Screening high risk populations for cancer: Hepatobiliary

Cancers of the hepatobiliary tract are highly fatal, prompting the need for early detection to provide treatment and decrease the mortality rate. Screening patients for hepatobiliary cancers can provide early detection, but it is not feasible or efficient to screen all patients. Therefore, it is important to consider the known risk factors for each hepatobiliary cancer which creates a smaller population that is amenable to screening.     

They think you earn too much,but they probably don't care

• A survey of patients and physicians in southern California indicates that patients overestimate Medicare payments to hospitals for elective coronary stenting several‐fold and overestimate Medicare payments to physicians for coronary stenting over 15‐fold. Patients think payments should be less than they erroneously think hospitals and physicians are paid but should be much more than hospitals and physicians are paid.
• The authors hypothesize that patients’ view of physician payments may interfere with the physician–patient relationship, but data from other studies of physician–patient relationships suggest other factors are much more important.
• The importance of patients’ opinions regarding physician payments for procedures could be further assessed by surveying patients about relationships with physicians before versus after information is given about actual payments.

     

Patient preferences prompt a peek at priorities

• Patients rate the downsides of bare metal stents (higher restenosis rates) as being of similar magnitude to the downsides of drug eluting stents (longer dual anti‐platelet therapy).
• Patient preferences regarding choice of bare metal versus drug eluting stents should be elicited before coronary stenting.
• This article does not study actual patient preferences for stent type. Future studies should assess how personalized discussions of trade‐offs of stent types affect patient preferences.

     

Interventional economics provide a roadmap to better patient care

• Costs of percutaneous coronary intervention including the index procedure and care in the subsequent 30 days are increased by half for patients who are readmitted, and increased up to two-fold for those who have major adverse events during the initial admission.
• Many factors “predicting” adverse events and readmission are not modifiable. However, some are modifiable. Interventionalists should focus on those.
• In addition to using strategies to avoid adverse events, interventionalists should lead teams to implement strategies to prevent readmission. This will require a new nonprocedural focus for interventionalists.