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. Survey shows firearm safety rarely discussed between patients and clinicians
Abstract: https://www.acpjournals.org/doi/10.7326/M20-6314
URL goes live when the embargo lifts
A national survey of approximately 4,000 adults who live in households with firearms found that fewer than 10 percent have ever discussed firearm safety with a clinician (12% of those with children, 5% of those without). When conversations occurred, the most common advice given across all clinical settings was to lock all household firearms. A brief report is published in Annals of Internal Medicine.
Researchers from Northeastern, Harvard, and Quinnipiac Universities analyzed data from the 2019 National Firearms Survey, conducted online from July to August 2019. Adults living in homes with firearms were asked if a physician or other health care provider ever spoke to them about firearm safety. If yes, the participants were asked where the discussions occurred and whether the patient was an adult or child. They were also asked about the advice given.
The researchers found that discussions about firearm safety were uncommon in the health care setting. When firearm safety was discussed, the safety advice offered varied by context. Of respondents spoken to about firearms, approximately half (48%) said that locking all firearms was discussed at their most recent visit, one-third (32%) said that storing ammunition separately from firearms was discussed, and one in six (16%) said that removing firearms from the home was discussed. In pediatric settings, even when firearm safety was discussed, removing firearms from the home was rarely mentioned. By contrast, when an adult other than the respondent was the patient, removal was discussed in more than half of encounters in which firearm safety was discussed (and in one-quarter of such encounters when the respondent was the patient). According to the researchers, these findings suggest that there is considerable room for improvement when it comes to promoting firearm safety discussions in clinical settings. In light of recent evidence that patients are usually open to such conversations, addressing clinician's concerns that these discussions will negatively affect the physician-patient relationship may be helpful.
Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the corresponding author, Matthew Miller, MD, MPH, ScD, please email him at ma.miller@northeastern.edu.
2. Medicare value-based payment programs may prompt practice changes that benefit all patients, reduce health care costs
Abstract: https://www.acpjournals.org/doi/10.7326/M19-3792
URL goes live when the embargo lifts
Medicare's use of bundled payments may stimulate health delivery organizations to implement innovations in care delivery that extend to all patients, not just those in Medicare. According to researchers, such improvements in care observed in the Bundled Payments for Care Improvement (BPCI) program could potentially amplify the impact of Medicare programs on health care affordability. Findings from a quasi-experimental study are published in Annals of Internal Medicine.
Under the BPCI program, bundled payments for lower-extremity joint replacement are associated with 2% to 4% cost savings with stable quality among Medicare fee-for-service beneficiaries. Whether these cost savings also benefit patients with commercial insurance has not been studied.
Researchers from the University of Pennsylvania studied Health Care Cost Institute claims from 2011 to 2016 to examine the association between hospital participation in BPCI and lower-extremity joint replacement outcomes for nearly 185,000 patients with commercial insurance or Medicare Advantage. Lower-extremity joint replacement was chosen because it is the most common procedure among the 48 included in the BPCI program. The researchers found that BPCI participation was likely associated with modest decreases in episode spending but not changes in 90-day readmissions among non-Medicare fee-for-service patients. The savings seemed to be driven by Medicare Advantage patients and changes in patterns of postacute care use--notably, decreases in discharge to skilled-nursing facilities.
According to the researchers, these findings suggest that voluntary bundled payments may have prompted hospitals to implement practice changes that went beyond Medicare fee-for-service, and these changes could spill over into savings for all health care users nationwide. The findings also underscore the likely association between bundled payment participation and stable episode quality. Finally, the authors say these findings suggest that as policymakers continue shifting the country toward value-based payment, they could consider implementing multi-payer alternative payment models.
Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the corresponding author, Amol S. Navathe, MD, PhD, please contact Melissa Moody at melissa.moody@pennmedicine.upenn.edu.
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Also in this issue:
My COVID coping mechanisms
Grace Farris, MD
Graphic Medicine
Abstract: https://www.acpjournals.org/doi/10.7326/G20-0117
Journal
Annals of Internal Medicine