Division of General Internal Medicine Week-in-Review | July 1, 2024
Dear DGIM,
Congratulations to Pete Groeneveld (CHERP Director) and the VA CHERP team. The Center for Health Equity Research and Promotion (CHERP) was renewed for another 5 years after receiving the highest VA HSR Center renewal score in the country!
Congratulations to the following recipients of DGIM Pilot Grants:
- Maggie Lowenstein got a Matt Slap Pilot Research Grant for her project: “Patient Perspectives on a Transitional Hospital-to-Housing Model.”
- Aaron Schwartz got a Matt Slap Pilot Research Grant for his project: “Pilot Study of an AI Large Language Model (LLM) to Support Frontline Health Workers in Low-Resource Settings.”
- Jen Kogan and Jessica Dine got a Sam Martin Education Pilot Award for their project: “The Opportunity Costs Associated with Publish or Perish in Undergraduate Medical Education.”
I look forward to reporting back on the results from these projects.
Congratulations to David Aizenberg. He received the DOM Andrew Schafer Leadership in Medicine Award.
It is that time of year when we say goodbye to our senior residents and say hello to the new interns. Congratulations to our primary care residents: Virginia Waldrop (Ambulatory Chief Resident), Nicole Scaramella, Hector Mora, Patrick Sayre (Residency APD), Casey Krickis, Rani Nandiwada (Primary Care Residency Program Director), Menaka Dhingra, Uttara Gadde, Nichole Smith, Hannah Lampert, Jessica Zuo, Eva Szymanski, Abby Schmucker, and Kurt Koehler.
Maggie Lowenstein, Rachael Truchil, Judy Chertok (FM) and other Penn colleagues have an article in the Journal of Substance Use & Addiction Treatment assessing outcomes for patients treated by a mobile low-threshold OUD treatment program (Prevention Point van). The program served a predominantly male Black population. Impressively 69% completed 4 or more visits with the mobile program. Of the people served, 51% of the 237 had at least one visit with an outside site and 30% followed up at least two times. Being referred to a site where the people who staffed the mobile clinic (i.e. Penn) increased the odds of a successful linkage to brick-and-mortar care (OR 2.3, 95% CI 1.2-4.5). Glass ½ full or ½ empty? While the direct linkage to care may have been lower than they hoped and on par with other efforts, they reached a very hard to reach, transient population and connected 4 or more times with almost 70% of the population, supporting a medication first approach to OUD treatment.
Bob Burke has a new article out in Journal of the American Geriatrics Society looking at the relationship between a VA facility being recognized by IHI as “Age-Friendly” and subsequent facility-free days in older Veterans. They find a small but statistically significant increase in facility free days among veterans seen in an Age-Friendly recognized medical center – about one extra day per year. This effect was consistent across subgroups and level of recognition (Level 1 versus 2 where Level 2 is considered a higher level of Age-Friendly recognition). While this might not seem a lot, Bob points out that if this was spread across the VA during the time frame under analysis (2018-2022) it would have saved the VA about $1.3 billion (although this number does not include the cost of implementing Age-Friendly practices so likely lower in reality). This study was a high-level analysis. Many of the veterans included in the analysis may not have been touched by Age-Friendly practices. If this is true, one would expect greater effects with more people touched. Implementing comprehensive Age-Friendly practices can be hard to do and expensive. An ROI analysis might help determine if the effort is worth it both from a financial perspective and quality of life perspective.
Katy Milkman (Wharton) just published a paper in Nature with Kevin Volpp and many other Penn faculty showing that almost any text message was just as good at getting people to get a COVID booster as were free roundtrip Lyft rides to a CVS pharmacy where they could get the booster. This was a megastudy of over 4 million people. The effect size was about a 1% overall increase in booster uptake (compared to a control group) and a small but significant spillover effect with a 0.34% increase in influenza vaccination completion. We know transportation is a barrier to care, but we have yet to show that providing transportation significantly increases care receipt. The text messaging effect is consistent with other studies – text move the needle a little, but are cheap, and we are able to easily get them to many different people.
Turning research into policy: Aaron Schwartz recently learned that Medicare has adopted quality measures he developed as a graduate student for the AHEAD accountable care organization global payment model. For those who are interested in the details, you can find the measures on page 91 of the financial specs. Aaron says the lesson learned is If external parties ask for your help/code to build on your prior work, help them.
Wellness: On Tuesday, June 25th, Penn Medicine on Demand (PMOD) became the first call for after-hours clinical calls coming into the PIMUC and Cooper Clinics. They are covering weeknights and weekends, including holidays. This has already been rolled out to some of the Penn Medicine Primary Care Clinics and has led to a substantial reduction in after-hours calls (see graph) and incredible provider satisfaction (basically 100% of people said their life was better due to the program). The plans are to eventually roll this out to all the clinics. We are thrilled. Thank you Kevin Mahoney and the team making this happen!
Teddy Wu was selected to become SGIM National Membership Committee Co-Chair. He will serve in this capacity for the next 2 years, and of course he encourages you all to renew your membership or join SGIM if you’re not a member. Teddy also wants you all to note that the fall Mid-Atlantic SGIM regional meeting is Friday October 18, at Rutgers-Robert Wood Johnson Hospital, and next year’s Annual SGIM Meeting is May 15-17 in Hollywood, Florida!
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