Public Release: 

Annals of Internal Medicine tip sheet for July 22, 2014

American College of Physicians

1. National Quality Forum cautions hospital performance measures must adjust for patient sociodemographic status or risk widening the care gap

Hospital performance measures must be adjusted to consider patient sociodemographic status (SDS) factors or disparities in outcomes and access will only worsen for low income and disadvantaged patients, writes Steven H. Lipstein, MHA and W. Claiborne Dunagan, MD, MS, in a commentary being published in Annals of Internal Medicine ( Lipstein and Dunagan are members of an Expert Panel that was convened by the National Quality Forum (NQF) to make recommendations on whether or not hospital performance measures should be risk adjusted for patient SDS factors present at initiation of medical care. Currently, hospital performance measures adjust for clinical factors but not for patient SDS factors. Socially disadvantaged patients are at higher risk for some undesired outcomes, including hospital readmission. The panel concluded that SDS factors should be included in risk adjustment of the performance score, as these factors affect an outcome or process of care.

Not everyone agreed with the NQF Expert Panel. When the NQF's draft recommendations were released, the Centers for Medicare and Medicaid Services (CMS) Director of Quality Measurement and Health Assessment publicly opposed them, suggesting that such adjustments may mask disparities in the quality of care provided.

Quality measures matter because Medicare has already reduced payments to hospitals with poor outcomes under provisions of the Affordable Care Act (ACA) Act of 2010, the Budget Control Act of 2011 (the "Sequester"), and the Taxpayer Relief Act of 2013 (the "Fiscal Cliff"). Resource-restrained hospitals who disproportionately serve disadvantage patients, also known as safety net providers, may incur an unfair proportion of outcome measure financial penalties when SDS factors are not factored into the equation.

The Annals of Internal Medicine commentary is being published in time with the July 23 NQF board meeting, at which the Expert Panel will discuss its recommendation to include SDS factors in hospital performance measures and the potential for trial implementation. The meeting will be open to the public. In the meantime, the authors encourage the public to read the NQF Expert Panel Report and consider the consequences of not adjusting performance metrics for SDS factors.

Note: The URL will go live at 5:00 p.m. on Monday, July 21 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks. To speak with an author, please contact Kim Kitson at or 314-286-2047.

2. Long-term remission of HIV returns after patients stop antiretroviral treatment

Two patients achieved long-term remission of HIV following allogeneic hematopoietic stem cell transplantation (HSCT) with HIV-susceptible donor cells, but the virus returned when they stopped taking antiretroviral therapy, according to an article being published in Annals of Internal Medicine ( A major challenge in finding a cure for HIV is the persistence of latently infected cells. Sustained HIV remission was demonstrated in a patient who received allogeneic HSCT from a donor with HIV-resistant cells, but it is not known the extent to which latently infected cells in the blood and other tissues are reduced in patients transplanted with HIV susceptible cells. To determine if allogeneic HSCT with HIV-1 susceptible cells could lead to sustained antiretroviral-free HIV remission, researchers had two patients who had undergone allogeneic HSCT and had no detectible HIV in their blood stop taking their antiretroviral therapy. Antiretroviral therapy was interrupted until HIV rebound was detected in the patients' blood and cerebral spinal fluid. The researchers detected HIV rebound at 12 and 32 weeks; despite a significant reduction in reservoir size following transplantation. The author of an accompanying editorial suggests that these two cases show the complex interplay between virus and host and that there is still much more work to do before science can find a cure for HIV.

Note: The URL will go live at 5:00 p.m. on Monday, July 21 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks. To speak with an author, please contact Lori Schroth or (617) 525-6374.


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