News Release 

More than 70% of hospital data breaches include sensitive demographic or financial info that could lead to identity theft

American College of Physicians

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.

1. More than 70 percent of hospital data breaches include sensitive demographic or financial info that could lead to identity theft

Abstract: http://annals.org/aim/article/doi/10.7326/M19-1759

URLs go live when the embargo lifts

More than 70 percent of hospital data breaches include sensitive demographic or financial information that could lead to identity theft or fraud. A brief research report is published in Annals of Internal Medicine.

When a hospital data system is hacked, criminals gain access to sensitive health, demographic, and financial information that compromise patient privacy and financial security. While reports often focus on how many patients are affected by these breaches, it has not been a requirement to share what types of data were compromised.

Researchers from Michigan State University and Johns Hopkins University studied 1,461 breaches of protected health information over the past 10 years to examine for the first time the types of information that were compromised in these breaches. The information was categorized as demographic, such as names, email addresses, and other personal identifiers; service or financial information, which included service date, billing amount, payment information; and medical information, such as diagnoses or treatment. The researchers found that all 1,461 breaches contained at least one piece of demographic information. In addition, 71 percent of the breaches affecting 159 million patients compromised sensitive demographic or financial information that could be exploited for identity or financial fraud. Two percent of the breaches affecting 2.4 million patients comprised sensitive medical information, potentially threating their clinical privacy. According to the researchers, these findings suggest that policymakers may consider requiring entities to provide standardized documentation of the types of information compromised, in addition to the number of persons affected, when reporting on protected health information breaches.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the corresponding author, John (Xuefeng) Jiang, PhD, please contact Caroline Brooks at caroline.brooks@cabs.msu.edu.

2. High-intensity surveillance colonoscopy reduces CRC risk and is cost-effective for managing patients with colorectal adenomas

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3633

Editorial: http://annals.org/aim/article/doi/10.7326/M19-2795

URLs go live when the embargo lifts

High-intensity surveillance colonoscopy is effective and cost-effective for managing patients who have had precancerous adenomas found during screening, suggests a cost-effectiveness analysis published in Annals of Internal Medicine. These findings support current but contended U.S. guidelines for surveillance colonoscopy.

Robust evidence suggests that screening substantially reduces colorectal cancer death through removal of precancerous adenomas and early detection. However, few outcome data exist to inform appropriate management of patients in whom adenomas have been removed.

Researchers from Erasmus MC University Medical Center, the Netherlands, and Stanford University used a U.S. cancer registry, cost data, and published literature to develop a microsimulation model comparing the lifetime benefits and costs of high-versus low-intensity surveillance of patients aged 50, 60, or 70 years with low-risk adenomas (LRA) or high-risk adenomas (HRA) removed after screening with colonoscopy or fecal immunochemical testing (FIT). Patients either had no further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after low-risk adenoma removal and 5 years after high-risk adenoma removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal). Based on the computer model, incidence of colorectal cancer would be reduced by roughly 40 to 60 percent. The more frequent surveillance schedules of every 3 years rather than every 5 years for high-risk adenomas and every 5 versus every 10 years for low-risk adenomas achieved incremental benefit at acceptable cost (<$30 000 per quality-adjusted life-year [QALY] gained).

The authors of an accompanying editorial from University of Pittsburgh and Fox Chase Cancer Center discuss the paucity of research surrounding surveillance and suggest that greater effort be focused on figuring out the need for and timing of follow-up colonoscopy.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with author, Reinier G.S. Meester, PhD, please contact him directly at r.meester@erasmusmc.nl. To reach the editorialist, Robert Schoen, MD, MPH, please contact Madison Brunner at brunnerm@upmc.edu.

3. Updated guidelines offer recommendations for prevention, diagnosis, treatment, and management of HCV in CKD

Abstract: http://annals.org/aim/article/doi/10.7326/M19-1539

URLs go live when the embargo lifts

The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 Clinical Practice Guideline Update provides 66 recommendations for the diagnosis, evaluation, prevention, and treatment of hepatitis C virus (HCV) in chronic kidney disease (CKD). An extensive update to KDIGO's 2008 recommendations, the guideline reflects major advances since the introduction of direct-acting antivirals (DAAs) to this patient population. A synopsis focusing on 32 key recommendations is published in Annals of Internal Medicine.

The guideline's overall objective is to inform the management of HCV, including the use of DAAs in adults with CKD. Its target audience includes nephrologists, transplant physicians, hepatologists, infectious disease specialists, primary care physicians, and other practitioners caring for adults with HCV and CKD worldwide. The guideline is organized by chapters for easy reference. Chapters include The Detection and Evaluation of HCV in CKD; Treatment of HCV Infection in Patients with CKD; Prevention of HCV Transmission in Hemodialysis Units; Management of HCV-infected Patients Before and After Kidney Transplantation; and Diagnosis and Management of Kidney Diseases Associated with HCV Infection.

The KDIGO work group developing the guideline consisted of an international body of clinicians and researchers, including nephrologists, hepatologists, virologists, a representative from the Centers for Disease Control and Prevention (CDC), and a professional evidence review team.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Craig E. Gordon, MD, MS, please contact Jeremy Lechen at jlechan@tuftsmedicalcenter.org.

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