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.
1. In-hospital mortality low in pregnant patients with COVID-19
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New research based on an analysis of data from a large U.S. health care database suggests that in-hospital mortality is low in pregnant women with COVID-19. The retrospective cohort study is published in Annals of Internal Medicine.
Previous reports suggested an increased risk for death in pregnant women with COVID-19 compared to nonpregnant women of reproductive age. However, these studies may have been limited by factors such as registries with a significant proportion of missing data and biased case ascertainment.
Researchers from the University of Maryland School of Medicine and The University of Texas Health Science Center at Houston studied data from the Premier Healthcare Database, an all-payer data repository that captures 20% of U.S. hospitalizations, to evaluate the risk for in-hospital death among pregnant and nonpregnant patients of reproductive age hospitalized with COVID-19. The cohort consisted of 1,062 pregnant and 9,815 nonpregnant patients aged 15 to 45 hospitalized with COVID-19 and viral pneumonia from April to November 2020. The data showed that in-hospital death occurred in 0.8% of pregnant patients and 3.5% of nonpregnant patients. Among the subgroup of patients admitted to an intensive care unit, in-hospital mortality was 3.5% in pregnant patients and 14.9% in nonpregnant patients. Among those who received mechanical ventilation, in-hospital death occurred in 8.6% of pregnant patients and 31.4% of nonpregnant patients. Of note, pregnant patients were less likely to have most comorbid conditions, including hypertension, chronic pulmonary disease, diabetes, and obesity.
These findings demonstrate that overall and within multiple subgroups, pregnant patients had a substantially lower rate of in-hospital mortality. According to the researchers, these findings are important because studies with more thorough ascertainment of COVID-19 in pregnancy are needed to provide the foundation for clinical management and health care policy.
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2. ACP recommends caution in the use of patient-reported outcome-based performance measures
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A new paper from the American College of Physicians (ACP) acknowledges the potential for patient-reported outcome-based performance measures that are methodologically sound and evidence-based to assess and improve patient-centered care, but recommends caution in how they are used. The paper is published in Annals of Internal Medicine.
The ACP Performance Measurement Committee used its published criteria for assessing performance measures. In the case of patient-reported outcome-based performance measures, certain aspects take on greater importance.
The paper says that data are needed demonstrating that patient-reported outcome-based performance measures improve quality of care and are an effective tool to accurately compare physician performance and, as a result, can be used for accountability purposes. Additionally, patient-reported outcome-based performance measures should be based on the same rigor of evidence as any other performance measure. Challenges in developing and applying measures include:
- The number of physician-, system-, and patient-related factors tied to the successful management of multiple chronic conditions--as is done in both ambulatory and hospital-based internal medicine;
- Some patient-reported outcome-based performance measures are highly dependent on patient factors (e.g., access to care, family and community support);
- Studies have demonstrated limited correlation between some patient-reported outcome-based performance measures scores and individual physician performance, citing factors that are not under the influence of the individual physician.
Because of these challenges, the paper states that patient-reported outcome-based performance measures should not be used to measure individual physician performance unless there is evidence to show an association between the patient-reported outcome measure and the care provided by the physician. The paper says that a risk-adjustment strategy is paramount to account for patient and population characteristics that are proven to affect outcomes, independent of treatment, and details additional considerations related to usability and feasibility.
The paper advises that caution is warranted before widespread adoption into ambulatory and hospital-based internal medicine until patient-reported outcome-based performance measures are developed in a rigorous manner and physicians can seamlessly integrate patient-reported data collection into practice. In their current state, the measures are not optimal for improving patient outcomes.
The paper states that measure developers and public and private payers should adopt a rigorous method for assessing the validity of patient-reported outcome-based performance measures before including them in quality and reimbursement programs.
Also new in this issue:
In The Clinic
Intern Year 2020: Expectations vs. Reality
Annals of Internal Medicine