Search Results for ""
- ACP Online (7495)
- Annals of Internal Medicine (6736)
- IM Matters (4542)
- ACP Hospitalist (2332)
- Annals of Internal Medicine: Clinical Cases (500)
- ACP Store (254)
Displaying 771 - 780 of 7495 in ACP Online
How ACP members can support current disaster recovery and aid efforts in Hawai'i
Hawaiʻi Community Foundation and Maui United Way are accepting online monetary donations to benefit Maui residents affected by fires. The Hawaiʻi Community Foundation started a Maui Strong Fund to support residents affected by the wildfires, which firefighting crews continue to battle in Lahaina, Pulehu/Kīhei and Upcountry areas. Donations can be made at www.hawaiicommunityfoundation.org/maui-strong.
How ACP members can support current disaster recovery and aid efforts
The earthquakes in Turkey and Syria are being described as the worst in that area in a century. ACP members who wish to provide support in the recovery efforts can help via these organizations. - The U.S. non-profit Bridge to Turkiye has a history of supporting cultural and educational initiatives in Turkey, and is working on providing food and water through the Turkish aid organization, Ahbap Association
Follow ACP | Blogs, Social Media, RSS
Stay up to date on the latest from the American College of Physicians and Annals of Internal Medicine by following our various media accounts. Social Media American College of Physicians
ACP 2025: The Works Package
Meet your end-of-year CME/ MOC requirements with the new ACP product, The Works! Gain immediate access to 160+ hours of video lectures & more. See details & pricing.
PPE Materials Available to ACP Members
Log in to see the special members-only offers below.
MKSAP 19 Tracker
Targeted Learning Assessment and Remediation
MKSAP 19 - Help
Questions answered for MKSAP 19, including log-in details and how to get started.
MKSAP 19 - Errata and Revisions
Review the MKSAP 19 errata and revisions.
Displaying 771 - 780 of 6736 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
- Visit annals.org to search all content back to 1927.
- View Annals of Internal Medicine CME by topic here.
Distributional Cost-Effectiveness of Equity-Enhancing Gene Therapy in Sickle Cell Disease in the United States
Background: Gene therapy is a potential cure for sickle cell disease (SCD). Conventional cost-effectiveness analysis (CEA) does not capture the effects of treatments on disparities in SCD, but distributional CEA (DCEA) uses equity weights to incorporate these considerations. Objective: To compare gene therapy versus standard of care (SOC) in patients with SCD by using conventional CEA and DCEA. Design: Markov model. Data Sources: Claims data and other published sources. Target Population: Birth cohort of patients with SCD. Time Horizon: Lifetime. Perspective: U.S. health system. Intervention: Gene therapy at age 12 years versus SOC. Outcome Measures: Incremental cost-effectiveness ratio (ICER) (in dollars per quality-adjusted life-years [QALYs] gained) and threshold inequality aversion parameter (equity weight). Results of Base-Case Analysis: Gene therapy versus SOC for females yielded 25.5 versus 15.7 (males: 24.4 vs. 15.5) discounted lifetime QALYs at costs of $2.8 million and $1.0 million (males: $2.8 million and $1.2 million), respectively, with an ICER of $176 000 per QALY (full SCD population). The inequality aversion parameter would need to be 0.90 for the full SCD population for gene therapy to be preferred per DCEA standards. Results of Sensitivity Analysis: SOC was favored in 100.0% (females) and 87.1% (males) of 10 000 probabilistic iterations at a willingness-to-pay threshold of $100 000 per QALY. Gene therapy would need to cost less than $1.79 million to meet conventional CEA standards. Limitation: Benchmark equity weights (as opposed to SCD-specific weights) were used to interpret DCEA results. Conclusion: Gene therapy is cost-ineffective per conventional CEA standards but can be an equitable therapeutic strategy for persons living with SCD in the United States per DCEA standards. Primary Funding Source: Yale Bernard G. Forget Scholars Program and Bunker Endowment.
Risk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Retrospective Cohort Study: Annals of Internal Medicine: Vol 176, No 6
Background: Amiodarone, the most effective antiarrhythmic drug in atrial fibrillation, inhibits apixaban and rivaroxaban elimination, thus possibly increasing anticoagulant-related risk for bleeding. Objective: For patients receiving apixaban or rivaroxaban, to compare risk for bleeding-related hospitalizations during treatment with amiodarone versus flecainide or sotalol, antiarrhythmic drugs that do not inhibit these anticoagulants’ elimination. Design: Retrospective cohort study. Setting: U.S. Medicare beneficiaries aged 65 years or older. Patients: Patients with atrial fibrillation began anticoagulant use between 1 January 2012 and 30 November 2018 and subsequently initiated treatment with study antiarrhythmic drugs. Measurements: Time to event for bleeding-related hospitalizations (primary outcome) and ischemic stroke, systemic embolism, and death with or without recent (past 30 days) evidence of bleeding (secondary outcomes), adjusted with propensity score overlap weighting. Results: There were 91 590 patients (mean age, 76.3 years; 52.5% female) initiating use of study anticoagulants and antiarrhythmic drugs, 54 977 with amiodarone and 36 613 with flecainide or sotalol. Risk for bleeding-related hospitalizations increased with amiodarone use (rate difference [RD], 17.5 events [95% CI, 12.0 to 23.0 events] per 1000 person-years; hazard ratio [HR], 1.44 [CI, 1.27 to 1.63]). Incidence of ischemic stroke or systemic embolism did not increase (RD, −2.1 events [CI, −4.7 to 0.4 events] per 1000 person-years; HR, 0.80 [CI, 0.62 to 1.03]). The risk for death with recent evidence of bleeding (RD, 9.1 events [CI, 5.8 to 12.3 events] per 1000 person-years; HR, 1.66 [CI, 1.35 to 2.03]) was greater than that for other deaths (RD, 5.6 events [CI, 0.5 to 10.6 events] per 1000 person-years; HR, 1.15 [CI, 1.00 to 1.31]) (HR comparison: P = 0.003). The increased incidence of bleeding-related hospitalizations for rivaroxaban (RD, 28.0 events [CI, 18.4 to 37.6 events] per 1000 person-years) was greater than that for apixaban (RD, 9.1 events [CI, 2.8 to 15.3 events] per 1000 person-years) (P = 0.001). Limitation: Possible residual confounding. Conclusion: In this retrospective cohort study, patients aged 65 years or older with atrial fibrillation treated with amiodarone during apixaban or rivaroxaban use had greater risk for bleeding-related hospitalizations than those treated with flecainide or sotalol. Primary Funding Source: National Heart, Lung, and Blood Institute.
Prioritizing Quality Measures in Acute Stroke Care: A Cost-Effectiveness Analysis: Annals of Internal Medicine: Vol 176, No 5
Background: The American Heart Association and American Stroke Association (AHA/ASA) endorsed 15 process measures for acute ischemic stroke (AIS) to improve the quality of care. Identifying the highest-value measures could reduce the administrative burden of quality measure adoption while retaining much of the value of quality improvement. Objective: To prioritize AHA/ASA-endorsed quality measures for AIS on the basis of health impact and cost-effectiveness. Design: Individual-based stroke simulation model. Data Sources: Published literature. Target Population: U.S. patients with incident AIS. Time Horizon: Lifetime. Perspective: Health care sector. Intervention: Current versus complete (100%) implementation at the population level of quality measures endorsed by the AHA/ASA with sufficient clinical evidence (10 of 15). Outcome Measures: Life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and incremental net health benefits. Results of Base-Case Analysis: Discounted life-years gained from complete implementation would range from 472 (tobacco use counseling) to 34 688 (early carotid imaging) for an annual AIS patient cohort. All AIS quality measures were cost-saving or highly cost-effective by AHA standards (<$50 000 per QALY for high-value care). Early carotid imaging and intravenous tissue plasminogen activator contributed the largest fraction of the total potential value of quality improvement (measured as incremental net health benefit), accounting for 72% of the total value. The top 5 quality measures accounted for 92% of the total potential value. Results of Sensitivity Analysis: A web-based user interface allows for context-specific sensitivity and scenario analyses. Limitation: Correlations between quality measures were not incorporated. Conclusion: Substantial variation exists in the potential net benefit of quality improvement across AIS quality measures. Benefits were highly concentrated among 5 of 10 measures assessed. Our results can help providers and payers set priorities for quality improvement efforts and value-based payments in AIS care. Primary Funding Source: National Institute of Neurological Disorders and Stroke.
Effect of Medicare Advantage on Hospital Readmission and Mortality Rankings
Background: Medicare links hospital performance on readmissions and mortality to payment solely on the basis of outcomes among fee-for-service (FFS) beneficiaries. Whether including Medicare Advantage (MA) beneficiaries, who account for nearly half of all Medicare beneficiaries, in the evaluation of hospital performance affects rankings is unknown. Objective: To determine if the inclusion of MA beneficiaries in readmission and mortality measures reclassifies hospital performance rankings compared with current measures. Design: Cross-sectional. Setting: Population-based. Participants: Hospitals participating in the Hospital Readmissions Reduction Program or Hospital Value-Based Purchasing Program. Measurements: Using the 100% Medicare files for FFS and MA claims, the authors calculated 30-day risk-adjusted readmissions and mortality for acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia on the basis of only FFS beneficiaries and then both FFS and MA beneficiaries. Hospitals were divided into quintiles of performance based on FFS beneficiaries only, and the proportion of hospitals that were reclassified to a different performance group with the inclusion of MA beneficiaries was calculated. Results: Of the hospitals in the top-performing quintile for readmissions and mortality based on FFS beneficiaries, between 21.6% and 30.2% were reclassified to a lower-performing quintile with the inclusion of MA beneficiaries. Similar proportions of hospitals were reclassified from the bottom performance quintile to a higher one across all measures and conditions. Hospitals with a higher proportion of MA beneficiaries were more likely to improve in performance rankings. Limitation: Hospital performance measurement and risk adjustment differed slightly from those used by Medicare. Conclusion: Approximately 1 in 4 top-performing hospitals is reclassified to a lower performance group when MA beneficiaries are included in the evaluation of hospital readmissions and mortality. These findings suggest that Medicare's current value-based programs provide an incomplete picture of hospital performance. Primary Funding Source: Laura and John Arnold Foundation.