Changes in Cancer Screening Rates Following a New Cancer Diagnosis in a Primary Care Patient Panel

Abstract

Key Points Question Is primary care physician (PCP) exposure to a patient with a new breast or colorectal cancer diagnosis associated with increases in cancer screenings for other patients who subsequently visit the affected PCP? Findings In this cohort study of 3158 PCPs caring for 1 920 189 patients, using stacked difference-in-differences analyses, there were rapid and sustained increases in cancer screening rates for patients visiting PCPs who were recently exposed to new cancer diagnoses, for both breast cancer and colorectal cancer. Meaning These findings suggest that PCPs’ exposures to new diagnoses of cancer are associated with significant, sustained increases in cancer screening rates for other patients subsequently visiting the exposed PCPs.

Effect of patient death on referrals to cardiac specialists

“…Results in Column 2 of Table 2 and Panel B of Figure 1 suggest that there is a significant decline in the probability of referring physician referring to the heart surgeon after patient death. The results in Column 3 indicate that the decrease in referrals is associated with reduced payments for j's patients to surgeon k. Prior literature suggests that adverse events including procedure complications or new diagnoses can impact physician treatment decisions (Ly, 2021;Singh, 2021;Wang et al, 2022). It is possible that the referring physicians not only update their beliefs about a particular surgeon but about all cardiac surgeons and procedures after a patient dies.…”

Chief Residency—More Than Just Teaching and Scheduling—Reply

“…As we noted when discussing our utilization results (minimal differences between former chief and nonchief PCPs), chiefs may not be selected based on competency in evidence-based medicine. Another explanation may be that spending a year teaching about rare cases (ie, zebras) with long differential diagnoses may be associated with more aggressive testing later in practice owing to the availability heuristic . Although our results cannot directly speak to this, we should consider the possible effects of a chief residency on all of our outcomes.…”