How Behavioral Economics Can Advance The Design Of Effective Clinician Incentive Programs
Editor’s note: This is one of several posts Health Affairs Blog will publish stemming from sessions at the June 2015 AcademyHealth Annual Research Meeting (ARM) in Minneapolis. Watch Health Affairs Blog for additional posts on topics raised at the ARM.
We’re still looking for the right levers to drive what we all seek from our health care system — a system that helps people optimize their health and is affordable. Fundamentally, if we could better influence the health-related decisions that take place between a clinician and a patient, we’d be making significant strides towards the triple aim. Every day billio...
Source: Health Affairs Blog - September 15, 2015 Category: Health Management Authors: Anne-Marie Audet and Mark Zezza Tags: Costs and Spending Equity and Disparities Featured Health Professionals Hospitals Medicare Organization and Delivery Quality behavioral economics Dan Ariely Predictably Irrational quality metrics Social and Behavioral Sciences Team Source Type: blogs
The Value And Limits Of Economic Evaluation In Policy Analysis
Health care resources, no matter how represented, are ultimately finite. Trade-offs occur as spending in one area means that those same resources are unavailable to fund another program. In spite of this, U.S. policymakers remain reluctant to engage in conversations that even hint at “rationing.” This reluctance is evidenced by the fact that the Patient-Centered Outcomes Research Initiative (PCORI) is legislatively forbidden to include cost-effectiveness ratios in its comparative effectiveness evaluations.
Diametrically opposed to the U.S. system, most other countries embrace cost-effectiveness, whereby competing progr...
Source: Health Affairs Blog - September 1, 2015 Category: Health Management Authors: Victoria Phillips Tags: Costs and Spending Drugs and Medical Technology Equity and Disparities Global Health Health Policy Lab Medicaid and CHIP Payment Policy Population Health Quality Comparative Effectiveness cost-effectiveness health economics heart d Source Type: blogs
Praluent, the Next Expensive "Game Changer," Blockbuster," "New Hope," - But Not Yet Shown to Benefit Patients
ConclusionsThe NEJM study was accompanied by an editorial by Stone and Lloyd-Jones(2) which documented that drugs previously shown to lower cholesterol were never proved to do any good for patients, and concluded,it would be premature to endorse these drugs for widespread use before the ongoing randomized trials, appropriately powered for primary end-point analysis and safety assessment, are available. After an FDA advisory committee recommended approval of aliromucab and another PCSK9 inhibitor in June, 2015, John Mandrola entitled a Medscape article,Dear FDA: Resist the Urge on PCSK9 DrugsHis reasons included lack o...
Source: Health Care Renewal - August 5, 2015 Category: Health Management Tags: aliromucab evidence-based medicine health care prices manipulating clinical research PCSK9 inhibitor Praluent Regeneron Sanofi-Aventis Source Type: blogs
Aortocoronary bypass
(ACB) is same as coronary bypass except that connection of a left anterior descending coronary artery to a coronary artery cannot be technically considered as an aortocoronary bypass. Aortocoronary bypass involves using a reversed saphenous vein or a free graft of a radial artery or some other conduit to connect a small opening created in the ascending aorta to the coronary artery distal to the obstruction. In the initial era of coronary artery bypass surgery, aortocoronary bypass was used synonymously as coronary artery bypass grafting because internal mammary artery live grafts were seldom used for coronary bypass. The...
Source: Cardiophile MD - July 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Graft failure after CABG
Potential pointers to graft failure after coronary artery bypass grafting (CABG):
Electrocardiographic signs of myocardial ischemia
Ventricular arrhythmias
Significant elevation of biomarkers (five times elevation for CPK)
New wall motion abnormalities noted on echocardiography
Hemodynamic instability
The post Graft failure after CABG appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - July 12, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs
Heart Team
The Heart Team includes clinical or non-invasive cardiologists, interventional cardiologists and cardiac surgeons and is entrusted the process of balanced decision making in case of interventional or surgical therapies for stable, complex coronary artery disease. The concept of a multidisciplinary Heart Team was developed by the SYNTAX Investigators [1] and endorsed by the European (ESC/EACTS) Guidelines on Myocardial Revascularization 2010 [2]. In an interesting study by Long J and colleagues [3] found that on rediscussion of same patient data one year later yielded a different advice in about a quarter of the cases, sugg...
Source: Cardiophile MD - July 1, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiac Surgery Coronary Interventions Source Type: blogs
Stroke after CABG
Factors predicting stroke after coronary artery bypass grafting (CABG)
Presence of intracerebral and extracerebral atherosclerotic disease
Demonstration of previous stroke by imaging
Atheromatous disease of the aorta
It may be noted that aortic plaques have a high chance of embolization while cannulating the aorta for cardiopulmonary bypass. Avoiding cardiopulmonary bypass with off pump CABG may have an edge over conventional on pump CABG in this situation. Previous history of stroke of transient ischemic attacks (TIA) within the previous six months is an important risk factor for perioperative stroke. Though the chance ...
Source: Cardiophile MD - July 1, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs
Porcelain aorta
Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Calcified aorta has an egg shell like appearance. The dense calcification makes the ascending aorta unclampable during procedures requiring cardiopulmonary bypass like coronary artery bypass grafting and valve replacement. The calcification may be detected by chest-ray, CT scan and sometimes by echocardiography (usually trans esophageal). The calcification is also visible during fluroscopy for coronary angiography. When such calcification is detected prior to aortic valve replacement, option of transcatheter aortic valve impla...
Source: Cardiophile MD - June 23, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Antithrombotic for giant coronary aneurysm – Cardiophile MCQ
Most common anti thrombotic regimen for giant coronary aneurysms in Kawasaki disease:
a) Low dose aspirin alone
b) Low dose aspirin + warfarin
c) Low molecular weight heparin
d) Unfractionated heparin
Correct answer: b) Low dose aspirin + warfarin
Giant coronary aneurysms in Kawasaki disease have a high risk of thrombosis. Most commonly used treatment is low dose aspirin along with dose adjusted Warfarin. Aneurysms with proximal and distal stenoses have a higher chance of thrombosis due to higher platelet activation by shear stress at the stenosis and eddy currents within the aneurysm. Presence of a chronic thrombus withi...
Source: Cardiophile MD - June 3, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Wide Complex Tachycardia Refractory to Anti-dysrhythmics and Cardioversion.
This was contributed by Rebecca Kornas, MD, one of our EM Residents. Edited and commented upon by Smith.A middle-aged male with a history of CAD and two vessel CABG and ischemic cardiomyopathy (EF 20%) presented to the emergency department (ED) after an out-of-hospital cardiac arrest. Paramedics found him in ventricular fibrillation and started mechanical CPR via the LUCAS device, five rounds of epinephrine, and delivered six unsuccessful defibrillation attempts before arriving in the ED. He was defibrillated into a wide complex rhythm. There was no pulse. Che...
Source: Dr. Smith's ECG Blog - June 3, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Forty-Year Struggle for Openness
In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following day...
Source: Spontaneous Circulation - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Forty-Year Struggle for Openness
In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following day...
Source: Spontaneous Circulation - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Influenza vaccination for CABG patients – Cardiology MCQ
Influenza vaccination for CABG patients is a:
a) Class I recommendation
b) Class IIa recommendation
c) Class IIb recommendation
d) Class III recommendation
Correct answer: a) Class I recommendation
As per the American Heart Association (AHA) 2015 guidelines, influenza vaccination should be offered to all coronary artery bypass graft (CABG) patients unless there is a contraindication (Class I recommendation with level of evidence B). In the general population, CentreS for Disease Control and Prevention (CDC) has recommended annual influenza vaccination for all above the age of six months if there is no specific contra indic...
Source: Cardiophile MD - May 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
The affect heuristic and conflicts of interest
Understanding the affect heuristic leads one to expand their understanding of the term “conflict of interest”. My simple explanation of the affect heuristic follows:
If you like something, you overestimate the benefits and underestimate the risk. The contrary holds also. If you dislike something, you underestimate the benefits and overestimate the risks.
This concept helps us understand that we should consider multiple conflicts of interest. Clearly the pharmaceutical and device industries have taken advantage of this concept. They hire very likable representatives. This representatives treat physicians v...
Source: DB's Medical Rants - May 25, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Bariatric surgery for CABG patients – Cardiology MCQ
Bariatric surgery is recommended for CABG patients if their BMI (body mass index) is more than:
a) Twenty kilograms per square meter body surface area
b) Twenty five kilograms per square meter body surface area
c) Thirty kilograms per square meter body surface area
d) Thirty five kilograms per square meter body surface area
Correct answer: d) Thirty five kilograms per square meter body surface area
As per the American Heart Association (AHA) guidelines 2015, bariatric surgery is recommended for coronary artery bypass grafting (CABG) patients if their BMI is more than thirty five kilograms per square meter (>35 Kg/...
Source: Cardiophile MD - May 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
