Patient ID Now Coalition Letter to Senate to Remove Section 510 in FY24 Budget

Patient ID Now Coalition Letter to House to Remove Section 510 in FY24 Budget

Patient Centered Primary Care Collaborative to Policymakers Supporting Primary Care and PCMH

Over-the-Counter Drugs: Proposed Labeling Requirements. Letter to Food and Drug Adminstration.

Over-the-Counter Drugs: Proposed Labeling Requirements. Letter to Department of Health and Human Services.

Oppose the $194.5 million in health care provider user fees included in President Clinton"s FY2000 Budget Request to Congress.

Joint Open Letter Urging COVID-19 Vaccine Coverage During Pregnancy

Open Letter to Congress Regarding Site-Neutral Payment and Billing Transparency Reform

Joint Letter Urging Increased Appropriations for Programs in the Depts. of Education, HHS and Labor

President Obama: Support Tort Reform

Associations Between Dietary Patterns and Subclinical Cardiac Injury: An Observational Analysis From the DASH Trial: Annals of Internal Medicine: Vol 172, No 12

Background: The DASH diet has been found to lower blood pressure (BP) and low-density lipoprotein cholesterol levels. Objective: To compare diets rich in fruits and vegetables with a typical American diet in their effects on cardiovascular injury in middle-aged adults without known preexisting cardiovascular disease (CVD). Design: Observational study based on a 3-group, parallel-design, randomized trial conducted in the United States from 1994 to 1996. (ClinicalTrials.gov: NCT00000544) Setting: 3 of the 4 original clinical trial centers. Participants: 326 of the original 459 trial participants with available stored specimens. Intervention: Participants were randomly assigned to 8 weeks of monitored feeding with a control diet typical of what many Americans eat; a diet rich in fruits and vegetables but otherwise similar to the control diet; or the DASH diet, which is rich in fruits, vegetables, low-fat dairy, and fiber and has low levels of saturated fat and cholesterol. Weight was kept constant throughout feeding. Measurements: Biomarkers collected at baseline and 8 weeks: high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro–B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP). Results: The mean age of participants was 45.2 years, 48% were women, 49% were black, and mean baseline BP was 131/85 mm Hg. Compared with the control diet, the fruit-and-vegetable diet reduced hs-cTnI levels by 0.5 ng/L (95% CI, −0.9 to −0.2 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, −0.5 to −0.1 pg/mL). Compared with the control diet, the DASH diet reduced hs-cTnI levels by 0.5 ng/L (CI, −0.9 to −0.1 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, −0.5 to −0.04 pg/mL). Levels of hs-CRP did not differ among diets. None of the markers differed between the fruit-and-vegetable and DASH diets. Limitation: Short duration, missing specimens, and an inability to isolate the effects of specific foods or micronutrients. Conclusion: Diets rich in fruits and vegetables given over 8 weeks were associated with lower levels of markers for subclinical cardiac damage and strain in adults without preexisting CVD. Primary Funding Source: National Institutes of Health, National Heart, Lung, and Blood Institute.

Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States: A Qualitative Study: Annals of Internal Medicine: Vol 173, No 2

Background: Behavioral health integration is uncommon among U.S. physician practices despite recent policy changes that may encourage its adoption. Objective: To describe factors influencing physician practices' implementation of behavioral health integration. Design: Semistructured interviews with leaders and clinicians from physician practices that adopted behavioral health integration, supplemented by contextual interviews with experts and vendors in behavioral health integration. Setting: 30 physician practices, sampled for diversity on specialty, size, affiliation with parent organizations, geographic location, and behavioral health integration model (collaborative or co-located). Participants: 47 physician practice leaders and clinicians, 20 experts, and 5 vendors. Measurements: Qualitative analysis (cyclical coding) of interview transcripts. Results: Four overarching factors affecting physician practices' implementation of behavioral health integration were identified. First, practices' motivations for integrating behavioral health care included expanding access to behavioral health services, improving other clinicians' abilities to respond to patients' behavioral health needs, and enhancing practice reputation. Second, practices tailored their implementation of behavioral health integration to local resources, financial incentives, and patient populations. Third, barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians and billing difficulties. Fourth, practices described the advantages and disadvantages of both fee-for-service and alternative payment models, and few reported positive financial returns. Limitation: The practice sample was not nationally representative and excluded practices that did not implement or sustain behavioral health integration, potentially limiting generalizability. Conclusion: Practices currently using behavioral health integration face cultural, informational, and financial barriers to implementing and sustaining behavioral health integration. Tailored, context-specific technical support to guide practices' implementation and payment models that improve the business case for practices may enhance the dissemination and long-term sustainability of behavioral health integration. Primary Funding Source: American Medical Association and The Commonwealth Fund.

Electronic Health Record Time Among Outpatient Physicians: Reflections on the Who, What, and Why

Health Is More Than Health Care

Annals Clinical Decision Making: Avoiding Cognitive Errors in Clinical Decision Making

Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence: A Prospective Cohort Study: Annals of Internal Medicine: Vol 172, No 11

Background: Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown. Objective: To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA). Design: Prospective cohort study comparing stroke or TIA recurrence in patients with and without residual shunt after PFO closure. Setting: Single hospital center. Participants: 1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic stroke who were undergoing percutaneous PFO closure were followed for up to 11 years. Measurements: Residual shunt was evaluated by transthoracic echocardiography with saline contrast. Primary outcome was a composite of the first recurrent ischemic stroke or TIA after PFO closure. Results: Compared with complete closure, the presence of residual shunt after PFO closure was associated with an increased incidence of recurrent stroke or TIA: 2.32 versus 0.75 events per 100 patient-years (hazard ratio [HR], 3.05 [95% CI, 1.65 to 5.62]; P < 0.001). This result remained robust after adjustment for important covariates, namely age; study period; device; presence of atrial septal aneurysm, hypertension, hyperlipidemia, diabetes, hypercoagulability, or hypermobile septum; and medication use (HR, 3.01 [CI, 1.59 to 5.69]; P < 0.001). Further stratification based on shunt size revealed that moderate or large residual shunts were associated with a higher risk for stroke or TIA recurrence (HR, 4.50 [CI, 2.20 to 9.20]; P < 0.001); the result for small residual shunts was indeterminate (HR, 2.02 [CI, 0.87 to 4.69]; P = 0.102). Limitation: Nonrandomized study with potential unmeasured confounding. Conclusion: Among patients undergoing PFO closure to prevent future stroke, the presence of residual shunt, particularly a moderate or large residual shunt, was associated with an increased risk for stroke or TIA recurrence. Primary Funding Source: National Institutes of Health.

The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines

Description: In September 2019, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients with chronic insomnia disorder and obstructive sleep apnea (OSA). This guideline is intended to give health care teams a framework by which to screen, evaluate, treat, and manage the individual needs and preferences of VA and DoD patients with either of these conditions. Methods: In October 2017, the VA/DoD Evidence-Based Practice Work Group initiated a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature, created three 1-page algorithms, and advanced 41 recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: This synopsis summarizes the key recommendations of the guideline in 3 areas: diagnosis and assessment of OSA and chronic insomnia disorder, treatment and management of OSA, and treatment and management of chronic insomnia disorder. Three clinical practice algorithms are also included.

Recommendations for Lowering Prescription Drug Spending in Public Programs

Effect of Acupuncture for Postprandial Distress Syndrome: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 172, No 12

Background: Postprandial distress syndrome (PDS) is the most common subtype of functional dyspepsia. Acupuncture is commonly used to treat PDS, but its effect is uncertain because of the poor quality of prior studies. Objective: To assess the efficacy of acupuncture versus sham acupuncture in patients with PDS. Design: Multicenter, 2-group, randomized clinical trial. (ISRCTN registry number: ISRCTN12511434) Setting: 5 tertiary hospitals in China. Participants: Chinese patients aged 18 to 65 years meeting Rome IV criteria for PDS. Intervention: 12 sessions of acupuncture or sham acupuncture over 4 weeks. Measurements: The 2 primary outcomes were the response rate based on overall treatment effect and the elimination rate of all 3 cardinal symptoms: postprandial fullness, upper abdominal bloating, and early satiation after 4 weeks of treatment. Participants were followed until week 16. Results: Among the 278 randomly assigned participants, 228 (82%) completed outcome measurements at week 16. The estimated response rate from generalized linear mixed models at week 4 was 83.0% in the acupuncture group versus 51.6% in the sham acupuncture group (difference, 31.4 percentage points [95% CI, 20.3 to 42.5 percentage points]; P < 0.001). The estimated elimination rate of all 3 cardinal symptoms was 27.8% in the acupuncture group versus 17.3% in the sham acupuncture group (difference, 10.5 percentage points [CI, 0.08 to 20.9 percentage points]; P = 0.034). The efficacy of acupuncture was maintained during the 12-week posttreatment follow-up. There were no serious adverse events. Limitation: Lack of objective outcomes and daily measurement, high dropout rate, and inability to blind acupuncturists. Conclusion: Among patients with PDS, acupuncture resulted in increased response rate and elimination rate of all 3 cardinal symptoms compared with sham acupuncture, with sustained efficacy over 12 weeks in patients who received thrice-weekly acupuncture for 4 weeks. Primary Funding Source: Beijing Municipal Science and Technology Commission.

Deciphering the Relationship Between Health Care Provider Burnout and Quality of Care