scholarly journals Commentary on: The Impact of a Plastic Surgeon’s Gender on Patient Choice

2017 ◽  
Vol 37 (4) ◽  
pp. 472-473 ◽  
Author(s):  
Simeon Wall ◽  
Holly Wall
Keyword(s):  
Patient Choice ◽  
The Impact

Patient Choice and Patient Empowerment in Northern European Health Systems: A Conceptual Framework

1994 ◽  
Vol 24 (2) ◽  
pp. 201-229 ◽  
Author(s):  
Richard B. Saltman
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Patient Empowerment ◽  
Patient Choice ◽  
Care Providers ◽  
Care Systems ◽  
European Health ◽  
The Impact

The issue of patient choice presents a complicated challenge to publicly operated health systems. Increased patient choice can strengthen the citizen's commitment to traditional welfare state objectives, or alternatively, it can severely damage that commitment, depending upon the design of the choice mechanism and the structural context within which patient choice occurs. For patient choice to be linked to true empowerment, choice must reinforce rather than undercut the accountability of health care providers to the population they serve. This article explores the basic issues involved in empowering patients within publicly operated health systems. The author first reviews the conceptual components that could or should be incorporated within the notion of empowered patients, then examines what would be required to actually empower patients within health systems, defined in terms of expanding not only logistical choice but also clinical influence and decision-making participation. The article concludes with a wide-ranging analysis of the impact of potential policies and mechanisms on the long-term objectives of achieving democratically accountable health care systems.

Legal Issues in Gamete and Embryo Cryopreservation: An Overview

2018 ◽  
Vol 36 (05) ◽  
pp. 299-310
Author(s):  
Susan Crockin ◽  
Kathryn Gottschalk
Keyword(s):  
Informed Consent ◽  
Constitutional Law ◽  
Reproductive Potential ◽  
Legal Issues ◽  
Patient Choice ◽  
Embryo Cryopreservation ◽  
Art Practice ◽  
Legal Principles ◽  
The Impact ◽  
Cryopreserved Embryos

AbstractThis article provides an overview of existing and developing law surrounding IVF embryos and those who handle them. It discusses what law and legal theories of liability may apply to embryology labs, and gamete and embryo banks in the context of embryo loss, abandonment, shipping and implantation. It explores how often intertwined theories of law have been applied to this unique field, including contract, informed consent, health, tort and Constitutional law. Recent so-called “Personhood” initiatives are reviewed for their impact on ART practice. The article also explores how legal principles related to patient choice, autonomy, informed consent, and the various rights and responsibilities of providers and patients have been applied to this area of medicine which is unique both because it involves at least two patients and due to the singular nature and reproductive potential of ex-utero and cryopreserved embryos and gametes. Through an examination of largely US judicial and statutory perspectives and trends, the article assesses the complexities of the impact of the law on, and attempts to offers guidance to, those involved in this continually evolving and challenging field of medicine.

Intermittent chemotherapy (ICh) for metastatic castration-resistant prostate cancer (mCRPC): Results of a prospective randomized phase II trial of the DoD Prostate Cancer Clinical Trials Consortium.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 133-133
Author(s):  
A. L. Harzstark ◽  
T. M. Beer ◽  
V. K. Weinberg ◽  
C. S. Higano ◽  
L. T. Nordquist ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Standard Of Care ◽  
Patient Choice ◽  
Castration Resistant Prostate Cancer ◽  
Gm Csf ◽  
Randomized Phase Ii ◽  
Intermittent Chemotherapy ◽  
The Impact

133 Background: Docetaxel remains the standard of care for patients (pts) with mCRPC. However, the optimal duration of chemotherapy (Ch) is not known. Providing Ch holidays is often undertaken, but is not well characterized. A randomized phase II trial was undertaken to test two ICh regimens. Methods: Pts with Ch naive mCRPC and KPS > 60% were eligible. Pts were treated with “induction” docetaxel 75 mg/m2 q3 weeks, and prednisone 5 mg po bid. After 6 cycles, responding pts (PSAWG1 criteria) stopped Ch and were randomized to observation (Obs) or to GM-CSF, 250 mcg/m2 sq daily for 14 days out of every 28 day cycle. Pts were followed with monthly PSA and imaging every 2 cycles until progressive disease (PD) by PSAWG1 criteria, at which point they resumed treatment with Ch, again for 6 cycles, followed by the same “off Ch” regimen. The primary endpoint was the time to PD while on Ch (time to Ch resistance.) Results: Of 97enrolled pts to date, 94 are evaluable (3 are still undergoing induction). 69 pts completed induction (25 did not due to PD, adverse events (AE), or MD choice), of which 27 had PD after 6 cycles. Thus, 42/94 evaluable pts (45%) were eligible for randomization. Of these, 21 pts underwent Obs and 21 received GM-CSF. To date, 23/42 (55%) pts who underwent a Ch holiday restarted Ch, all for PSA PD. 8/23 (35%) had a response to Ch re-initiation. (15 pts did not re-start Ch because of AE, other therapy being started, or patient choice, and 4 pts are still undergoing either Obs or GM-CSF.) Obs pts were “off Ch” for a median of 2 months (range 2-4), compared with 3 months (range 2-8) for GM-CSF pts. Conclusions: While feasible, only 45% of pts met criteria for ICh. 35% of pts responded to Ch re-initiation. Insufficient data exist to assess the impact of GM-CSF on time off Ch or time to Ch resistance. No significant financial relationships to disclose.

Competition and Quality in Healthcare

2019 ◽  
Author(s):  
Peter Sivey ◽  
Yijuan Chen
Keyword(s):  
Empirical Studies ◽  
Patient Choice ◽  
Future Research ◽  
Quality Competition ◽  
Improve Quality ◽  
Competitive Markets ◽  
Quality Improvements ◽  
Provider Quality ◽  
Quality In Healthcare ◽  
The Impact

Quality competition between alternative providers is an increasingly important topic in the health economics literature. This literature includes theoretical and empirical studies that have been developed in parallel to 21st-century policies to increase competition between doctors or hospitals. Theoretical studies have clarified how competitive markets can give healthcare providers the incentive to improve quality. Broadly speaking, if providers have an incentive to attract more patients and patients value quality, providers will raise quality until the costs of raising quality are equal to the additional revenue from patients attracted by the rise in quality. The theoretical literature has also investigated how institutional and policy parameters determine quality levels in equilibrium. Important parameters in models of quality competition include the degree of horizontal differentiation, the level of information about provider quality, the costs of switching between providers, and the time-horizon of quality investment decisions. Empirical studies have focused on the prerequisites of quality competition (e.g., do patients choose higher quality providers?) and the impact of pro-competition policies on quality levels. The most influential studies have used modern econometric approaches, including difference-in differences and instrumental variables, to identify plausibly causal effects. The evidence suggests that in most contexts, quality is a determinant of patient choice of provider, especially after greater patient choice is made available or information is published about provider quality. The evidence that increases in competition improve quality in healthcare is less clear cut. Perhaps reflecting the economic theory of quality competition, showing that different parameter combinations or assumptions can produce different outcomes, empirical results are also mixed. While a series of high-quality studies in the United Kingdom appear to show strong improvements in quality in more competitive areas following pro-competition reforms introducing more choice and competition, other studies showed that these quality improvements do not extend to all types of healthcare or alternative measures of quality. The most promising areas for future research include investigating the “black box” of quality improvement under competition, and behavioral studies investigating financial and nonfinancial motivations for quality improvements in competitive markets.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

Population-based patterns of palliative systemic therapy use in elderly patients with metastatic colorectal cancer (mCRC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9547-9547
Author(s):  
Matthew Chan ◽  
Gillian Gresham ◽  
Winson Y. Cheung
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Systemic Therapy ◽  
Early Treatment ◽  
Cox Regression ◽  
Young Patients ◽  
Population Based ◽  
Patient Choice ◽  
Advanced Age ◽  
The Impact

9547 Background: Elderly cancer patients are consistently under-represented in clinical trials, which may lead to under-treatment. Our aims were to 1) determine the impact of advanced age on use of palliative systemic therapy in mCRC, 2) examine the reasons for treatment choices and 3) compare adverse events and treatment discontinuations in elderly vs young patients. Methods: All patients diagnosed with mCRC from 2006 to 2007 and referred to any 1 of 5 regional cancer centers in British Columbia, Canada were reviewed. Summary statistics were used to describe treatment patterns between elderly patients (EP; >/=70 years) and young patients (YP; <70 years). Cox regression models that adjusted for age and confounders were used to determine the effect of systemic therapy on overall survival (OS). Results: We identified 1,013 patients: median age was 67 years (range 23-93); 42% were elderly and 58% were young; 57% were men; and 66% had ECOG 0/1. Compared to YP, fewer EP were offered systemic therapy (46 vs 76%, p<0.001). Among those treated, EP were less likely than YP to be given combination chemotherapy (47 vs 81%, p<0.001) and bevacizumab (19 vs 47%, p<0.001). Most common reasons for no treatment were similar in EP and YP: patient choice (32% for both), poor ECOG (18% of EP and 16% of YP), and significant comorbidities (11% for both). Advanced age alone was also cited as a reason among EP (7%) for not receiving therapy. In the subset that was treated, risk of adverse events (24 vs 14%, p=0.24) and early treatment discontinuations (14 vs 13%, p=0.88) were comparable between EP and YP, respectively. Receipt of systemic therapy was associated with improved OS in both the elderly (HR for death 0.45, 95% CI 0.37-0.56, p<0.001) and the young (HR for death 0.43, 95% CI 0.35-0.53, p<0.001), regardless of age (p interaction of age and treatment >0.05). Conclusions: In this population-based cohort of mCRC, EP were more likely to receive no treatment, monotherapy rather than combination therapy, or a regimen without bevacizumab. In carefully selected EP, however, it appears that rate of adverse events, frequency of early treatment discontinuations, and magnitude of survival benefit from systemic therapy were comparable to YP.

The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge

2021 ◽  
pp. 0272989X2110397
Author(s):  
K. D. Valentine ◽  
Pete Wegier ◽  
Victoria A. Shaffer ◽  
Laura D. Scherer
Keyword(s):  
Cancer Screening ◽  
Risk Communication ◽  
Screening Test ◽  
Online Survey ◽  
Task Force ◽  
Patient Choice ◽  
Communication Strategy ◽  
Screening Tests ◽  
Intervention Preferences ◽  
The Impact

Purpose The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits. Method A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured. Results With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions. Conclusions Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.

scholarly journals Comparing the Impact of Online Ratings and Report Cards on Patient Choice of Cardiac Surgeon: Large Observational Study (Preprint)

2021 ◽  
Author(s):  
Xuan Li ◽  
Shin-Yi Chou ◽  
Mary E Deily ◽  
Mengcen Qian
Keyword(s):  
Subjective Experience ◽  
Report Card ◽  
Patient Choice ◽  
Report Cards ◽  
Objective Health ◽  
Online Ratings ◽  
Online Rating ◽  
Cardiac Surgeon ◽  
The Impact ◽  
Rating Information

BACKGROUND Patients may use two information sources about a health care provider’s quality: online physician reviews, which are written by patients to reflect their subjective experience, and report cards, which are based on objective health outcomes. OBJECTIVE The aim of this study was to examine the impact of online ratings on patient choice of cardiac surgeon compared to that of report cards. METHODS We obtained ratings from a leading physician review platform, Vitals; report card scores from Pennsylvania Cardiac Surgery Reports; and information about patients’ choices of surgeons from inpatient records on coronary artery bypass graft (CABG) surgeries done in Pennsylvania from 2008 to 2017. We scraped all reviews posted on Vitals for surgeons who performed CABG surgeries in Pennsylvania during our study period. We linked the average overall rating and the most recent report card score at the time of a patient’s surgery to the patient’s record based on the surgeon’s name, focusing on fee-for-service patients to avoid impacts of insurance networks on patient choices. We used random coefficient logit models with surgeon fixed effects to examine the impact of receiving a high online rating and a high report card score on patient choice of surgeon for CABG surgeries. RESULTS We found that a high online rating had positive and significant effects on patient utility, with limited variation in preferences across individuals, while the impact of a high report card score on patient choice was trivial and insignificant. About 70.13% of patients considered no information on Vitals better than a low rating; the corresponding figure was 26.66% for report card scores. The findings were robust to alternative choice set definitions and were not explained by surgeon attrition, referral effect, or admission status. Our results also show that the interaction effect of rating information and a time trend was positive and significant for online ratings, but small and insignificant for report cards. CONCLUSIONS A patient’s choice of surgeon is affected by both types of rating information; however, over the past decade, online ratings have become more influential, while the effect of report cards has remained trivial. Our findings call for information provision strategies that incorporate the advantages of both online ratings and report cards.

scholarly journals Economic Impact of Converting an Interventional Pain Medicine Physician Office-Based Practice into a Provider-Based Ambulatory Pain Practice

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E253-E261 ◽  
Author(s):  
Jay S. Grider
Keyword(s):  
Health Care ◽  
Community Hospital ◽  
Patient Choice ◽  
Practice Setting ◽  
Pain Medicine ◽  
Fee Structure ◽  
Physician Office ◽  
Medicine Physician ◽  
Ambulatory Practice ◽  
The Impact

Background: One consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. These acquired practices are often converted into hospital- or provider-based clinics. This designation brings the increased services of the hospital, the accreditation of the hospital, and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). One potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. The aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. Objective: Determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu. Setting: Community hospital-based academic interventional pain medicine practice. Study Design: Economic analysis of effect of change in price structure on clinical volumes. Methods: The current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. Results: Clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. Following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. Limitations: Single practice entity and single geographic location in southeastern United States. Conclusions: The conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. These results imply that factors other than price are a driver of patient choice. Key words: Economics of interventional pain medicine, hospital-based ambulatory practice, provider-based ambulatory practice, physician-office based practice, price in-elasticity of health care

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