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Annals of Internal Medicine Tip Sheet
September 26, 2017

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Age matters when it comes to ranking hospital quality

Including data from younger patients may improve accuracy of hospital mortality rankings


Hospital rankings based exclusively on heart attack mortality data for older patients may not accurately represent hospital quality for all ages. A study lead by Yale researchers found that hospital mortality rates after heart attack differ by age, suggesting a need to include data on younger patients in such assessments. The findings are published in Annals of Internal Medicine.

The Centers for Medicare & Medicaid Services (CMS) uses data for Medicare fee-for-service beneficiaries aged 65 or older to calculate 30-day risk-standardized mortality rates after acute myocardial infarction, or heart attack, to rate hospital quality. It is not known if outcomes for older patients reflect outcomes for all patients, including younger ones.

Using data from the largest U.S. clinical registry of acute myocardial infarction, the researchers calculated mortality rates within 30 days of admission and ranked hospitals based on those rates for older and younger patients hospitalized for a heart attack. The researchers found that half of the hospitalized heart attack patients were under the age of 65, and that mortality rankings differed for older versus younger patient groups. These findings suggest that hospital rankings based solely on data for older patients are not generalizable and may not provide a complete picture of hospital quality.

2. Younger and higher income individuals more likely to use activity trackers


Activity tracker use is on the rise, but varies based on age and income. Interventions designed to encourage use of activity trackers may need to be targeted based on individual sociodemographic characteristics. The findings of a brief research report are published in Annals of Internal Medicine.

Interest in tracking daily health behaviors using wearable devices and smartphones is growing, with many large employers using these technologies in workplace wellness programs. Understanding the characteristics of persons who use these devices could inform interventions designed to encourage adoption.

Researchers studied data for more than 4.4 million Humana subscribers with access to HumanVitality (now Go365), a wellness program offered across the United States, between 2014 and 2015 to describe rates of initial use of activity trackers, sustained use after 6 months, and step counts across different sociodemographic characteristics. The data showed that initial activation, use, and step counts varied across sociodemographic characteristics. Initial activation was low, particularly among older and lower-income persons; however, overall activation rates increased between 2014 and 2015. Sustained use and mean step counts were high among those who initially activated their devices, which could have been due to the program’s use of gamification and incentives.

The study is the first national evaluation of activity tracker use among a large, diverse sample. The findings may help to inform interventions using wearable devices and smartphones.

3. Trump-era immigration policy threatens clinical and biomedical research efforts


Recently proposed changes to U.S. immigration policy threaten the long-standing ability of foreign medical graduates to train and practice in the United States, raising concerns about the impact on clinical and biomedical research. A commentary from Harvard Medical School is published in Annals of Internal Medicine.

Foreign medical graduates make up nearly a quarter of the physician workforce and disproportionately practice in underserved areas as well as in specialties with practitioner shortages. Some states and hospitals rely heavily on physicians in the H-1B visa program, which the Trump administration recently proposed revamping. With these changes in mind, some leading scientific and academic organizations have urged President Trump to rescind the recent executive order.

As support, researchers sought to examine the scientific contributions of foreign medical graduates to U.S. biomedical research. While published research was sparse, researchers were able to mine data from Doximity, a cross-sectional database of all U.S. physicians, and found that foreign medial students play a substantial role in clinical teaching, mentorship, and biomedical research. The data showed that 18.3 percent of U.S. academic physicians and 15.1 percent of full professors were foreign medical graduates. They were responsible for 18 percent of all publications, 18.5 percent of first-authored publications, and led 18.5 percent of clinical trials. These findings suggest that physicians educated abroad but working in the United States play a critical role in promoting and maintaining America’s biomedical competitiveness.

4. World faces potentially catastrophic shortage of yellow fever vaccine


An accelerated, prolonged increase in the global stockpile of yellow fever vaccine is needed to avoid a potentially catastrophic shortage that could occur if the virus ever spreads in Asia. A commentary from a Georgetown University Medical Center professor is published in Annals of Internal Medicine.

In 2016, the World Health Organization (WHO) declared that a single yellow fever vaccination provides lifelong protection from the mosquito-borne illness. However, shortages are already occurring. In 2016, an epidemic in the Democratic Republic of Congo caused a shortage, with about 7.5 million persons using only one-fifth of the normal dose per person, which does not provide life-long protection. In 2017, Brazil had to import vaccine and sharply increase domestic vaccine production to help stop an epidemic. And currently, in the United States, where there is only one yellow fever vaccine licensed by the U.S. Food and Drug Administration, there is a vaccine shortage that began in mid-2017 and will last through mid-2018. If yellow fever epidemics occur before 2019 for the first time anywhere in Asia, where the mosquitoes that transmit the virus are present, then a severe vaccine shortage is likely.

The lead author will discuss this topic at the annual conference of the Infectious Disease Society of America (IDSA, or IDWeek) on October 6th in San Diego.

Also in this issue:

Curing Hepatitis C Virus Infection: Best Practices From the U.S. Department of Veterans Affairs

Pamela S. Belperio, PharmD; Maggie Chartier, PsyD, MPH; David B. Ross, MD, PhD, MBI; Poonam Alaigh, MD; and David Shulkin, MD
Medicine and Public Issues


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