Older adults spend 3 weeks each year receiving health care outside of the home

Embargoed for release until 5:00 p.m. ET on Monday 22 January 2024  
Annals of Internal Medicine Tip Sheet   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.  
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1. Older adults spend 3 weeks each year receiving health care outside of the home

“Health care contact days” offer new patient-centered metric for evaluating care

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2331

Editorial: https://www.acpjournals.org/doi/10.7326/M23-3453

URL goes live when the embargo lifts  

A cross-sectional study of more than 6,500 adults aged 65 years and older found that, on average, older adults spent 3 weeks each year getting health care outside the home. In this nationally representative group, 11% of older adults spent 50 or more days each year receiving health care services. These days spent obtaining health care outside the home, or health care contact days, are a new patient-centered metric for evaluating care for older adults. The study is published in Annals of Internal Medicine.

Days spent obtaining health care outside the home can represent not only access to needed care but also substantial time, effort, and cost, especially for older adults and their care partners. These tradeoffs, along with known practice variation in health care, suggest that there may be both need and opportunity to optimize contact days for patients and their families. This study suggests some targets for improving how we use these contact days. For example, it finds that half of the days spent getting a test are NOT on the same day as a doctor’s visit, so doctors can do a better job coordinating tests with visits. It also finds that office visits, tests, and procedures are less likely to be on Fridays compared to other weekdays, even if that may be more convenient for patients.

Researchers from Brigham and Women’s Hospital and Harvard Medical School studied Medicare Current Beneficiary Survey data for 6,619 adults aged 65 years and older to assess composition of, variation and patterns in, and factors associated with contact days. They found that, on average, older adults spent 20.7 days in the year getting health care outside of the home, of which 17.3 days were for ambulatory services like office visits, tests, and procedures. The authors note that  factors associated with more contact days included younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and certain care-seeking behaviors (for example, patients who said they go to the doctor as soon as they start to feel bad). According to the authors, these results show factors beyond clinical need that may drive overuse and underuse of contact days and opportunities to optimize this person-centered measure to reduce patient burdens.

The authors of an accompanying editorial from Weill Cornell Medicine and Beth Israel Deaconess Medical Center say this study provides important and salient insights on the extent to which patients interact with different components of the health care system, but patient preference related to contact days may vary significantly from patient to patient. They say the findings cannot provide insight into whether contact days for individual patients are clinically necessary. They advise that research is needed, including qualitative research with patients and relevant stakeholders, to paint a more comprehensive picture of the circumstances surrounding health care contact days and what they mean for patient care.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Ishani Ganguli, MD, MPH, please contact Haley Bridger at hbridger@mgb.org.

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2. Analysis suggests gene therapy beneficial and likely cost-effective with less than $2mill price tag for patients with sickle cell disease

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1520        

URL goes live when the embargo lifts   

A modeling study comparing the cost-effectiveness of gene therapy versus common care for patients with sickle cell disease found that gene therapy is beneficial in this patient population and likely cost-effective if the price stays below $2 million per person. The findings are published in Annals of Internal Medicine.

Researchers from the University of Washington and the Fred Hutchinson Cancer Research Center applied two independently developed simulation models to Centers for Medicare & Medicaid Services (CMS) claims data from 2008 to 2016 and published literature to evaluate the cost-effectiveness of gene therapy for SCD and its value-based prices. The University of Washington Model for Economic Analysis of Sickle Cell Cure (UW-MEASURE) and the Fred Hutchinson Institute Sickle Cell Disease Outcomes Research and Economics Model (FH-HISCORE) simulated the progression of SCD under real-world–based care methods to estimate costs and outcomes over a lifetime from both the health care sector and societal perspectives with and without gene therapy. The models assumed a $2 million price for gene therapy.

From the healthcare sector perspective, the UW-MEASURE estimated an incremental cost-effectiveness ratio (ICER) of $193,000 per quality-adjusted life year (QALY) and the FH-HISCORE estimated an ICER of $427,000 per QALY. Under the societal perspective, UW-MEASURE estimated an ICER of $126,000 per QALY and FHHISCORE estimated an ICER of $281,000 per QALY. The authors note that both models projected fewer pain crisis events with gene therapy over a lifetime, which can offset the high upfront administration costs of gene therapy, greatly improve patients' prospects for long-term employment, decrease or possibly eliminate caregiver burden, and substantially improve recipients' life expectancy and recipients’ and caregivers' quality of life. They recommend that future work comparing the clinical and economic effects of gene therapy versus stem cell transplantation will assist decision-makers in guiding patients to the most appropriate and cost-effective therapy.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Anirban Basu, PhD, please contact basua@uw.edu.

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3. Trend report shows that more than half of mental health care visits conducted via video-based telemedicine

Phone-based telemedicine visits have dropped off following the pandemic, while video-based telemedicine visits remain high, with a 2,300% increase compared with pre-pandemic levels

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2644        

URL goes live when the embargo lifts   

An analysis of clinical outpatient data found that telemedicine rates remain high following the COVID-19 pandemic, with more than half of mental health care visits being conducted remotely via video conferencing.  While rates of telephone-based care have decreased to pre-pandemic levels, video-based visits have maintained a 2,300% increase compared with pre-pandemic levels. A brief research report is published in Annals of Internal Medicine.

The rapid uptake of telemedicine in the early phases of the COVID-19 pandemic is well documented, yet there is little published literature on the redistribution of in-person and telemedicine encounters as U.S. health care systems enter a post-pandemic phase.

Researchers from the Veterans Affairs Health Care System analyzed data from the VA’s Corporate Data Warehouse to describe trends for more than 200,000 patient encounters between January 2019 and August 2023. They found that telephone- and video-based care decreased from a peak of 79 percent of care in April 2020 to 36 percent in April 2023. This decrease was caused by fewer telephone-based encounters. Video-based encounters have continued to make up 11 to 12 percent of all clinical care encounters. As of August 2023, video-based encounters accounted for 34 percent of mental health, 3.7 percent of subspecialty, and 3.5 percent of primary care encounters, and telephone encounters accounted for 20.3 percent, 34.8 percent, and 16.7 percent, respectively. According to the authors, these trends may obscure disparities in access to and use of telemedicine that disproportionately affect older adults, individuals in rural regions, and patients from historically marginalized groups. They advise that future research should consider evaluating quality, safety, and health outcomes of telemedicine in this new equilibrium.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Jacqueline M. Ferguson, PhD, please email Jacqueline.Ferguson@va.gov

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Also in this issue:

Talking With Patients About the New Anti-amyloid Alzheimer Disease Medications

Ideas and Opinions

Catherine A. Sarkisian, MD, MSHS; Artem Romanov, BS; and John N. Mafi, MD, MPH

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3377