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Source Citation Gorelick PB, Richardson D, Kelly M, et al. Aspirin and ticlopidine for prevention of recurrent stroke in black patients: a randomized trial. JAMA. 2003;289:2947-57. 12799402

Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians

Major depressive disorder (MDD) is a severe mood disorder that affects at least 8.4% of the adult population in the United States. Characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. The illness may progress quickly and have devastating consequences if left untreated. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the criteria for validity, reliability, evidence, and meaningfulness. The American College of Physicians (ACP) embraces performance measurement as a means to externally validate the quality of care of practices, medical groups, and health plans and to drive reimbursement processes. However, a plethora of performance measures that provide low or no value to patient care have inundated physicians, practices, and systems and burdened them with collecting and reporting of data. The ACP’s Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. Out of 8 performance measures, the PMC found only 1 measure (suicide risk assessment) that was valid at all levels of attribution. This paper presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.

Ethical Guidance for Physicians and Health Care Institutions on Grateful Patient Fundraising: A Position Paper From the American College of Physicians

Physician solicitation of charitable contributions from patients—also known among other things as grateful patient fundraising—raises significant ethical concerns. These include pressure on patients to donate and the effects of this on the patient–physician relationship, potential expectations of donor patients for treatment that is not indicated or preferential care, justice and fairness issues, disclosure and use of confidential patient information for nontreatment purposes, and conflicts of interest. The patient–physician relationship and knowledge of the patient’s medical history, clinical status, personal information, and financial circumstances are some of the reasons development and administrative officials might see physicians as strong potential fundraisers. But those are among the reasons grateful patient fundraising is ethically problematic. This American College of Physicians position paper explores these issues and offers guidance.

Impact of Clinical Demands on the Educational Mission in Hospital Medicine at 17 Academic Medical Centers: A Qualitative Analysis: Annals of Internal Medicine: Vol 176, No 11

Background: Clinical growth is outpacing the growth of traditional educational opportunities at academic medical centers (AMCs). Objective: To understand the impact of clinical growth on the educational mission for academic hospitalists. Design: Qualitative study using semistructured interviews that were analyzed using a mixed inductive and deductive method at the semantic level. Setting: Large AMCs across the United States that experienced clinical growth in the past 5 years. Participants: Division heads, section heads, and other hospital medicine (HM) leaders who oversaw and guided academic and clinical efforts of HM programs. Measurements: Themes and subthemes. Results: From September 2021 to January 2022, HM leaders from 17 AMCs participated in the interviews, and 3 key themes emerged. First, AMCs’ disproportionate clinical growth highlighted the tension between clinical and educational missions. This included a mismatch in supply and demand for traditional teaching time, competing priorities, and clinical growth being seen as both an opportunity and a threat. Second, amid the shifting landscape of high clinical demands and evolving educational opportunities, hospitalists still strongly prefer traditional teaching. To address this mismatch, HM groups have had to alter recruitment strategies and create innovative solutions to help build academic careers. Third, participants noted a need to reimagine the role and identity of an academic hospitalist, emphasizing tailored career pathways and educational roles spanning well beyond traditional house staff teaching teams. Limitation: The study focused on large AMCs. Conclusion: Although HM groups have implemented many creative strategies to address clinical growth and keep education front and center, challenges remain, particularly heavy clinical workloads and a continued dilution of traditional teaching opportunities. Primary Funding Source: Society of Hospital Medicine Student Scholar Grant.

Quality Indicators for Osteoporosis in Adults: A Review of Performance Measures by the American College of Physicians

Primary osteoporosis is characterized by decreasing bone mass and density and reduced bone strength that leads to a higher risk for fracture, especially hip and spine fractures. The prevalence of osteoporosis in the United States is estimated at 12.6% for adults older than 50 years. Although it is most frequently diagnosed in White and Asian females, it still affects males and females of all ethnicities. Osteoporosis is considered a major health issue, which has prompted the development and use of several performance measures to assess and improve the effectiveness of screening, diagnosis, and treatment. These performance measures are often used in accountability, public reporting, and/or payment programs. However, the reliability, validity, evidence, attribution, and meaningfulness of performance measures have been questioned. The purpose of this paper is to present a review of current performance measures on osteoporosis and inform physicians, payers, and policymakers in their selection of performance measures for this condition. The Performance Measurement Committee identified 6 osteoporosis performance measures relevant to internal medicine physicians, only 1 of which was found valid at all levels of attribution. This paper also proposes a performance measure concept to address a performance gap for the initial approach to therapy for patients with a new diagnosis of osteoporosis based on the current American College of Physicians guideline.

Performance Measures for Physicians Providing Clinical Care Using Telemedicine: A Position Paper From the American College of Physicians

There has been an exponential growth in the use of telemedicine services to provide clinical care, accelerated by the COVID-19 pandemic. Clinical care delivered via telemedicine has become a major and accepted method of health care delivery for many patients. There is an urgent need to understand quality of care in the telemedicine environment. This American College of Physicians position paper presents 6 recommendations to ensure the appropriate use of performance measures to evaluate quality of clinical care provided in the telemedicine environment.

The American College of Physicians Living Guideline on Depression: A Step Forward, but Gaps Remain

Reproductive Health Policy in the United States: An American College of Physicians Policy Brief

The legal landscape around access to reproductive health care services was substantially altered after the Supreme Court decision in Dobbs v Jackson Women's Health Organization. In the aftermath of the decision, some state governments have begun to impose stringent restrictions and complete bans on the provision of abortion, whereas others have sought to protect and expand access. Some have gone as far as imposing criminal and civil penalties on physicians and other clinicians who provide evidence-based, clinically indicated reproductive health care services and information that is guided by biomedical ethics and provided in the best interest of the patient's health and well-being. In several states, lawmakers have attempted and successfully used new approaches to enforcing and achieving these prohibitions, including prohibitions on crossing state lines to obtain abortion care, prohibitions on the mailing of medication abortion, and the authorization of third-party civil lawsuits. In this policy brief, the American College of Physicians (ACP) updates and expands on its previous public policy positions on abortion from its 2018 policy paper, “Women's Health Policy in the United States,” to reflect this new reality. The College also offers policymakers and payers recommendations to promote equitable access to reproductive health care services and safeguard maternal health. ACP reaffirms its opposition to undue and unnecessary governmental interference in the patient–physician relationship that criminalizes the provision of health care made in the physician's clinical judgment and based on clinical evidence and the standard of care.

Health Care During Incarceration: A Policy Position Paper From the American College of Physicians

The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.

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