Healthcare Resources for Refugees, Asylees, and Non-Detained Asylum Seekers Living in the US

Physicians and their teams play an essential role in caring for asylum seekers, refugees, undocumented immigrants, and migrants. Clinicians may use this toolkit to better understand the background, healthcare coverage options and health considerations for this patient population.

Patient and Interprofessional Education

ACP’s Patient and Interprofessional Partnership Committee works to promote high quality education for all members of the healthcare team. Learn more.

Independent Practice Resources

ACP helps medical practices with the business side of medicine. Learn about our medical practice management resources here.

Tech Tips and Support for Peer Coaching Programs

General Requirements The program is delivered via an online platform. You will log into the platform using your first and last name and the email address you used when registering (your ACP account email—see https://www.acponline.org/myacp to check if you aren’t sure which email address is your primary on your ACP account).

Physician Coaching & Training Program | Peer Coaching

Train in evidence-based coaching techniques through ACP’s peer coaching program to support colleagues, boost well-being, and earn CME credit.

What to Expect from Coaching

What can you expect from your coaching session? Your coach will help you define the area of focus for your session, explore what success looks like within that area, and identify the potential ways to move forward. You will be provided with a safe space where you will be listened to and have time to organize your thoughts. Your coach will offer reflections and ask questions to help you find the answers.

Group Coaching Sessions

ACP has designed a series of 1-hr group coaching sessions to support your career and professional development. During each session, you and up to 5 of your peers will work with an ACP Physician Peer coach on the following topics. Overcoming Career Obstacles as an Early Career PhysicianMonday, May 11, 2026, 12:00-1:00pm EST Transform obstacles into opportunities. Identify the changes you need to make and the actions to take that will help you achieve your desired goals.

Group Coaching Resources for Early Career Physicians

Work with an ACP Physician Peer coach and up to 5 fellow early career physicians in this series of 1-hr group coaching sessions. Participate in one or attend multiple sessions to gain insights in key areas designed to help support your career and professional development. Overcoming Career Obstacles as an Early Career Physician Monday, May 11, 2026, 12:00-1:00pm EST Transform obstacles into opportunities. Identify the changes you need to make and the actions to take that will help you achieve your desired goals.

Get to Know Your ACP Physician Peer Coaches

Bisi Alli, DO, MS, DipABLM, FACP, FAMWAWellNEST Medicine LLCPhoenix, AZAll settingsEarly-Mid-CareerLinkedIn Link

Meet Your Lead Coach: Kerri Palamara, MD, MACP

Kerri Palamara, MD, MACP — LOCATION — Boston, MA (Massachusetts General Hospital) — PRACTICE TYPE — Outpatient — CAREER LEVEL — Mid-career

Comparative Performance of Common Fecal Immunochemical Tests: A Cross-Sectional Study: Annals of Internal Medicine: Vol 177, No 10

Background: Despite widespread use of fecal immunochemical tests (FITs) for colorectal cancer (CRC) screening, data to guide test selection are limited. Objective: To compare the performance characteristics of 5 commonly used FITs, using colonoscopy as the reference standard. Design: Cross-sectional study. (ClinicalTrials.gov: NCT03264898) Setting: Three U.S. academic medical centers and affiliated endoscopy units. Participants: Patients aged 50 to 85 years undergoing screening or surveillance colonoscopy. Intervention: Participants completed 5 different FITs before their colonoscopy, including 4 qualitative tests (Hemoccult ICT, Hemosure iFOB, OC-Light S FIT, QuickVue iFOB) and 1 quantitative test (OC-Auto FIT, which was run at the manufacturer's threshold for positivity of >100 ng/mL). Measurements: The primary outcome was test performance (sensitivity and specificity) for each of the 5 FITs for advanced colorectal neoplasia (ACN), defined as advanced polyps or CRC. Positivity rates, positive and negative predictive values, and rates of unevaluable tests were compared. Multivariable models were used to identify factors affecting sensitivity. Results: A total of 3761 participants were enrolled, with a mean age of 62.1 years (SD, 7.8); 63.2% of participants were female, 5.7% were Black, 86.4% were White, and 28.7% were Hispanic. There were 320 participants with ACN (8.5%), including 9 with CRC (0.2%). The test positivity rate varied 4-fold (3.9% to 16.4%) across FITs. Rates of unevaluable FITs ranged from 0.2% to 2.5%. The sensitivity for ACN varied from 10.1% to 36.7%, and specificity varied from 85.5% to 96.6%. Differences in sensitivity between FITs were all statistically significantly different except between Hemosure iFOB and QuickVue iFOB, and specificity differences were all statistically significantly different from one another. In addition to FIT brand, distal location of ACN was also associated with higher FIT sensitivity. Limitation: The study did not assess the programmatic sensitivity of annual FIT. Conclusion: Although considered a single class, FITs have varying test performance for detecting ACN and should not be considered interchangeable. Primary Funding Source: National Institutes of Health.

A Tale of Three Hospitals

To My Doctor on the Day of My Death

Annals Video Summary - Computer-Aided Diagnosis for Leaving Colorectal Polyps In Situ

Association Between the SaFETy Score and Self-reported Firearm Violence Among Young Adults Presenting to Emergency Departments in Three Cities: A Cross-Sectional Study

Effectiveness of Integrating Suicide Care in Primary Care: Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial: Annals of Internal Medicine: Vol 177, No 11

Background: Primary care encounters are common among patients at risk for suicide. Objective: To evaluate the effectiveness of implementing population-based suicide care (SC) in primary care for suicide attempt prevention. Design: Secondary analysis of a stepped-wedge, cluster randomized implementation trial. (ClinicalTrials.gov: NCT02675777) Setting: 19 primary care practices within a large health care system in Washington State, randomly assigned launch dates. Patients: Adult patients (aged ≥18 years) with primary care visits from January 2015 to July 2018. Intervention: Practice facilitators, electronic medical record (EMR) clinical decision support, and performance monitoring supported implementation of depression screening, suicide risk assessment, and safety planning. Measurements: Clinical practice and patient measures relied on EMR and insurance claims data to compare usual care (UC) and SC periods. Primary outcomes included documented safety planning after population-based screening and suicide risk assessment and suicide attempts or deaths (with self-harm intent) within 90 days of a visit. Mixed-effects logistic models regressed binary outcome indicators on UC versus SC, adjusted for randomization stratification and calendar time, accounting for repeated outcomes from the same site. Monthly outcome rates (percentage per 10 000 patients) were estimated by applying marginal standardization. Results: During UC, 255 789 patients made 953 402 primary care visits and 228 255 patients made 615 511 visits during the SC period. The rate of safety planning was higher in the SC group than in the UC group (38.3 vs. 32.8 per 10 000 patients; rate difference, 5.5 [95% CI, 2.3 to 8.7]). Suicide attempts within 90 days were lower in the SC group than in the UC group (4.5 vs. 6.0 per 10 000 patients; rate difference, −1.5 [CI, −2.6 to −0.4]). Limitation: Suicide care was implemented in combination with care for depression and substance use. Conclusion: Implementation of population-based SC concurrent with a substance use program resulted in a 25% reduction in the suicide attempt rate in the 90 days after primary care visits. Primary Funding Source: National Institute of Mental Health.

Shifting Trends in the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptions: A Nationwide Analysis

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The Effect of Denosumab on Risk for Emergently Treated Hypocalcemia by Stage of Chronic Kidney Disease: A Target Trial Emulation: Annals of Internal Medicine: Vol 178, No 1

Background: There is a paucity of data on treatment of osteoporosis in patients with advanced chronic kidney disease (CKD). Objective: To assess the risk for emergently treated hypocalcemia with denosumab by stage of CKD and presence of CKD–mineral and bone disorder (CKD-MBD). Design: Target trial emulation. Setting: Medicare fee-for-service data with prescription drug coverage, 2012 to 2020. Participants: Female patients aged 65 years or older initiating denosumab, oral bisphosphonates, or intravenous (IV) bisphosphonates for osteoporosis. Measurements: Hospital and emergency department admissions (that is, emergent care) for hypocalcemia were assessed in the first 12 treatment weeks. Inverse probability of treatment weighted cumulative incidence and weighted risk differences (RDs) were calculated. Results: A total of 361 453 patients treated with denosumab, 829 044 treated with oral bisphosphonates, and 160 413 treated with IV bisphosphonates were identified. Risk for emergently treated hypocalcemia with denosumab versus oral bisphosphonates increased with worsening CKD stage (P < 0.001), with greatest risk among dialysis-dependent (DD) patients (3.01% vs. 0.00%; RD, 3.01% [95% CI, 2.27% to 3.77%]) and non–dialysis-dependent (NDD) patients with CKD stages 4 and 5 (0.57% vs. 0.03%; RD, 0.54% [CI, 0.41% to 0.68%]). Among patients with stages 4 and 5 CKD (NDD + DD), denosumab had a greater risk for emergently treated hypocalcemia versus oral bisphosphonates in those with CKD-MBD (1.53% vs. 0.02%; RD, 1.51% [CI, 1.21% to 1.78%]) than in those without CKD-MBD (0.22% vs. 0.03%; RD, 0.19% [CI, 0.08% to 0.31%]). Denosumab also showed increased risk compared with IV bisphosphonates. Limitation: Generalizability to men and non-Medicare populations. Conclusion: Risk for emergently treated hypocalcemia with denosumab increased with worsening CKD stage and was highest in DD patients and those with CKD-MBD. Primary Funding Source: U.S. Food and Drug Administration.

Epidemiology of Homebound Population Among Beneficiaries of a Large National Medicare Advantage Plan

Background: Interest in home-based care is increasing among Medicare Advantage (MA) plans. The epidemiology of homebound MA beneficiaries is unknown. Objective: To determine the prevalence, characteristics, predictors, health service use, and mortality outcomes of homebound beneficiaries of a large national MA plan. Design: Cross-sectional. Setting: National MA plan. Participants: Humana MA beneficiaries in 2022 (n = 2 435 519). Measurements: Homebound status was assessed via in-home assessment using previously defined categories: homebound (never or rarely left home in the past month), semihomebound (left home with assistance, had difficulty, or needed help leaving home), and not homebound. Demographic, clinical, health service use, and mortality outcomes were compared by homebound status. Results: In 2022, the overall prevalence of homebound beneficiaries was 22.0% (8.4% of beneficiaries were homebound, and 13.6% were semihomebound). In adjusted models, female sex (odds ratio [OR], 1.36 [95% CI, 1.35 to 1.37), low-income status or dual eligibility for Medicare and Medicaid (OR, 1.56 [CI, 1.55 to 1.57]), dementia (OR, 2.36 [CI, 2.33 to 2.39]), and moderate to severe frailty (OR, 4.32 [CI, 4.19 to 4.45]) were predictive of homebound status. In multivariable logistic regression, homebound status was associated with increased odds of any emergency department visit (OR, 1.14 [ CI, 1.14 to 1.15]), any inpatient hospital admission (OR, 1.44 [CI, 1.42 to 1.46]), any skilled-nursing facility admission (OR, 2.18 [CI, 2.13 to 2.23]), and death (OR, 2.55 [CI, 2.52 to 2.58]). Limitation: The study period overlapped the tail end of the COVID-19 pandemic, and data were derived from a single national MA plan, which limits generalizability. Conclusion: Overall homebound prevalence in a national MA plan was 22.0% and was independently associated with increased health service use and mortality. Study findings can inform strategic initiatives to identify and manage care for homebound beneficiaries. Primary Funding Source: Humana, under a collaborative research agreement with Johns Hopkins University.

MKSAP Quiz: Slow, labored gait in a patient with MS

Urinary metal levels associated with risk for cardiovascular disease

Oral drugs for acute migraines compared head to head

And the winner is …

Update your registration on National Voter Registration Day

ACP recognizes National Physician Suicide Awareness Day on Sept. 17

Poststroke patients with cognitive impairment at increased risk for recurrent stroke, death

MKSAP Quiz: Follow-up visit for hypertension

Model including hepatitis B viral load accurately predicts HCC risk in untreated patients

Atrial fibrillation rates rose even more than predicted

Pleural effusion may be indicator of mortality risk in certain conditions | ACP Hospitalist

On the threshold | ACP Hospitalist

Hammer and nails | ACP Hospitalist

Early stroke complications associated with poor outcomes after discharge | ACP Hospitalist

U.S. has higher CV hospitalization rate of older adults than Denmark | ACP Hospitalist

Thrombectomy fails to provide benefit in stroke with medium, distal occlusions | ACP Hospitalist

Take a quiz about the Feb. 5 issue! | ACP Hospitalist

Nonopioid approved for moderate to severe pain | ACP Hospitalist

Hospitalists lack knowledge about handling dysphagia in dementia, survey finds | ACP Hospitalist

Genotyping may help predict afib risk after stroke | ACP Hospitalist

Uncommon Presentation of Autoimmune Pancreatitis With Refractory Ulcerative Colitis | Annals of Internal Medicine: Clinical Cases

Patients diagnosed with autoimmune pancreatitis (AIP) are at significantly higher risk for ulcerative colitis (UC), and the concurrent diagnoses continue to be a challenge to recognize. A previously healthy symptomatic 23-year-old man was diagnosed with type II AIP with UC and, despite aggressive treatment with steroids and infliximab, ultimately had a total colectomy. This patient case illustrates the association between AIP and UC and proposes that a concomitant diagnosis suggests a worse prognosis. Determining the relationship between these 2 pathologies and early diagnosis will allow physicians to escalate therapy more quickly and improve outcomes in patients.

Severe Retiform Purpura Associated With COVID-19 Infection | Annals of Internal Medicine: Clinical Cases

A healthy, unvaccinated 44-year-old woman developed a severe, diffusely spread, and intensely painful purpuric rash following mild COVID-19 infection. A punch skin biopsy revealed small vessel inflammation and intravascular thrombi consistent with thrombotic leukocytoclastic vasculitis. She was successfully managed with therapeutic anticoagulation, high-dose steroids, intravenous immunoglobulin, and aggressive analgesia. This case highlights an atypical and severe presentation of an uncommon cutaneous manifestation of COVID-19 that has been linked with significant morbidity and mortality.

Intercostal Retraction With Pleural Effusion | Annals of Internal Medicine: Clinical Cases

An 80-year-old man presented to our hospital with a cough for 2 weeks and a 2-day history of fever. On physical examination, a localized intercostal retraction was observed in his right lower thorax. The most intriguing point in this case is that when a localized intercostal retraction on inspiration is found, clinicians should consider pleural effusion.

Ophthalmoplegia and Tumor Lysis Syndrome: An Uncommon Presentation of Posttransplant Lymphoproliferative Disorder | Annals of Internal Medicine: Clinical Cases

A 55-year-old man presented with 1 month of fatigue, nausea, vomiting, and weight loss, and blurry vision in his left eye. He has a history of type 1 diabetes mellitus after allogenic kidney and pancreas transplantation 15 years prior. He was found to have tumor lysis syndrome (TLS), total left-sided ophthalmoplegia and ptosis, and left cavernous, abdomen, and pelvic masses. Biopsy revealed an Epstein-Barr virus–negative diffuse large B-cell lymphoma, a type of posttransplant lymphoproliferative disorder (PTLD). It is essential to consider PTLD in transplant patients who present with TLS and compressive neurologic deficits.

Cushing Syndrome Secondary to Ectopic ACTH Production in Pregnancy: A Case Report | Annals of Internal Medicine: Clinical Cases

Ectopic adrenocorticotropic hormone production is an extremely rare cause of Cushing syndrome in pregnancy and is associated with significant morbidity. A 37-year-old multiparous woman at 32 weeks’ gestation presented with hypertension, anasarca, hypokalemia, and fetal distress requiring an urgent cesarean section. Her adrenocorticotropic hormone and cortisol levels were elevated, and high-dose dexamethasone failed to suppress them, suggesting ectopic adrenocorticotropic hormone production. Multimodality imaging did not identify a source, and she had urgent bilateral adrenalectomy for refractory severe hypercortisolism. Ectopic Cushing syndrome in pregnancy requires a high index of suspicion for diagnostic testing and prompt treatment to minimize maternal and fetal complications.

Spontaneous Hemopericardium: A Lesson on Risk-Benefit Profile of Contemporary Oral Anticoagulant Therapy Prompted by an Uncommon Occurrence | Annals of Internal Medicine: Clinical Cases

Anticoagulation therapy is of paramount importance in atrial fibrillation (AF) because of the substantial risk for stroke associated with high morbidity and mortality. The current therapeutic options include vitamin K antagonists and novel oral anticoagulant agents. Despite meticulous therapy selection, the risk for bleeding remains with all forms of anticoagulation and has infrequently been reported in the form of hemopericardium. We highlight a patient case of an 84-year-old man with a history of permanent atrial fibrillation on warfarin who presented with shortness of breath and was found to have a massive hemopericardium.

Sarcomatoid Carcinoma of the Colon in a 46-Year-Old: A Rare Disease With Limited Literature | Annals of Internal Medicine: Clinical Cases

Sarcomatoid carcinoma (SCA) is an extremely aggressive, rare malignancy composed of mixed epithelial and mesenchymal components. Fewer than 10 cases of SCA of primary colonic origin have been reported in the literature. SCA has a poor prognosis. Currently, there is limited consensus regarding treatment recommendations. We review the current literature and present the case of a 46-year-old man with stage 3c sigmoid sarcomatoid carcinoma who presented with 3 months of abdominal distension, weight loss, and abdominal mass. The patient had a sigmoid colectomy with adjuvant chemotherapy and is currently alive at 8 months.

Ivermectin-Clorsulon Overdose in Attempting Coronavirus Disease 2019 Prophylaxis: A Case Report | Annals of Internal Medicine: Clinical Cases

With aims of coronavirus disease 2019 (COVID-19) prophylaxis, a 60-year-old woman ingested a formulation of ivermectin and clorsulon, intended for veterinarian use, that contained 30 times the U.S. Food and Drug Administration–approved dose of ivermectin (5.4 mg/kg). She developed altered mental status requiring intubation. Symptoms were similar to other cases of supratherapeutic ivermectin ingestion. Misinformation propagated about COVID-19 prophylaxis and treatment has led to adverse effects both from misuse of medications and disregard of proven options.

A Case of Multiple Skin Lesions After LipodissolveTM Injection | Annals of Internal Medicine: Clinical Cases

Mycobacterium abscessus (M. abscessus) is a rapidly growing nontuberculous mycobacterium commonly found in soil and water. It can cause localized infection when inoculated during surgical or cosmetic procedures. We describe a case of a patient who developed multiple skin nodules resulting from injection of LipodissolveTM for cosmetic purposes. We highlight the following points: M. abscessus can have inducible resistance to macrolides and may require novel agents for treatment; outbreaks can occur when injectables contaminated with M. abscessus are inoculated into the skin; and local health departments and the U.S. Food and Drug Administration should be contacted for outbreak investigation.

Aplasia Cutis Congenita in the Setting of Maternal Cystic Fibrosis | Annals of Internal Medicine: Clinical Cases

Aplasia cutis congenita is a rare scalp defect. An affected neonate was delivered after in utero exposure beginning in the midtrimester to elexacaftor/tezacaftor/ivacaftor for maternal cystic fibrosis management. Although aplasia cutis congenita has many potential etiologies, maternal cystic fibrosis transmembrane regulator modulator therapy has not been implicated.