Week-in-Review | January 31, 2025
Dear DGIM,
While some of us with outside plans for MLK day were thwarted by cold and snow, Robin Canada and her son were at Comegys elementary school in Southwest Philly painting the halls cheerful colors where she ran into one of her favorite patients also volunteering.
Congratulations to Jen Kogan. She was named a one of the Journal of Graduate Medical Education 2024 Outstanding Reviewer. Reviewing takes times and commitment to doing it well. It is nice when the efforts are recognized.
Congratulations to Marguerite Balasta. In case you did not see it, she is DGIM’s new Director of Population Health.
Bob Burke has a new article in Implementation Science Communications with Kyra O’Brien from Neurology, and other Penn colleagues including Judy Shea. The team used chart-stimulated recall to talk to PCPs about how they evaluate cognitive complaints, using actual patients. She used CFIR to inform interviews and frame results. Then, she presented these results to a Delphi panel of primary care representatives to have them rank strategies that would be most helpful to address the barriers she found. Her Penn PORTAL project is now implementing a pilot intervention using these findings. Bob says, “to me, it’s one of the best examples of being very thoughtful about building step-by-step an effective, implementable intervention in in primary care I’ve seen.” As someone who worked with Judy Shea for years, I see her fingerprints all over this approach.
Kevin Volpp and Shivan Mehta (GI), and other Penn colleagues have a new article in JAMA Cardiology looking at the efficacy of bulk ordering and text messaging on lipid screening. In patients needing lipid screens, bulk ordering and a letter, or bulk ordering, a letter, and text messages increased lipid screening rates at three months by about 10% over usual care. At 6 months, these differences were about 5% but no longer statistically significant. At best screening rates went up to about 20% in the intervention arms at 6 months. Bulk ordering is cheap and easy to do. But to really increase screening rates, more active interventions are needed.
Elinore Kaufman (Surgery), Anna Morgan, Kit Delgado (EM), and other Penn collaborators have a new paper in Trauma and Acute Care Surgery looking at patients admitted with trauma who were retroactively insured through Medicaid comparing them to patients already on Medicaid and those who remained uninsured. Compared to patients who remained uninsured, those who got insurance were more likely to be discharged to in-patient post-acute care (3% versus 11%). This was associated with longer length of stays (even compared to those already on Medicaid and adjusting for severity of trauma) and higher costs. Emergency Medicaid enrollment helped people gain access to needed care, more efficient enrollment could help diminish LOS and costs.
Jalpa Doshi and her project manager Alex Li have a recent article in Advances in Therapy using claims data to assess the real-world effectiveness of long-acting injectable antipsychotics (LAIs) to oral daily antipsychotic (OAPs) medications. They find that compared to OAPs, LAIS were associated with lower risk of discontinuation of medications, psychiatric hospitalizations, and treatment failure. While RCTs have shown inconsistent benefit of LAIs compared to OAPs, they feel this is in part due to the high bar needed to engage in an RCT thus likely underestimating the true effectiveness of LAIs, especially for patients who have difficulty adhering to daily medications. Not surprisingly, the longer the dosing interval the lower the risk of poor outcomes (the best was paliperidone dosed q 3 months). Notably, less than 20% of the sample were on LAIs. Time to start talking to patients open to using these medications about the benefits of LAIs.
The Nudge Unit is now accepting submissions. “Submit an idea to improve care delivery and outcomes for a chance to get behavioral change support and expertise.” The due date is February 28th. You submit the idea, and if selected they help you design, test, and evaluate your nudge.
GO BIRDS!!!!
Keep the news coming.
Judith
Judith A. Long, MD
Sol Katz Professor of Medicine
Chief, Division of General Internal Medicine
University of Pennsylvania Perelman School of Medicine
Core Faculty, VA Center for Health Equity Research and Promotion
Corporal Michael J. Crescenz, VA Medical Center