of a disappointing gift (DG) procedure (P. M. Cole, 1986; C. Saarni, 1984, 1992).

METHOD

Participants consisted of 16 CWS and CWNS (11 boys and 5 girls in each talker group) who were 3 to 5 years of age. After assessing each child's knowledge of display rules about socially appropriate expression of emotions, the authors asked the children to participate in a DG procedure. The children received a desirable gift preceding the first free-play task and a disappointing gift preceding a second free-play task. Dependent variables consisted of participants' positive and negative expressive nonverbal behaviors exhibited during receipt of a desirable gift and disappointing gift as well as conversational speech disfluencies exhibited following receipt of each gift.

RESULTS

Findings indicated that CWS and CWNS exhibited no significant differences in amount of positive emotional expressions after receiving the desired gift; however, CWS--when compared with CWNS--exhibited more negative emotional expressions after receiving the undesirable gift. Furthermore, CWS were more disfluent after receiving the desired gift than after receiving the disappointing gift. Ancillary findings also indicated that CWS and CWNS had equivalent knowledge of display rules.

CONCLUSION

Findings suggest that efforts to concurrently regulate emotional behaviors and that speech disfluencies may be problematic for preschool-age CWS.

Influence of stuttering variation on talker group classification in preschool children: preliminary findings

The purpose of this study was to investigate whether variations in disfluencies of young children who do (CWS) and do not stutter (CWNS) significantly change their talker group classification or diagnosis from stutterer to nonstutterer, and vice versa. Participants consisted of seventeen 3- to 5-year-old CWS and nine 3- to 5-year-old CWNS, with no statistically significant between-group difference in chronological age (CWS: M=45.53 months, S.D.=8.32; CWNS: M=47.67 months, S.D.=6.69). All participants had speech, language, and hearing development within normal limits, with the exception of stuttering for CWS. Both talker groups participated in a series of speaking samples that varied by: (a) conversational partner [parent and clinician], (b) location [home and clinic], and (c) context [conversation and narrative]. The primary dependent measures for this study were the number of stuttering-like disfluencies (SLD) per total number of spoken words [%SLD] and the ratio of SLD to total disfluencies (TD) [SLD/TD]. The results indicated that significant variability of stuttering did not exist as a result of conversational partner or location. Changes in context, however, did impact the CWS, who demonstrated higher SLD/TD in the conversation sample versus a narrative sample. Consistent with hypotheses, CWS and CWNS were accurately identified as stutterers and nonstutterers, respectively, regardless of changes to conversational partner, location or context for the overall participant sample. Present findings were taken to suggest that during assessment, variations in stuttering frequency resulting from changes in conversational partner, location or context do not significantly influence the diagnosis of stuttering, especially for children not on the talker group classification borderline between CWS and CWNS.

LEARNING OUTCOMES

Readers will be able to: (1) Describe the role of variability in stuttering frequency for young children who stutter; (2) Identify three fundamental measurements of the frequency of stuttering-like and nonstuttering-like disfluencies; (3) Describe the effects of stuttering variation on talker group classification of stuttering or nonstuttering.

Do you believe in magic? Infants' social looking during violations of expectations

Young infants tend to look longer at physical events that have unexpected outcomes than those that have expected outcomes, suggesting that they have knowledge of physical principles such as numerosity and occlusion (Baillargeon & Graber, 1987; Wynn, 1992). Although infants are typically tested in the presence of a caregiver, the social component of violations of expectations has received little attention. The present study investigated social looking during presumably expected and unexpected cognitive/perceptual events. Two experiments replicated the results of well-known physical knowledge experiments on addition/subtraction and occlusion in 6- (Experiments 1 and 2) and 9-month-old infants (Experiment 1), in that infants at both ages looked longer at unexpected than at expected events. Furthermore, infants at both ages initiated more looks at their caregivers' faces during unexpected than expected events. These findings are interpreted as suggesting that infants as young as 6 months of age actively seek to embed their experiences of unexpected physical/cognitive events in a social context.

Positive emotion, negative emotion, and emotion control in the externalizing problems of school-aged children

The present study examined the role of emotion and emotion control in children's externalizing problems. Third- to sixth-grade children were administered a self-report measure of positive emotion, negative emotion, and emotion control. Peer- and teacher-reported adjustment problems were assessed. Structural equations modeling revealed that negative emotion, especially anger, was important in externalizing problems. Less positive emotion was associated with more externalizing problems. However, when negative emotion was examined in a more differentiated manner (anger, sadness and fear), the effect of positive emotion was diminished. Anger consistently emerged as a significant predictor of behavior problems. No interaction between either positive emotion and emotion control or negative emotion and emotion control was significant. Results showed main effects of each emotion component, with small interaction effects. Methodological and conceptual implications of the findings from the present study are discussed.

Relation of emotional reactivity and regulation to childhood stuttering

The purpose of the present study was to examine relations between children's emotional reactivity, emotion regulation and stuttering. Participants were 65 preschool children who stutter (CWS) and 56 preschool children who do not stutter (CWNS). Parents completed the Behavior Style Questionnaire (BSQ) [McDevitt S. C., & Carey, W. B. (1978). A measure of temperament in 3-7 year old children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 19, 245-253]. Three groups of BSQ items measuring emotional reactivity, emotion regulation, and attention regulation were identified by experts in children's emotions. Findings indicated that when compared to their normally fluent peers, CWS were significantly more reactive, significantly less able to regulate their emotions, and had significantly poorer attention regulation, even after controlling for gender, age, and language abilities. Findings suggest that the relatively greater emotional reactivity experienced by preschool children who stutter, together with their relative inability to flexibly control their attention and regulate the emotions they experience, may contribute to the difficulties these children have establishing reasonably fluent speech and language.

LEARNING OUTCOMES

The reader should be able to (1) define emotional reactivity and emotion regulation, (2) explain how emotional reactivity and emotion regulation relate to preschool stuttering, and (3) understand recent empirical evidence linking reactivity and regulation to preschool stuttering.

Predicting shared parent--child book reading in infancy

This study examined the degree to which parental contextual factors and infant characteristics predicted whether parents read aloud to their 8-month-old infants. Discriminant function analysis revealed that mothers with higher family incomes and those who reported less parenting stress and fewer general hassles were more likely to read to their infants. Gender and temperament of the infant did not significantly predict whether mothers would engage in shared reading. Furthermore, there was no evidence that mothers who reported reading aloud to their infants display more enriching parenting practices in the laboratory. Paternal contextual factors did not discriminate readers from nonreaders, but infant temperament did. Fathers who read aloud had infants who were less soothable and who displayed longer durations of orienting. The possibility that book reading could serve as 1 mediator of the temperament-cognition relationship is discussed.

Processes in language acquisition: the roles of gender, attention, and maternal encouragement of attention over time

This longitudinal study including 87 infant-mother dyads examined the relation between infant temperamental attention, maternal encouragement of attention, language, and the effects of gender. At ages 0;4, 0;8, and 1;0, global attention was assessed from Rothbart's (1981) IBQ; manipulative exploration was assessed with the Bayley (1969) IBR; and maternal verbal, visual and physical encouragement of attention were coded from 5 minutes of mother-infant free-play. At 1;0, language was measured using language items from the Bayley Mental Scale and parent-report items from Hendrick, Prather & Tobin's (1984) SICD-Revised. Multiple regressions indicated that gender, infants' manipulative exploration and maternal physical encouragement of attention at 0;4, and maternal verbal encouragement of attention at 1;0, were all positively related to language at 1;0. Interactions indicated that girls high in 0;8 or 1;0 manipulative exploration had more advanced language skills than girls low in manipulative exploration or than boys, regardless of their attention level. Additionally, maternal verbal encouragement of attention appears to be particularly salient in the development of language for boys.