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ACP calls for comprehensive reform of US health in a series of policy papers

January 20, 2020

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. ACP calls for comprehensive reform of U.S. health in a series of policy papers
Recommendations offer new vision of American health care and policies to achieve it

Note: HD video soundbites of the authors discussing the paper are available to download at http://www.dssimon.com/MM/ACP-new-vision/.

Call to Action: http://annals.org/aim/article/doi/10.7326/M19-2411

Coverage and Cost of Care: http://annals.org/aim/article/doi/10.7326/M19-2415

Health Care Delivery and Payments: http://annals.org/aim/article/doi/10.7326/M19-2407

Reducing Barriers to Care: http://annals.org/aim/article/doi/10.7326/M19-2410

Editorial: http://annals.org/aim/article/doi/10.7326/M19-3775
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3894
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3895
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3896
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3712

URLs go live when the embargo lifts

The American College of Physicians issued a bold call to action challenging the U.S. to implement systematic reform of the healthcare system, and released an ambitious new vision for a better health care system for all and expansive policy recommendations for how to achieve it. The series of policy papers is published as a supplement in Annals of Internal Medicine.

"Better is Possible: The American College of Physicians Vision for the U.S. Health Care System" is a comprehensive, interconnected set of policies to guide the way to a better U.S. health care system for all. It includes a call to action that challenges the U.S. not to settle for the status quo, but to implement systematic healthcare reforms. The additional set of ACP policy papers address issues related to coverage and cost of care, healthcare payment and delivery systems, and barriers to care and social determinants of health, and offer specific recommendations supported by evidence about ways the U.S. can change the status quo and achieve a better healthcare system for all. The papers are:
  • "Envisioning a Better Health Care System for All: The American College of Physicians' Call to Action"
  • "Envisioning a Better Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health"
  • "Envisioning a Better Health Care System for All: Coverage and Cost of Care"
  • "Envisioning a Better Health Care System for All: Health Care Delivery and Payment System Reform"
ACP developed the papers based on examination and analysis of the strengths and weaknesses of the current U.S. health care system and an analysis of the major problems with American health care. Potential solutions outlined in the papers use as their foundation, the best available data and evidence, and a comprehensive review of the literature and recommendations, that build on ACP's day-to-day advocacy to support the daily practice and well-being of its members, and health of patients.

In an accompanying editorial, ACP physician leaders offer their perspective on why physicians have an obligation to speak out about the problems plaguing the U.S. health care system, as well as the expertise to attempt to create workable solutions to serve the country and patients better. The editorial serves to reiterate ACP's longstanding commitment to advocating through an evidence-based approach to fulfill the responsibility that physicians have to work on behalf of the patients they serve.

The supplement includes four other editorials that lend insight from physicians at Google Health, the Trust for America's Health, The Council of Medical Specialty Societies, The University of Chicago, and the City University of New York at Hunter College.

Notes and media contacts: For an embargoed PDF or to speak with someone from ACP, please contact Jacquelyn Blaser at Jblaser@acponline.org.


2. Bone marrow transplantation has significantly increased survival rates for cancer patients

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2936
URLs go live when the embargo lifts

Following allogeneic hematopoietic cell transplantation, cancer deaths dropped 34 percent between 2013 and 2017 compared with patients treated between 2003 and 2007. While survival has improved, death due to recurrence remains a major problem. Findings from a cohort study are published in Annals of Internal Medicine.

Blood-forming cells transplanted from a donor can replenish bone marrow and help to eliminate cancer cells for patients with blood cancer and other diseases. Fred Hutchison Cancer Research Center specializes in this kind of therapy and previously reported that outcomes have been improving for patients receiving bone marrow transplants since the 1990s, yet many patients continued to experience dangerous or deadly complications. Whether or not these improvements have continued into the mid-2000s has not been studied.

Researchers from Fred Hutchinson compared cohorts that had bone marrow transplants during 2003 to 2007 versus 2013 to 2017 to determine whether survival has improved over the past decade and to note impediments to better outcomes. The most recent cohort was older, with more co-morbid conditions at baseline. Survival outcome measures were analyzed, along with transplant-related complications. The researchers found that over the past 25 years, the frequency of day-200 non-relapse mortality has progressively decreased (from 30 percent to 16 percent, and now 11 percent), while relapse rates also decreased. Rates of infectious, gastrointestinal, kidney, and respiratory complications had decreased, and in some cases the complications that did occur were less severe overall. According to the authors, these improvements likely result from the accumulation of many individual, incremental advances in conditioning therapy, graft-versus-host disease prophylaxis, prednisone dosing, infection control, and supportive care. While these findings are considered encouraging, the results are only relative to an earlier era. In absolute terms, the frequency of overall mortality during 2013 to 2017 was 40 percent, and this proportion will undoubtedly increase with further follow-up.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, George B. McDonald, MD, please contact Molly McElroy at mwmcelro@fredhutch.org.


3. Lack of evidence makes it difficult to determine the optimal number of patients primary care physicians should care for

A small number of studies suggest that quality of care decreases slightly as panel size increases

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2491
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3673
URLs go live when the embargo lifts

Evidence is insufficient to make evidence-based recommendations about the optimal primary care panel size, or number of patients physicians should see, for achieving beneficial health outcomes. Findings from a systematic evidence review are published in Annals of Internal Medicine.

A key component of population health is the primary care physician, who is responsible for the care of a defined number of patients. Determining the optimal panel size, or number of patients, a full-time primary care physician should see is a complex undertaking that requires balancing patient needs with those of the provider team. There are a number of methods employed to determine this number, yet the optimal panel size remains unclear.

Researchers from West Los Angeles Veterans Affairs Medical Center reviewed 16 hypothesis-testing studies and 12 simulation modeling studies on the association of panel size with six major aims of quality health care and physician burnout to help providers and policymakers make databased decisions about panel size. They found that the quality of evidence was modest at best. The few available studies included in their analysis provided a signal that increasing panel size may be associated with modest worsening of clinical quality and patient experience. Modeling studies support the idea that risk adjustment and practice-level variables influence the optimal panel size for patient access to care. The researchers point out that current recommendations about panel size are based more on historical experience than on evidence.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, Neil M. Paige, MD, MSHS, please contact Patricia Pryer at Patricia.Preyer@va.gov.


4. Colorado researchers report positive response to gun storage maps tool intended to prevent suicides

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2944
URLs go live when the embargo lifts

Researchers from the Colorado School of Public Health and the University of Colorado School of Medicine at the Anschutz Medical Campus report an encouraging response to their gun storage map tool for suicide prevention. Since it was launched last August, the gun storage map site has been viewed approximately 24,000 times and has reported positive buy-in from both the medical and firearm communities. An editorial describing the project is published in Annals of Internal Medicine.

Preventing firearm-related injury and death requires pragmatic, community-based solutions to promote safer storage of firearms during periods of risk. The Gun Storage Map program is an online resource for the public and for clinicians who counsel at-risk patients. The statewide map displays firearm retailers and law enforcement agencies willing to consider requests for voluntary, temporary gun storage.

The map was disseminated to targeted Colorado stakeholders, including medical and behavioral health providers, hospital groups, the crisis system, professional organizations, and the population at large through media relations. In total, 46 retailers (45 firearm retailers and 1 safe deposit box company) and 15 law enforcement agencies agreed to be listed on the map. While ongoing evaluation of the map's effects is needed, the researchers believe that with proper dissemination the storage map tool could help translate safe storage counseling into action. It may also be useful in other scenarios when individuals might want to store firearms away from home, such as home rental, visitors, or extended travel.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, Sara Brandspigel, MPH, please contact Julia Milzer at julia.milzer@cuanschutz.edu.
-end-
Also new in this issue:

The Role of Hospitalists in the Creation of Learning Healthcare Systems
Heather M. Gilmartin, PhD, NP; Vincent X. Liu, MD, MSc; Robert E. Burke, MD, MS
Hospitalist Commentary
Abstract: http://annals.org/aim/article/doi/10.7326/M19-3873

American College of Physicians

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