Joint Letter to Congressional Leadership Supporting "Dreamers"

Joint Letter Urging Congressional Leaders to Protect DACA Health Care Workforce

Joint Letter to House and Senate Leaders Supporting Extension of CHIP

Joint Letter to Congressional Leaders Requesting a Moratorium on the Medicare Sequestration Cuts

Joint Letter to Congressional Leaders Regarding the Physician Workforce

Joint Letter to Congressional Leaders Regarding Annual Medicare Inflationary Updates

Joint Letter to Congressional Leaders Opposing Medicaid Block Grants, Per Capita Spending Caps, and Other Funding Cuts

Joint letter to Congressional appropriators supporting funding for the Centers for Disease Control and Prevention Office on Smoking and Health

Joint Letter to Congressional Appropriators Urging Increased Funding for the Title V Maternal and Child Health (MCH) Services Block Grant

Joint Letter to Congressional Appropriators Urging Increased Funding for the Title V Maternal and Child Health (MCH) Services Block Grant

Effect of Health Service Area on Primary Care Physician Provision of Low-Value Cancer Screening

Background: Using a health systems approach to investigate low-value care (LVC) may provide insights into structural drivers of this pervasive problem. Objective: To evaluate the influence of service area practice patterns on low-value mammography and prostate-specific antigen (PSA) testing. Design: Retrospective study analyzing LVC rates between 2008 and 2018, leveraging physician relocation in 3-year intervals of matched physician and patient groups. Setting: U.S. Medicare claims data. Participants: 8254 physicians and 56 467 patients aged 75 years or older. Measurements: LVC rates for physicians staying in their original service area and those relocating to new areas. Results: Physicians relocating from higher-LVC areas to low-LVC areas were more likely to provide lower rates of LVC. For mammography, physicians staying in high-LVC areas (LVC rate, 10.1% [95% CI, 8.8% to 12.2%]) or medium-LVC areas (LVC rate, 10.3% [CI, 9.0% to 12.4%]) provided LVC at a higher rate than physicians relocating from those areas to low-LVC areas (LVC rates, 6.0% [CI, 4.4% to 7.5%] [difference, −4.1 percentage points {CI, −6.7 to −2.3 percentage points}] and 5.9% [CI, 4.6% to 7.8%] [difference, −4.4 percentage points {CI, −6.7 to −2.4 percentage points}], respectively). For PSA testing, physicians staying in high- or moderate-LVC service areas provided LVC at a rate of 17.5% (CI, 14.9% to 20.7%) or 10.6% (CI, 9.6% to 13.2%), respectively, compared with those relocating from those areas to low-LVC areas (LVC rates, 9.9% [CI, 7.5% to 13.2%] [difference, −7.6 percentage points {CI, −10.9 to −3.8 percentage points}] and 6.2% [CI, 3.5% to 9.8%] [difference, −4.4 percentage points {CI, −7.6 to −2.2 percentage points}], respectively). Physicians relocating from lower- to higher-LVC service areas were not more likely to provide LVC at a higher rate. Limitation: Use of retrospective observational data, possible unmeasured confounding, and potential for relocating physicians to practice differently from those who stay. Conclusion: Physicians relocating to service areas with lower rates of LVC provided less LVC than physicians who stayed in areas with higher rates of LVC. Systemic structures may contribute to LVC. Understanding which factors are contributing may present opportunities for policy and interventions to broadly improve care. Primary Funding Source: National Cancer Institute of the National Institutes of Health.

Harmonized Outcome Measures for Use in Depression Patient Registries and Clinical Practice

Major depressive disorder is a common mental health condition that affects an estimated 16.2 million adults and 3.1 million adolescents in the United States. Yet, a lack of uniformity remains in measurements and monitoring for depression both in clinical practice and in research settings. This project aimed to develop a minimum set of standardized outcome measures relevant to both patients and clinicians that can be collected in depression registries and clinical practice. Twenty-nine depression registries and related data collection efforts were identified and invited to submit outcome measures. Additional measures were identified through literature searches and reviews of quality measures. A multistakeholder panel representing clinicians; payers; government agencies; industry; and medical specialty, health care quality, and patient advocacy organizations categorized the 27 identified measures using the Agency for Healthcare Research and Quality's supported Outcome Measures Framework. The panel identified 10 broadly relevant measures and harmonized definitions for these measures through in-person and virtual meetings. The harmonized measures represent a minimum set of outcomes that are relevant to clinicians and patients and appropriate for use in depression research and clinical practice. Routine and consistent collection of these measures in registries and other systems would support creation of a national research infrastructure to efficiently address new questions, improve patient management and outcomes, and facilitate care coordination.

Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 170, No 6

Background: Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited. Objective: To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis. Design: Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343) Setting: 41 dialysis facilities in 3 U.S. metropolitan areas. Participants: Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2. Intervention: Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2). Measurements: The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms–Clinician-Rated (QIDS-C) at 12 weeks. Results: The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 [95% CI, −12.1 to 16.4]). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, −1.84 [CI, −3.54 to −0.13]; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group. Limitation: No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed. Conclusion: An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT. Primary Funding Source: Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.

Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians

Background: Many physicians believe that advanced practice clinicians (APCs [nurse practitioners and physician assistants]) provide care of relatively lower value. Objective: To compare use of low-value services among U.S. APCs and physicians. Design: Service use after primary care visits was evaluated for 3 conditions after adjustment for patient and provider characteristics and year. Patients with guideline-based red flags were excluded and analyses stratified by office- versus hospital-based visits, acute versus nonacute presentations, and whether clinicians self-identified as the patient's primary care provider (PCP). Setting: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 1997 to 2011. Patients: Patients presenting with upper respiratory infections (URIs), back pain, or headache. Measurements: Use of guideline-discordant antibiotics (for URIs), radiography (for URIs and back pain), computed tomography (CT) or magnetic resonance imaging (MRI) (for headache and back pain), and referrals to other physicians (for all 3 conditions). Results: 12 170 physician and 473 APC office-based visits and 13 359 physician and 2947 APC hospital-based visits were identified. Although office-based clinicians saw similar patients, hospital-based APCs saw younger patients (mean age, 42.6 vs. 45.0 years; P  < 0.001), and practiced in urban settings less frequently (49.7% vs. 81.7% of visits; P < 0.001) than hospital-based physicians. Unadjusted and adjusted results revealed that APCs ordered antibiotics, CT or MRI, radiography, and referrals as often as physicians in both settings. Stratification suggested that self-identified PCP APCs ordered more services than PCP physicians in the hospital-based setting. Limitation: NHAMCS reflects hospital-based APC care; NAMCS samples physician practices and likely underrepresents office-based APCs. Conclusion: APCs and physicians provided an equivalent amount of low-value health services, dispelling physicians' perceptions that APCs provide lower-value care than physicians for these common conditions. Primary Funding Source: U.S. Health Services and Research Administration, Ryoichi Sasakawa Fellowship Fund, and National Institutes of Health.

Unexplained Pauses in Centers for Disease Control and Prevention Surveillance: Erosion of the Public Evidence Base for Health Policy

Real-time federal surveillance of diseases and health care delivery informs clinical guidance and public health policy. However, in 2025, some U.S. Centers for Disease Control and Prevention (CDC) databases seemed to have “unexplained pauses” and ceased or delayed updates. The CDC public data catalog was audited to identify paused databases that had previously been updated at least monthly and evaluated their characteristics. Of 1359 catalog records examined on 28 October 2025, eighty-two were previously updated at least monthly. On the basis of each database’s stated periodicity, allowing for an additional 30-day grace period, their status was classified as either current or paused as of 28 October 2025. Forty-four databases (54%) were current, and 38 (46%) were paused. Thirty-four of the 38 databases (89%) had no data entries dated within 6 months of the date of analysis, whereas 4 (11%) paused more recently. Of the 38 paused databases, 33 (87%) were vaccination-related topics compared with none of the 44 current databases. Of the 5 paused databases on other topics, 4 addressed respiratory diseases, including disease burden and nonvaccine prevention measures, whereas 1 addressed public health (drug overdose deaths). The persistence of pauses as of 2 December 2025 was examined. Only 1 of the 38 paused databases had been updated. Such long pauses may have compromised evidence for decision making and policies by clinicians, administrators, professional organizations, and policymakers. Federal databases should adopt minimum transparency standards, including displaying the current update status, with a rationale if paused, and next expected update with criteria for resumption. Without such standards, unexplained pauses in surveillance risk undermining evidence-based medicine and public trust.

Implementation of Social Needs Screening and Intervention in Primary Care: A Systematic Review of Program-Level Determinants: Annals of Internal Medicine: Vol 179, No 1

Background: Health care systems are investing significant resources in social needs screening and intervention programs. Purpose: To understand characteristics contributing to implementation of social needs screening and intervention programs in primary care. Data Sources: CINAHL, Cochrane, Ovid, PubMed, and Scopus (January 2015 to April 2025). Study Selection: U.S.-based programs using structured tools to screen adult patients for at least 1 Healthcare Effectiveness Data and Information Set measure (food insecurity, transportation, and housing insecurity) and addressing social needs in primary care settings. Data Extraction: Program characteristics; screening and intervention implementation processes; and patient screening, intervention, clinical, and health care use outcomes. Data Synthesis: The review included 23 studies. Seventeen reported on screening outcomes, 11 in populations characterized by a particular condition or health care use and 6 in the general population. Programs with the highest percentage of patients screened focused on fewer than 500 patients with a particular condition or health care use and received support from additional staff or volunteers (4 of 17 studies). Of patients screened, 10.1% to 100% reported a social need. Eleven studies reported on receipt of assistance or resources, with a higher percentage of patients receiving assistance or resources among programs that targeted a smaller population. Few studies reported clinical and health care use outcomes, with mixed findings. Limitations: Few studies had complete reporting of screening and intervention rates and outcomes. Program characteristics and other screening and intervention processes varied across and within studies. Conclusion: Social needs programs focused on smaller, targeted populations were more likely to screen and assist a higher percentage of patients. Programs with adequate staffing may also screen a higher proportion of patients. However, evidence is mixed, particularly for clinical and health care use outcomes. Considerable differences among screening and intervention programs preclude simple suggestions for universal implementation. Primary Funding Source: Live Well Intramural Pilot Grant Program. (PROSPERO: CRD42023431151)

Impacts of Communication Type and Quality on Patient Safety Incidents: A Systematic Review: Annals of Internal Medicine: Vol 178, No 5

Background: Poor communication in health care increases the risk for patient safety incidents. However, there is no up-to-date synthesis of these data. Purpose: To synthesize studies investigating how poor communication between health care practitioners and patients (and between different groups of practitioners) affects patient safety. Data Sources: Ovid MEDLINE, CINAHL, APA PsycInfo, CENTRAL, Scopus, and the ProQuest Dissertations & Theses Citation Index from 1 January 2013 to 7 February 2024. Study Selection: Studies published in any language that quantified the effects of poor communication on patient safety. Data Extraction: Two independent reviewers extracted data, assessed risk of bias, and appraised strength of evidence. Study heterogeneity precluded meta-analysis, so results were reported with narrative description, reporting medians and interquartile ranges (IQRs). Data Synthesis: Forty-six eligible studies (67 826 patients) were included. Risk of bias was low for 20, moderate for 16, and high for 10 studies. Four studies investigated whether poor communication was the only identified cause of a patient safety incident; here, poor communication caused 13.2% (IQR, 6.1% to 24.4%) of safety incidents. Forty-two studies investigated whether poor communication contributed to patient safety incidents alongside other causes; here, poor communication contributed to 24.0% (IQR, 12.0% to 46.8%) of safety incidents. Study heterogeneity was high in terms of setting, continent, health care staff, and safety incident type. The strength of the evidence was low or very low. Limitation: There was important study heterogeneity, generally low study quality, and poor reporting of essential data. Conclusion: Poor communication is a major cause of patient safety incidents. Research is needed to develop effective interventions and to learn more about how poor communication leads to patient safety incidents. Primary Funding Source: Stoneygate Trust. (PROSPERO: CRD42024507578)

A Cautionary Tale: The 2019 Orphaning of Hahnemann's Graduate Medical Trainees

Hahnemann University Hospital provided care for Philadelphians starting in 1848, but its recent history has been riddled with financial turmoil that culminated in its rapid closure in summer 2019. As the hospital shuttered its doors to patients, it also orphaned 583 medical trainees. This crisis exposed vulnerabilities in graduate medical education (GME). In a firsthand account of the situation that developed in Philadelphia and reached academic institutions across the country, the authors reflect on lessons learned that may help leaders at other institutions mitigate the inevitable difficulties that arise when academic hospitals close. These lessons pertain to handling panic and administrative burdens in the aftermath of closure, the importance of well-defined processes, a clear understanding of GME funding, and strategies for placement of trainees that minimize disruption of their education.

Finding My Voice

Toward Historical Accountability and Remembrance: The German Society for Internal Medicine and Its Legacies From the Nazi Past

After decades of silence, the German Society for Internal Medicine (DGIM) has made considerable efforts to come to terms with its role and actions during the Nazi era (1933 to 1945). This is particularly important because, with more than 27 000 members, the DGIM is the largest medical society in present-day Germany. Since 1882, the society's annual congress in Wiesbaden has provided a forum and focus for the key medical topics of the day. Based on ongoing historical research, this article is organized in 2 parts. The first describes how the DGIM willingly adapted to the ideology and politics of the Nazi regime, showing no solidarity with its persecuted Jewish members. To illustrate their fates, the cases of Leopold Lichtwitz, who was forced to resign as elected chairman in 1933, and committee member Julius Bauer are investigated. Both men emigrated to the United States. Light is also shed on the decisions of those who led the society during the Nazi era and on the involvement of high-ranking members in medical crimes. The second part of the article analyzes developments in the postwar period and considers why it took so long to hold up a mirror to the past. Although critical voices could be heard from both outside and within the society, they remained isolated and without consequence. Only the past 2 decades have brought about both general and specific developments toward historical accountability and an active culture of remembrance. With a declaration first published in 2015, a new website bringing history and memory together, and a strong commitment to the norms and values of liberal democracy, the DGIM has found its way to a clear position—and has lessons to teach.