News Release 

Home hospital care proves an effective and cost-effective alternative to hospital care for selected

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. 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. Home hospital care proves an effective and cost-effective alternative to hospital care for selected acutely ill adults

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0600

Editorial: http://annals.org/aim/article/doi/10.7326/M19-3714

URLs go live when the embargo lifts

Substitutive home hospital care was found to reduce cost, decrease health care use and 30-day readmissions, and improve physical activity compared with traditional hospital care. If widely used, this model could transform how acute care is delivered in the United States. Findings from a randomized controlled trial are published in Annals of Internal Medicine.

Traditional hospital care is the standard for acute illness in the United States, but inpatient care is expensive and has many drawbacks for patients, such as adverse events like infections, delayed access to care, lack of physical activity, and sleep deprivation. The home hospital model aims to get the right care to patients in a timely, convenient, and cost-effective fashion, but high quality evidence of this model's effectiveness is lacking.

Researchers from Harvard Medical School, Brigham and Women's Hospital studied 91 acutely ill adults (43 home and 48 control) to determine how delivering hospital-level care in a patient's home compared with usual care in the hospital in terms of cost, health care utilization, quality, and patient experience. The home hospital patients received nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. In comparing outcomes, the researchers found that substitutive home care demonstrated reduced cost, utilization, and readmission; increased physical activity; and no appreciable difference in quality or safety versus traditional hospital care.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the lead author, David M. Levine, MD, MPH, MA, please contact Haley Bridger at hbridger@bwh.harvard.edu.

2. Antibodies against RNA Polymerase III found in patients with severe viral myopericarditis

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3074

URLs go live when the embargo lifts

Researchers from the Sorbonne University and the Pitié-Salpêtrière Hospital, Paris, France, report findings from the study of 56 patients admitted to the hospital with suspected viral myocarditis. Eleven of the patients had antibodies against RNA polymerase III (RNApol3) in the absence of severe systemic sclerosis. This syndrome that has not previously been reported. A brief research report is published in Annals of Internal Medicine.

Viruses cause most cases of acute myopericarditis, a rare disease characterized by inflammation and weakening of the heart muscle. Most of the patients included in the analysis had severe myopericarditis mainly related to influenza virus.

The clinicians believe that the RNApol3 antibodies were present before the viral infection and facilitated development of severe infection or participated in virus-induced myocardial injury. This is because nine patients recovered without receiving anti-inflammatory agents, which argues against the presence of an underlying autoimmune cause of cardiac inflammation. In addition, the antibodies against RNApol3 remained detectable for several months after resolution of rival infection, which is consistent with them being present before the illness. Finally, none of the 20 patients with severe influenza-related acute respiratory distress syndrome had antibodies against RNApol3, which suggests that flu itself does not provoke antibodies against RNApol3.

Media contacts: For embargoed PDFs please contact Lauren Evans at Laevans@acponline.org. To speak with the lead author, Marc Pineton de Chambrun, MD, MSc, please contact him directly at marc.pinetondechambrun@aphp.fr.

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Also new in this issue:

Should Health Care Demand Interpretable Artificial Intelligence or
Accept "Black Box" Medicine?
Fei Wang, PhD; Rainu Kaushal, MD, MPH; and Dhruv Khullar, MD, MPP
Ideas & Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M19-2548

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