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Patient Navigation Boosts Follow-Up Colonoscopy Completion
The intervention led to a significant 13-point increase in follow-up colonoscopy completion at 1 year, compared with usual care (55.1% vs 42.1%), according the study, which was published online in Annals of Internal Medicine.
“Patients with an abnormal fecal test results have about a 1 in 20 chance of having colorectal cancer found, and many more will be found to have advanced adenomas that can be removed to prevent cancer,” Gloria Coronado, PhD, of Kaiser Permanente Center for Health Research, Portland, Oregon, and University of Arizona Cancer Center, Tucson, said in an interview.
“It is critical that these patients get a follow-up colonoscopy,” she said. “Patient navigation can accomplish this goal.”
‘Highly Effective’ Intervention
Researchers compared the effectiveness of a patient navigation program with that of usual care outreach in increasing follow-up colonoscopy completion after an abnormal stool test. They also developed a risk-prediction model that calculated a patient’s probability of obtaining a follow-up colonoscopy without navigation to determine if the addition of this intervention had a greater impact on those determined to be less likely to follow through.
The study included 967 patients from a community health center in Washington State who received an abnormal fecal test result within the prior month. The mean age of participants was 61 years, approximately 45% were women and 77% were White, and 18% preferred a Spanish-language intervention. In total, 479 patients received the intervention and 488 received usual care.
The intervention was delivered by a patient navigator who mailed introductory letters, sent text messages, and made live phone calls. In the calls, the navigators addressed the topics of barrier assessment and resolution, bowel preparation instruction and reminders, colonoscopy check-in, and understanding colonoscopy results and retesting intervals.
Patients in the usual-care group were contacted by a referral coordinator to schedule a follow-up colonoscopy appointment. If they couldn’t be reached initially, up to two follow-up attempts were made at 30 and 45 days after the referral date.
Patient navigation resulted in a significant 13% increase in follow-up, and those in this group completed a colonoscopy 27 days sooner than those in the usual care group (mean, 229 days vs 256 days).
Contrary to the authors’ expectation, the effectiveness of the intervention did not vary by patients’ predicted likelihood of obtaining a colonoscopy without navigation.
Notably, 20.3% of patients were unreachable or lost to follow-up, and 29.7% did not receive navigation. Among the 479 patients assigned to navigation, 79 (16.5%) declined participation and 56 (11.7%) were never reached.
The study was primarily conducted during the height of the COVID-19 pandemic, which created additional systemic and individual barriers to completing colonoscopies.
Nevertheless, the authors wrote, “our findings suggest that patient navigation is highly effective for patients eligible for colonoscopy.”
“Most patients who were reached were contacted with six or fewer phone attempts,” Coronado noted. “Further efforts are needed to determine how to reach and motivate patients [who did not participate] to get a follow-up colonoscopy.”
Coronado and colleagues are exploring ways to leverage artificial intelligence and virtual approaches to augment patient navigation programs — for example, by using a virtual navigator or low-cost automated tools to provide education to build patient confidence in getting a colonoscopy.
‘A Promising Tool’
“Colonoscopy completion after positive stool-based testing is critical to mitigating the impact of colon cancer,” commented Rajiv Bhuta, MD, assistant professor of clinical gastroenterology & hepatology, Lewis Katz School of Medicine, Temple University, Philadelphia, who was not involved in the study. “While prior studies assessing navigation have demonstrated improvements, none were as large enrollment-wise or as generalizable as the current study.”
That said, Bhuta said in an interview that the study could have provided more detail about coordination and communication with local gastrointestinal practices.
“Local ordering and prescribing practices vary and can significantly impact compliance rates. Were colonoscopies completed via an open access pathway or were the patients required to see a gastroenterologist first? How long was the average wait time for colonoscopy once scheduled? What were the local policies on requiring an escort after the procedure?”
He also noted that some aspects of the study — such as access to reduced-cost specialty care and free ride-share services — may limit generalizable to settings without such resources.
He added: “Although patient navigators for cancer treatment have mandated reimbursement, there is no current reimbursement for navigators for abnormal screening tests, another barrier to wide-spread implementation.”
Bhuta said that the dropout rate in the study mirrors that of his own real-world practice, which serves a high-risk, low-resource community. “I would specifically like to see research that provides behavioral insights on why patients respond positively to navigation — whether it is due to reminders, emotional support, or logistical assistance. Is it systemic barriers or patient disinterest or both that drives noncompliance?”
Despite these uncertainties and the need to refine implementation logistics, Bhuta concluded, “this strategy is a promising tool to reduce disparities and improve colorectal cancer outcomes. Clinicians should advocate for or implement structured follow-up systems, particularly in high-risk populations.”
The study was funded by the US National Cancer Institute. Coronado received a grant/contract from Guardant Health. Bhuta declared no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
The intervention led to a significant 13-point increase in follow-up colonoscopy completion at 1 year, compared with usual care (55.1% vs 42.1%), according the study, which was published online in Annals of Internal Medicine.
“Patients with an abnormal fecal test results have about a 1 in 20 chance of having colorectal cancer found, and many more will be found to have advanced adenomas that can be removed to prevent cancer,” Gloria Coronado, PhD, of Kaiser Permanente Center for Health Research, Portland, Oregon, and University of Arizona Cancer Center, Tucson, said in an interview.
“It is critical that these patients get a follow-up colonoscopy,” she said. “Patient navigation can accomplish this goal.”
‘Highly Effective’ Intervention
Researchers compared the effectiveness of a patient navigation program with that of usual care outreach in increasing follow-up colonoscopy completion after an abnormal stool test. They also developed a risk-prediction model that calculated a patient’s probability of obtaining a follow-up colonoscopy without navigation to determine if the addition of this intervention had a greater impact on those determined to be less likely to follow through.
The study included 967 patients from a community health center in Washington State who received an abnormal fecal test result within the prior month. The mean age of participants was 61 years, approximately 45% were women and 77% were White, and 18% preferred a Spanish-language intervention. In total, 479 patients received the intervention and 488 received usual care.
The intervention was delivered by a patient navigator who mailed introductory letters, sent text messages, and made live phone calls. In the calls, the navigators addressed the topics of barrier assessment and resolution, bowel preparation instruction and reminders, colonoscopy check-in, and understanding colonoscopy results and retesting intervals.
Patients in the usual-care group were contacted by a referral coordinator to schedule a follow-up colonoscopy appointment. If they couldn’t be reached initially, up to two follow-up attempts were made at 30 and 45 days after the referral date.
Patient navigation resulted in a significant 13% increase in follow-up, and those in this group completed a colonoscopy 27 days sooner than those in the usual care group (mean, 229 days vs 256 days).
Contrary to the authors’ expectation, the effectiveness of the intervention did not vary by patients’ predicted likelihood of obtaining a colonoscopy without navigation.
Notably, 20.3% of patients were unreachable or lost to follow-up, and 29.7% did not receive navigation. Among the 479 patients assigned to navigation, 79 (16.5%) declined participation and 56 (11.7%) were never reached.
The study was primarily conducted during the height of the COVID-19 pandemic, which created additional systemic and individual barriers to completing colonoscopies.
Nevertheless, the authors wrote, “our findings suggest that patient navigation is highly effective for patients eligible for colonoscopy.”
“Most patients who were reached were contacted with six or fewer phone attempts,” Coronado noted. “Further efforts are needed to determine how to reach and motivate patients [who did not participate] to get a follow-up colonoscopy.”
Coronado and colleagues are exploring ways to leverage artificial intelligence and virtual approaches to augment patient navigation programs — for example, by using a virtual navigator or low-cost automated tools to provide education to build patient confidence in getting a colonoscopy.
‘A Promising Tool’
“Colonoscopy completion after positive stool-based testing is critical to mitigating the impact of colon cancer,” commented Rajiv Bhuta, MD, assistant professor of clinical gastroenterology & hepatology, Lewis Katz School of Medicine, Temple University, Philadelphia, who was not involved in the study. “While prior studies assessing navigation have demonstrated improvements, none were as large enrollment-wise or as generalizable as the current study.”
That said, Bhuta said in an interview that the study could have provided more detail about coordination and communication with local gastrointestinal practices.
“Local ordering and prescribing practices vary and can significantly impact compliance rates. Were colonoscopies completed via an open access pathway or were the patients required to see a gastroenterologist first? How long was the average wait time for colonoscopy once scheduled? What were the local policies on requiring an escort after the procedure?”
He also noted that some aspects of the study — such as access to reduced-cost specialty care and free ride-share services — may limit generalizable to settings without such resources.
He added: “Although patient navigators for cancer treatment have mandated reimbursement, there is no current reimbursement for navigators for abnormal screening tests, another barrier to wide-spread implementation.”
Bhuta said that the dropout rate in the study mirrors that of his own real-world practice, which serves a high-risk, low-resource community. “I would specifically like to see research that provides behavioral insights on why patients respond positively to navigation — whether it is due to reminders, emotional support, or logistical assistance. Is it systemic barriers or patient disinterest or both that drives noncompliance?”
Despite these uncertainties and the need to refine implementation logistics, Bhuta concluded, “this strategy is a promising tool to reduce disparities and improve colorectal cancer outcomes. Clinicians should advocate for or implement structured follow-up systems, particularly in high-risk populations.”
The study was funded by the US National Cancer Institute. Coronado received a grant/contract from Guardant Health. Bhuta declared no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
The intervention led to a significant 13-point increase in follow-up colonoscopy completion at 1 year, compared with usual care (55.1% vs 42.1%), according the study, which was published online in Annals of Internal Medicine.
“Patients with an abnormal fecal test results have about a 1 in 20 chance of having colorectal cancer found, and many more will be found to have advanced adenomas that can be removed to prevent cancer,” Gloria Coronado, PhD, of Kaiser Permanente Center for Health Research, Portland, Oregon, and University of Arizona Cancer Center, Tucson, said in an interview.
“It is critical that these patients get a follow-up colonoscopy,” she said. “Patient navigation can accomplish this goal.”
‘Highly Effective’ Intervention
Researchers compared the effectiveness of a patient navigation program with that of usual care outreach in increasing follow-up colonoscopy completion after an abnormal stool test. They also developed a risk-prediction model that calculated a patient’s probability of obtaining a follow-up colonoscopy without navigation to determine if the addition of this intervention had a greater impact on those determined to be less likely to follow through.
The study included 967 patients from a community health center in Washington State who received an abnormal fecal test result within the prior month. The mean age of participants was 61 years, approximately 45% were women and 77% were White, and 18% preferred a Spanish-language intervention. In total, 479 patients received the intervention and 488 received usual care.
The intervention was delivered by a patient navigator who mailed introductory letters, sent text messages, and made live phone calls. In the calls, the navigators addressed the topics of barrier assessment and resolution, bowel preparation instruction and reminders, colonoscopy check-in, and understanding colonoscopy results and retesting intervals.
Patients in the usual-care group were contacted by a referral coordinator to schedule a follow-up colonoscopy appointment. If they couldn’t be reached initially, up to two follow-up attempts were made at 30 and 45 days after the referral date.
Patient navigation resulted in a significant 13% increase in follow-up, and those in this group completed a colonoscopy 27 days sooner than those in the usual care group (mean, 229 days vs 256 days).
Contrary to the authors’ expectation, the effectiveness of the intervention did not vary by patients’ predicted likelihood of obtaining a colonoscopy without navigation.
Notably, 20.3% of patients were unreachable or lost to follow-up, and 29.7% did not receive navigation. Among the 479 patients assigned to navigation, 79 (16.5%) declined participation and 56 (11.7%) were never reached.
The study was primarily conducted during the height of the COVID-19 pandemic, which created additional systemic and individual barriers to completing colonoscopies.
Nevertheless, the authors wrote, “our findings suggest that patient navigation is highly effective for patients eligible for colonoscopy.”
“Most patients who were reached were contacted with six or fewer phone attempts,” Coronado noted. “Further efforts are needed to determine how to reach and motivate patients [who did not participate] to get a follow-up colonoscopy.”
Coronado and colleagues are exploring ways to leverage artificial intelligence and virtual approaches to augment patient navigation programs — for example, by using a virtual navigator or low-cost automated tools to provide education to build patient confidence in getting a colonoscopy.
‘A Promising Tool’
“Colonoscopy completion after positive stool-based testing is critical to mitigating the impact of colon cancer,” commented Rajiv Bhuta, MD, assistant professor of clinical gastroenterology & hepatology, Lewis Katz School of Medicine, Temple University, Philadelphia, who was not involved in the study. “While prior studies assessing navigation have demonstrated improvements, none were as large enrollment-wise or as generalizable as the current study.”
That said, Bhuta said in an interview that the study could have provided more detail about coordination and communication with local gastrointestinal practices.
“Local ordering and prescribing practices vary and can significantly impact compliance rates. Were colonoscopies completed via an open access pathway or were the patients required to see a gastroenterologist first? How long was the average wait time for colonoscopy once scheduled? What were the local policies on requiring an escort after the procedure?”
He also noted that some aspects of the study — such as access to reduced-cost specialty care and free ride-share services — may limit generalizable to settings without such resources.
He added: “Although patient navigators for cancer treatment have mandated reimbursement, there is no current reimbursement for navigators for abnormal screening tests, another barrier to wide-spread implementation.”
Bhuta said that the dropout rate in the study mirrors that of his own real-world practice, which serves a high-risk, low-resource community. “I would specifically like to see research that provides behavioral insights on why patients respond positively to navigation — whether it is due to reminders, emotional support, or logistical assistance. Is it systemic barriers or patient disinterest or both that drives noncompliance?”
Despite these uncertainties and the need to refine implementation logistics, Bhuta concluded, “this strategy is a promising tool to reduce disparities and improve colorectal cancer outcomes. Clinicians should advocate for or implement structured follow-up systems, particularly in high-risk populations.”
The study was funded by the US National Cancer Institute. Coronado received a grant/contract from Guardant Health. Bhuta declared no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
FROM ANNALS OF INTERNAL MEDICINE
Model May Predict Which UC Patients Risk Rehospitalization
a preliminary modeling study suggests.
“Absence of a gastroenterologist consultation within the year prior to admission, male sex, shorter length of hospital stay, and narcotic prescription at the time of discharge were independently associated with the risk for 90-day rehospitalization for a UC-related indication,” study author Sanjay Murthy, MD, associate professor of gastroenterology at the University of Ottawa, Ontario, Canada, and staff gastroenterologist at the Inflammatory Bowel Disease Centre at The Ottawa Hospital, said in an interview.
“While some hospital readmissions are likely unavoidable, a subset of them, particularly readmissions that occur soon after discharge, may be preventable with early and intensive postdischarge outpatient management,” he said. “Identifying those who are at high risk for early readmission is a rational first step toward applying targeted outpatient interventions that reduce this risk.”
The study was published in The Journal of the Canadian Association of Gastroenterology.
Major Predictor Variables
The researchers conducted a retrospective study in adults with UC who were admitted to The Ottawa Hospital between 2009 and 2016 for a UC flare or UC-related complication, excluding bowel cancer. Using medical records and administrative health databases, they derived and validated a multivariable logistic regression model of 90-day UC-related rehospitalization risk.
Participants’ mean age at UC diagnosis was 35.3 years and 50.4% were men. In the year before the index hospitalization, 138 (55.6%) participants had a gastroenterologist visit, whereas 41 (16.5%) were hospitalized.
During the index hospitalization, 42 (16.9%) patients were newly diagnosed with UC, and 25 (10.1%) underwent intra-abdominal surgery. At discharge, 34 (13.7%) patients were prescribed an outpatient narcotic. The mean length of hospital stay was 9.97 days. Twenty-seven individuals (10.9%) were rehospitalized within 90 days of discharge.
Out of 35 variables, the model identified the following four as significant predictors of 90-day rehospitalization: gastroenterologist consultation within the prior year (adjusted odds ratio [aOR], 0.09), male sex (aOR, 3.77), length of hospital stay (aOR, 0.93), and discharge with narcotics prescription (aOR, 5.94).
The model had 77.8% sensitivity, 80.9% specificity, 33% positive predictive value, and 96.7% negative predictive value for predicting high vs low risk for 90-day hospital readmission.
The researchers noted several study limitations. The cohort was relatively small, which limited the statistical power for model building and identifying variable associations with the outcome. In addition, the study was conducted in a single tertiary care center, which limits its generalizability. Retrospective data may have affected the accuracy of the measurements, and information on some relevant variables was not available.
Nevertheless, Murthy said, “optimally applying our prediction model at the point of hospital discharge would have classified only about a quarter of individuals in our cohort as being at high-risk for 90-day readmission and potentially needing targeted early outpatient intervention, and this would have captured close to 80% of individuals who were destined for early readmission.”
“However, our research is still preliminary and requires considerably more work to ensure that the findings are suitable for application to clinical practice,” he added. “In the meantime, practitioners may reflect on the potential importance of the major predictor variables identified in our study within their practices.”
Careful Follow-Up Key
Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at Temple University and a gastroenterologist at Temple University Hospital, both in Philadelphia, Pennsylvania, commented on the study but was not involved in it.
“The model performed fairly well (c-statistic of 0.78) using four variables: Gastroenterologist consultation within the prior year (protective), male sex (higher risk), length of stay (marginally protective), and narcotic prescription at discharge (higher risk). These are intuitive predictors that align with prior literature on UC hospitalizations,” said Bhuta.
“From a clinical perspective, this type of tool could be useful for targeting high-risk patients for early outpatient interventions (eg, close gastroenterology follow-up and pain management strategies). The negative predictive value (96.7%) suggests that it is particularly good at identifying patients at low risk for rehospitalization, which may help prioritize resource allocation more efficiently. However, practical implementation will require external validation and integration into electronic medical records to automatically flag high-risk patients at discharge.”
In addition, Bhuta noted, “the study only examines patient data through 2016. Why have the last 8 years been excluded? Given the small sample size and the sea change in available inflammatory bowel disease therapies since 2016, there could be significantly different findings with more current data.”
Furthermore, there is a lack of specific data supporting the protective effect of a gastroenterology visit in the previous year, and the readmission rate was lower than that reported by others (10% vs 20%), which, he said “may skew their findings.”
“The strong protective effect of prior gastroenterologist visits underscores the importance of specialty proactive disease management in these complex patients,” Bhuta continued. “Narcotic prescriptions at discharge may indicate inadequate disease activity control, thus making these patients important targets for close follow-up. Narcotics are generally not required once successful disease control has been achieved with steroids or biologics.
“While promising, this tool should not yet replace clinical judgment until it undergoes external validation,” he concluded. “In the meantime, clinicians should focus on structured outpatient follow-up and careful discharge planning to minimize UC-related rehospitalizations.”
This study was funded by a grant provided to Murthy by the department of medicine at the University of Ottawa. Murthy and Bhuta declared having no relevant financial relationships.
A version of this article appeared on Medscape.com .
a preliminary modeling study suggests.
“Absence of a gastroenterologist consultation within the year prior to admission, male sex, shorter length of hospital stay, and narcotic prescription at the time of discharge were independently associated with the risk for 90-day rehospitalization for a UC-related indication,” study author Sanjay Murthy, MD, associate professor of gastroenterology at the University of Ottawa, Ontario, Canada, and staff gastroenterologist at the Inflammatory Bowel Disease Centre at The Ottawa Hospital, said in an interview.
“While some hospital readmissions are likely unavoidable, a subset of them, particularly readmissions that occur soon after discharge, may be preventable with early and intensive postdischarge outpatient management,” he said. “Identifying those who are at high risk for early readmission is a rational first step toward applying targeted outpatient interventions that reduce this risk.”
The study was published in The Journal of the Canadian Association of Gastroenterology.
Major Predictor Variables
The researchers conducted a retrospective study in adults with UC who were admitted to The Ottawa Hospital between 2009 and 2016 for a UC flare or UC-related complication, excluding bowel cancer. Using medical records and administrative health databases, they derived and validated a multivariable logistic regression model of 90-day UC-related rehospitalization risk.
Participants’ mean age at UC diagnosis was 35.3 years and 50.4% were men. In the year before the index hospitalization, 138 (55.6%) participants had a gastroenterologist visit, whereas 41 (16.5%) were hospitalized.
During the index hospitalization, 42 (16.9%) patients were newly diagnosed with UC, and 25 (10.1%) underwent intra-abdominal surgery. At discharge, 34 (13.7%) patients were prescribed an outpatient narcotic. The mean length of hospital stay was 9.97 days. Twenty-seven individuals (10.9%) were rehospitalized within 90 days of discharge.
Out of 35 variables, the model identified the following four as significant predictors of 90-day rehospitalization: gastroenterologist consultation within the prior year (adjusted odds ratio [aOR], 0.09), male sex (aOR, 3.77), length of hospital stay (aOR, 0.93), and discharge with narcotics prescription (aOR, 5.94).
The model had 77.8% sensitivity, 80.9% specificity, 33% positive predictive value, and 96.7% negative predictive value for predicting high vs low risk for 90-day hospital readmission.
The researchers noted several study limitations. The cohort was relatively small, which limited the statistical power for model building and identifying variable associations with the outcome. In addition, the study was conducted in a single tertiary care center, which limits its generalizability. Retrospective data may have affected the accuracy of the measurements, and information on some relevant variables was not available.
Nevertheless, Murthy said, “optimally applying our prediction model at the point of hospital discharge would have classified only about a quarter of individuals in our cohort as being at high-risk for 90-day readmission and potentially needing targeted early outpatient intervention, and this would have captured close to 80% of individuals who were destined for early readmission.”
“However, our research is still preliminary and requires considerably more work to ensure that the findings are suitable for application to clinical practice,” he added. “In the meantime, practitioners may reflect on the potential importance of the major predictor variables identified in our study within their practices.”
Careful Follow-Up Key
Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at Temple University and a gastroenterologist at Temple University Hospital, both in Philadelphia, Pennsylvania, commented on the study but was not involved in it.
“The model performed fairly well (c-statistic of 0.78) using four variables: Gastroenterologist consultation within the prior year (protective), male sex (higher risk), length of stay (marginally protective), and narcotic prescription at discharge (higher risk). These are intuitive predictors that align with prior literature on UC hospitalizations,” said Bhuta.
“From a clinical perspective, this type of tool could be useful for targeting high-risk patients for early outpatient interventions (eg, close gastroenterology follow-up and pain management strategies). The negative predictive value (96.7%) suggests that it is particularly good at identifying patients at low risk for rehospitalization, which may help prioritize resource allocation more efficiently. However, practical implementation will require external validation and integration into electronic medical records to automatically flag high-risk patients at discharge.”
In addition, Bhuta noted, “the study only examines patient data through 2016. Why have the last 8 years been excluded? Given the small sample size and the sea change in available inflammatory bowel disease therapies since 2016, there could be significantly different findings with more current data.”
Furthermore, there is a lack of specific data supporting the protective effect of a gastroenterology visit in the previous year, and the readmission rate was lower than that reported by others (10% vs 20%), which, he said “may skew their findings.”
“The strong protective effect of prior gastroenterologist visits underscores the importance of specialty proactive disease management in these complex patients,” Bhuta continued. “Narcotic prescriptions at discharge may indicate inadequate disease activity control, thus making these patients important targets for close follow-up. Narcotics are generally not required once successful disease control has been achieved with steroids or biologics.
“While promising, this tool should not yet replace clinical judgment until it undergoes external validation,” he concluded. “In the meantime, clinicians should focus on structured outpatient follow-up and careful discharge planning to minimize UC-related rehospitalizations.”
This study was funded by a grant provided to Murthy by the department of medicine at the University of Ottawa. Murthy and Bhuta declared having no relevant financial relationships.
A version of this article appeared on Medscape.com .
a preliminary modeling study suggests.
“Absence of a gastroenterologist consultation within the year prior to admission, male sex, shorter length of hospital stay, and narcotic prescription at the time of discharge were independently associated with the risk for 90-day rehospitalization for a UC-related indication,” study author Sanjay Murthy, MD, associate professor of gastroenterology at the University of Ottawa, Ontario, Canada, and staff gastroenterologist at the Inflammatory Bowel Disease Centre at The Ottawa Hospital, said in an interview.
“While some hospital readmissions are likely unavoidable, a subset of them, particularly readmissions that occur soon after discharge, may be preventable with early and intensive postdischarge outpatient management,” he said. “Identifying those who are at high risk for early readmission is a rational first step toward applying targeted outpatient interventions that reduce this risk.”
The study was published in The Journal of the Canadian Association of Gastroenterology.
Major Predictor Variables
The researchers conducted a retrospective study in adults with UC who were admitted to The Ottawa Hospital between 2009 and 2016 for a UC flare or UC-related complication, excluding bowel cancer. Using medical records and administrative health databases, they derived and validated a multivariable logistic regression model of 90-day UC-related rehospitalization risk.
Participants’ mean age at UC diagnosis was 35.3 years and 50.4% were men. In the year before the index hospitalization, 138 (55.6%) participants had a gastroenterologist visit, whereas 41 (16.5%) were hospitalized.
During the index hospitalization, 42 (16.9%) patients were newly diagnosed with UC, and 25 (10.1%) underwent intra-abdominal surgery. At discharge, 34 (13.7%) patients were prescribed an outpatient narcotic. The mean length of hospital stay was 9.97 days. Twenty-seven individuals (10.9%) were rehospitalized within 90 days of discharge.
Out of 35 variables, the model identified the following four as significant predictors of 90-day rehospitalization: gastroenterologist consultation within the prior year (adjusted odds ratio [aOR], 0.09), male sex (aOR, 3.77), length of hospital stay (aOR, 0.93), and discharge with narcotics prescription (aOR, 5.94).
The model had 77.8% sensitivity, 80.9% specificity, 33% positive predictive value, and 96.7% negative predictive value for predicting high vs low risk for 90-day hospital readmission.
The researchers noted several study limitations. The cohort was relatively small, which limited the statistical power for model building and identifying variable associations with the outcome. In addition, the study was conducted in a single tertiary care center, which limits its generalizability. Retrospective data may have affected the accuracy of the measurements, and information on some relevant variables was not available.
Nevertheless, Murthy said, “optimally applying our prediction model at the point of hospital discharge would have classified only about a quarter of individuals in our cohort as being at high-risk for 90-day readmission and potentially needing targeted early outpatient intervention, and this would have captured close to 80% of individuals who were destined for early readmission.”
“However, our research is still preliminary and requires considerably more work to ensure that the findings are suitable for application to clinical practice,” he added. “In the meantime, practitioners may reflect on the potential importance of the major predictor variables identified in our study within their practices.”
Careful Follow-Up Key
Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at Temple University and a gastroenterologist at Temple University Hospital, both in Philadelphia, Pennsylvania, commented on the study but was not involved in it.
“The model performed fairly well (c-statistic of 0.78) using four variables: Gastroenterologist consultation within the prior year (protective), male sex (higher risk), length of stay (marginally protective), and narcotic prescription at discharge (higher risk). These are intuitive predictors that align with prior literature on UC hospitalizations,” said Bhuta.
“From a clinical perspective, this type of tool could be useful for targeting high-risk patients for early outpatient interventions (eg, close gastroenterology follow-up and pain management strategies). The negative predictive value (96.7%) suggests that it is particularly good at identifying patients at low risk for rehospitalization, which may help prioritize resource allocation more efficiently. However, practical implementation will require external validation and integration into electronic medical records to automatically flag high-risk patients at discharge.”
In addition, Bhuta noted, “the study only examines patient data through 2016. Why have the last 8 years been excluded? Given the small sample size and the sea change in available inflammatory bowel disease therapies since 2016, there could be significantly different findings with more current data.”
Furthermore, there is a lack of specific data supporting the protective effect of a gastroenterology visit in the previous year, and the readmission rate was lower than that reported by others (10% vs 20%), which, he said “may skew their findings.”
“The strong protective effect of prior gastroenterologist visits underscores the importance of specialty proactive disease management in these complex patients,” Bhuta continued. “Narcotic prescriptions at discharge may indicate inadequate disease activity control, thus making these patients important targets for close follow-up. Narcotics are generally not required once successful disease control has been achieved with steroids or biologics.
“While promising, this tool should not yet replace clinical judgment until it undergoes external validation,” he concluded. “In the meantime, clinicians should focus on structured outpatient follow-up and careful discharge planning to minimize UC-related rehospitalizations.”
This study was funded by a grant provided to Murthy by the department of medicine at the University of Ottawa. Murthy and Bhuta declared having no relevant financial relationships.
A version of this article appeared on Medscape.com .
FROM THE JOURNAL OF THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY
Quality, Not Type, of Diet Linked to Microbiome Health
new research suggested.
For example, red meat was a strong driver of omnivore microbiomes, with corresponding signature microbes that are negatively correlated with host cardiometabolic health.
In contrast, the signature microbes found in vegans’ gut microbiomes were correlated with favorable cardiometabolic markers and were enriched in omnivores who ate more plant-based foods.
“From the viewpoint of the impact of diet on the gut microbiome, what seems to be more important is the diversity of healthy plant-based foods that are consumed,” principal author Nicola Segata, PhD, University of Trento in Italy, said in an interview. “Whether this comes within a vegan or an omnivore diet is less crucial, as long as there is no specific overconsumption of unhealthy food categories, such as red meat.”
Excluding broad categories of foods also can have consequences, he added. “For example, we saw that the exclusion of dairy fermented foods is associated with decreased presence of potentially probiotic microbes that are constitutive of such foods. Avoiding meat or dairy products does not necessarily have a positive effect if it does not come with a variety of quality plant-based products.”
The study was published online in Nature Microbiology.
Diet Tied to Microbial Signature
The researchers analyzed biological samples from 21,561 individuals across five multi-national cohorts to map how differences in diet patterns (omnivore, vegetarian, and vegan) are reflected in gut microbiomes.
They found that the three diet patterns are highly distinguishable by their microbial profiles and that each diet has corresponding unique signature microbes, including those tied to digestion of specific types of food and sometimes those derived from food itself.
The microbiomes of omnivores had an increased presence of bacteria associated with meat digestion, such as Alistipes putredinis, which is involved in protein fermentation. Omnivores also had more bacteria associated with both inflammatory bowel disease and increased colon cancer risk, such as Ruminococcus torques and Bilophila wadsworthia.
The microbiomes of vegans had an abundance of bacteria involved in fiber fermentation, such as several species of Bacteroides and Firmicutes phyla, which help produce short-chain fatty acids. These compounds have beneficial effects on gut health by reducing inflammation and helping to maintain a better homeostatic balance between an individual’s metabolism and immune system.
The main difference between vegetarians and vegans was the presence in vegetarians’ microbiomes of Streptococcus thermophilus, a bacterium found mainly in dairy products and used in the production of yogurt.
Dietary factors within each diet pattern, such as the amount of plant-based food, shape the microbiome more than the type of diet and are important for gut health, according to the authors. For example, by eating more plant-based foods, people with an omnivorous diet can bring the proportion of beneficial signature microbes in their microbiomes more in line with the levels in people who are vegan or vegetarian.
“Since our data showed that omnivores on average ingest significantly fewer healthy plant-based foods than vegetarians or vegans, optimizing the quality of omnivore diets by increasing dietary plant diversity could lead to better gut health,” they wrote.
The ultimate goal, Segata said, is “a precision nutrition approach that recommends foods based on the configuration of the microbiome of patients and of the aspects of the microbiome one wants to enhance. We are not there yet, but it is nonetheless important to know which foods are usually boosting which types of members of the gut microbiome.”
His team is currently analyzing changes in the gut microbiome induced by diet changes among thousands of participants in various cohorts.
“This is one of the next steps toward unraveling causality along the diet-microbiome-health axis, together with the cultivation of specific microbiome members of interest for potential prebiotic and probiotic strategies,” he said.
Conventional Dietary Advice for Now
The findings are consistent with those of previous studies, Jack Gilbert, MD, director of the Microbiome and Metagenomics Center at the University of California, San Diego, and president of Applied Microbiology International, Cambridge, England, said in an interview.
“Future research needs to focus on whether the gut microbial signature can predict those that develop cardiovascular disease in each cohort — ie, the n-of-1 studies, whereby a vegan develops cardiovascular disease, or a carnivore does not,” said Gilbert, who was not involved in the study.
With more data, he said, “we can also start examining these trends over time to understand what might be going on with these ‘oddballs.’ ”
“There is not much you can do with the ‘eat a healthy balanced diet’ routine,” he noted. “If I got a microbiome signature, I could potentially tell you what to eat to optimize your blood glucose trends and your lipid panels but not to handle long-term disease risk, yet. So sticking with the guideline-recommended dietary advice seems best, until we can provide more nuanced advice for the patient.
“Importantly, I would also like to see time-resolved data,” he added. “Signatures can fluctuate over time, even over days, and so collecting a few weeks of stool samples would help us to better align the microbiome signatures to clinical endpoints.”
Segata is a consultant to and receives options from ZOE. Gilbert is a member of the scientific advisory boards of Holobiome, BiomeSense, EcoBiomics Canadian Research Program, MASTER EU, Sun Genomics, and Oath; the editorial advisory board for The Scientist; and the external advisory board for the Binational Early Asthma & Microbiome Study. He is also an adviser for Bened Life.
A version of this article appeared on Medscape.com.
new research suggested.
For example, red meat was a strong driver of omnivore microbiomes, with corresponding signature microbes that are negatively correlated with host cardiometabolic health.
In contrast, the signature microbes found in vegans’ gut microbiomes were correlated with favorable cardiometabolic markers and were enriched in omnivores who ate more plant-based foods.
“From the viewpoint of the impact of diet on the gut microbiome, what seems to be more important is the diversity of healthy plant-based foods that are consumed,” principal author Nicola Segata, PhD, University of Trento in Italy, said in an interview. “Whether this comes within a vegan or an omnivore diet is less crucial, as long as there is no specific overconsumption of unhealthy food categories, such as red meat.”
Excluding broad categories of foods also can have consequences, he added. “For example, we saw that the exclusion of dairy fermented foods is associated with decreased presence of potentially probiotic microbes that are constitutive of such foods. Avoiding meat or dairy products does not necessarily have a positive effect if it does not come with a variety of quality plant-based products.”
The study was published online in Nature Microbiology.
Diet Tied to Microbial Signature
The researchers analyzed biological samples from 21,561 individuals across five multi-national cohorts to map how differences in diet patterns (omnivore, vegetarian, and vegan) are reflected in gut microbiomes.
They found that the three diet patterns are highly distinguishable by their microbial profiles and that each diet has corresponding unique signature microbes, including those tied to digestion of specific types of food and sometimes those derived from food itself.
The microbiomes of omnivores had an increased presence of bacteria associated with meat digestion, such as Alistipes putredinis, which is involved in protein fermentation. Omnivores also had more bacteria associated with both inflammatory bowel disease and increased colon cancer risk, such as Ruminococcus torques and Bilophila wadsworthia.
The microbiomes of vegans had an abundance of bacteria involved in fiber fermentation, such as several species of Bacteroides and Firmicutes phyla, which help produce short-chain fatty acids. These compounds have beneficial effects on gut health by reducing inflammation and helping to maintain a better homeostatic balance between an individual’s metabolism and immune system.
The main difference between vegetarians and vegans was the presence in vegetarians’ microbiomes of Streptococcus thermophilus, a bacterium found mainly in dairy products and used in the production of yogurt.
Dietary factors within each diet pattern, such as the amount of plant-based food, shape the microbiome more than the type of diet and are important for gut health, according to the authors. For example, by eating more plant-based foods, people with an omnivorous diet can bring the proportion of beneficial signature microbes in their microbiomes more in line with the levels in people who are vegan or vegetarian.
“Since our data showed that omnivores on average ingest significantly fewer healthy plant-based foods than vegetarians or vegans, optimizing the quality of omnivore diets by increasing dietary plant diversity could lead to better gut health,” they wrote.
The ultimate goal, Segata said, is “a precision nutrition approach that recommends foods based on the configuration of the microbiome of patients and of the aspects of the microbiome one wants to enhance. We are not there yet, but it is nonetheless important to know which foods are usually boosting which types of members of the gut microbiome.”
His team is currently analyzing changes in the gut microbiome induced by diet changes among thousands of participants in various cohorts.
“This is one of the next steps toward unraveling causality along the diet-microbiome-health axis, together with the cultivation of specific microbiome members of interest for potential prebiotic and probiotic strategies,” he said.
Conventional Dietary Advice for Now
The findings are consistent with those of previous studies, Jack Gilbert, MD, director of the Microbiome and Metagenomics Center at the University of California, San Diego, and president of Applied Microbiology International, Cambridge, England, said in an interview.
“Future research needs to focus on whether the gut microbial signature can predict those that develop cardiovascular disease in each cohort — ie, the n-of-1 studies, whereby a vegan develops cardiovascular disease, or a carnivore does not,” said Gilbert, who was not involved in the study.
With more data, he said, “we can also start examining these trends over time to understand what might be going on with these ‘oddballs.’ ”
“There is not much you can do with the ‘eat a healthy balanced diet’ routine,” he noted. “If I got a microbiome signature, I could potentially tell you what to eat to optimize your blood glucose trends and your lipid panels but not to handle long-term disease risk, yet. So sticking with the guideline-recommended dietary advice seems best, until we can provide more nuanced advice for the patient.
“Importantly, I would also like to see time-resolved data,” he added. “Signatures can fluctuate over time, even over days, and so collecting a few weeks of stool samples would help us to better align the microbiome signatures to clinical endpoints.”
Segata is a consultant to and receives options from ZOE. Gilbert is a member of the scientific advisory boards of Holobiome, BiomeSense, EcoBiomics Canadian Research Program, MASTER EU, Sun Genomics, and Oath; the editorial advisory board for The Scientist; and the external advisory board for the Binational Early Asthma & Microbiome Study. He is also an adviser for Bened Life.
A version of this article appeared on Medscape.com.
new research suggested.
For example, red meat was a strong driver of omnivore microbiomes, with corresponding signature microbes that are negatively correlated with host cardiometabolic health.
In contrast, the signature microbes found in vegans’ gut microbiomes were correlated with favorable cardiometabolic markers and were enriched in omnivores who ate more plant-based foods.
“From the viewpoint of the impact of diet on the gut microbiome, what seems to be more important is the diversity of healthy plant-based foods that are consumed,” principal author Nicola Segata, PhD, University of Trento in Italy, said in an interview. “Whether this comes within a vegan or an omnivore diet is less crucial, as long as there is no specific overconsumption of unhealthy food categories, such as red meat.”
Excluding broad categories of foods also can have consequences, he added. “For example, we saw that the exclusion of dairy fermented foods is associated with decreased presence of potentially probiotic microbes that are constitutive of such foods. Avoiding meat or dairy products does not necessarily have a positive effect if it does not come with a variety of quality plant-based products.”
The study was published online in Nature Microbiology.
Diet Tied to Microbial Signature
The researchers analyzed biological samples from 21,561 individuals across five multi-national cohorts to map how differences in diet patterns (omnivore, vegetarian, and vegan) are reflected in gut microbiomes.
They found that the three diet patterns are highly distinguishable by their microbial profiles and that each diet has corresponding unique signature microbes, including those tied to digestion of specific types of food and sometimes those derived from food itself.
The microbiomes of omnivores had an increased presence of bacteria associated with meat digestion, such as Alistipes putredinis, which is involved in protein fermentation. Omnivores also had more bacteria associated with both inflammatory bowel disease and increased colon cancer risk, such as Ruminococcus torques and Bilophila wadsworthia.
The microbiomes of vegans had an abundance of bacteria involved in fiber fermentation, such as several species of Bacteroides and Firmicutes phyla, which help produce short-chain fatty acids. These compounds have beneficial effects on gut health by reducing inflammation and helping to maintain a better homeostatic balance between an individual’s metabolism and immune system.
The main difference between vegetarians and vegans was the presence in vegetarians’ microbiomes of Streptococcus thermophilus, a bacterium found mainly in dairy products and used in the production of yogurt.
Dietary factors within each diet pattern, such as the amount of plant-based food, shape the microbiome more than the type of diet and are important for gut health, according to the authors. For example, by eating more plant-based foods, people with an omnivorous diet can bring the proportion of beneficial signature microbes in their microbiomes more in line with the levels in people who are vegan or vegetarian.
“Since our data showed that omnivores on average ingest significantly fewer healthy plant-based foods than vegetarians or vegans, optimizing the quality of omnivore diets by increasing dietary plant diversity could lead to better gut health,” they wrote.
The ultimate goal, Segata said, is “a precision nutrition approach that recommends foods based on the configuration of the microbiome of patients and of the aspects of the microbiome one wants to enhance. We are not there yet, but it is nonetheless important to know which foods are usually boosting which types of members of the gut microbiome.”
His team is currently analyzing changes in the gut microbiome induced by diet changes among thousands of participants in various cohorts.
“This is one of the next steps toward unraveling causality along the diet-microbiome-health axis, together with the cultivation of specific microbiome members of interest for potential prebiotic and probiotic strategies,” he said.
Conventional Dietary Advice for Now
The findings are consistent with those of previous studies, Jack Gilbert, MD, director of the Microbiome and Metagenomics Center at the University of California, San Diego, and president of Applied Microbiology International, Cambridge, England, said in an interview.
“Future research needs to focus on whether the gut microbial signature can predict those that develop cardiovascular disease in each cohort — ie, the n-of-1 studies, whereby a vegan develops cardiovascular disease, or a carnivore does not,” said Gilbert, who was not involved in the study.
With more data, he said, “we can also start examining these trends over time to understand what might be going on with these ‘oddballs.’ ”
“There is not much you can do with the ‘eat a healthy balanced diet’ routine,” he noted. “If I got a microbiome signature, I could potentially tell you what to eat to optimize your blood glucose trends and your lipid panels but not to handle long-term disease risk, yet. So sticking with the guideline-recommended dietary advice seems best, until we can provide more nuanced advice for the patient.
“Importantly, I would also like to see time-resolved data,” he added. “Signatures can fluctuate over time, even over days, and so collecting a few weeks of stool samples would help us to better align the microbiome signatures to clinical endpoints.”
Segata is a consultant to and receives options from ZOE. Gilbert is a member of the scientific advisory boards of Holobiome, BiomeSense, EcoBiomics Canadian Research Program, MASTER EU, Sun Genomics, and Oath; the editorial advisory board for The Scientist; and the external advisory board for the Binational Early Asthma & Microbiome Study. He is also an adviser for Bened Life.
A version of this article appeared on Medscape.com.
FROM NATURE MICROBIOLOGY
Leaving ED Without Being Seen Entails Increasing Risks
Higher rates of leaving the emergency department (ED) without being seen are linked to increased short-term mortality or hospitalization, according to a cohort study in Ontario, Canada.
“We found that after 2020, there was a 14% higher risk for death or hospitalization within 7 days” among patients who left without being seen (LWBS), Candace McNaughton, MD, PhD, associate professor of medicine at the University of Toronto and scientist at Sunnybrook Research Institute, both in Toronto, Ontario, Canada, told this news organization.
“When we looked at death by itself, there was a 46% higher risk after 2020,” she said. “Even 30 days after a LWBS ED visit, there was still a 5% increased risk for death/hospitalization and a 24% increased risk for death.”
The study was published in the Journal of the American College of Emergency Physicians Open.
LWBS Rates Increased
Researchers used linked administrative data to analyze temporal trends in monthly rates of ED and LWBS visits for adults in Ontario from 2014 to 2023.
They compared the composite outcome of 7-day all-cause mortality or hospitalization following an LWBS ED visit in April 2022‒March 2023 (recent period) with that following an LWBS ED visit in April 2014‒March 2020 (baseline period), after adjustment for age, sex, and Charlson Comorbidity Index (CCI).
In the two periods, patient characteristics were similar across age, sex, neighborhood-level income quartile, history of being unhoused, rurality, CCI, day, time, and mode of arrival. The median age was 40 years for the baseline period and 42 years for the recent period.
Temporal trends showed sustained increases in monthly LWBS rates after 2020, despite fewer monthly ED visits. The rate of LWBS ED visits after April 1, 2020, exceeded the baseline period’s single-month LWBS maximum of 4% in 15 of 36 months.
The rate of 7-day all-cause mortality or hospitalization was 3.4% in the recent period vs 2.9% in the baseline period (adjusted risk ratio [aRR], 1.14), despite similar rates of post-ED outpatient visits (7-day recent and baseline, 38.9% and 39.7%, respectively).
Similar trends were seen at 30 days for all-cause mortality or hospitalization (6.2% in the recent period vs 5.8% at baseline; aRR, 1.05) despite similar rates of post-ED outpatient visits (59.4% and 59.7%, respectively).
After April 1, 2020, monthly ED visits and the proportion of patients who LWBS varied widely.
The proportion of LWBS visits categorized as emergent on the Canadian Triage and Acuity Scale was higher during the recent period (12.9% vs 9.2% in the baseline period), and fewer visits were categorized as semiurgent (22.6% vs 31.9%, respectively). This finding suggested a higher acuity of illness among patients who LWBS in the recent period.
LWBS Visits ‘Not Benign’
Results of a preplanned subgroup analysis examining the risk for all-cause mortality after an LWBS visit were “particularly notable,” the authors wrote, with a 46% higher adjusted risk for death at 7 days and 24% higher adjusted risk at 30 days.
The observational study had several limitations, however. The authors could not draw conclusions regarding direct causes of the increased risk for severe short-term adverse health outcomes after an LWBS ED visit, and residual confounding is possible. Cause-of-death information was not available to generate hypotheses for future studies of potential causes. Furthermore, the findings may not be generalizable to systems without universal access to healthcare.
Nevertheless, the findings are a “concerning signal [and] should prompt interventions to address system- and population-level causes,” the authors wrote.
“Unfortunately, because of politics, since 2020, ED closures in Ontario have become more and more common and seem to be affecting more and more Ontarians,” said McNaughton. “It would be surprising if ED closure didn’t play some role in our findings.”
She added, “It is important to note that people in our study were relatively young, with a median age in their 40s; this makes our findings all the more concerning. Clinicians should be aware that LWBS ED visits are not necessarily benign, particularly when rates of LWBS ED visits are high.”
Unanswered Questions
The study raised the following questions that the authors are or will be investigating, according to McNaughton:
- Which patients are at greatest risk for bad outcomes if they leave the ED without being seen, and why?
- How much of the findings might be related to recent ED closures, longer ED wait times, or other factors? Are there geographic variations in risk?
- What can be done in the ED to prevent LWBS ED visits, and what can be changed outside the ED to prevent LWBS ED visits? For example, what can hospitals do to reduce boarding in the ED? If patients leave without being seen, should they be contacted to try to meet their health needs in other ways?
- What worked in terms of maintaining access to outpatient medical care, despite the considerable disruptions starting in 2020, and how can continued success be ensured?
To address the current situation, McNaughton said, “We need consistent, predictable, and sustained investment in our public healthcare system. We need long-term, consistent funding for primary care, ED care, as well as hospital and long-term care.”
“It takes years to recruit and train the teams of people necessary to provide the high-quality medical care that Canadians have a right to. There are no shortcuts,” she concluded.
‘Tragic Situation’
American College of Emergency Physicians (ACEP) spokesperson Jesse Pines, MD, chief of clinical innovation at US Acute Care Solutions; clinical professor of emergency medicine at George Washington University in Washington, DC; and professor of emergency medicine at Drexel University in Philadelphia, commented on the study for this news organization.
“Similar to what the authors found in their report, LWBS and other metrics — specifically boarding — have progressively increased in the United States, in particular, since the early part of 2021,” he said. “The primary factor in the US driving this, and one that ACEP is trying to address on a national scale, is the boarding of admitted patients.”
When the number of boarded patients increases, there is less space in the ED for new patients, and waits increase, Pines explained. Some patients leave without being seen, and a subset of those patients experience poor outcomes. “It’s a tragic situation that is worsening.”
“Emergency physicians like me always worry when patients leave without being seen,” he said. While some of those patients have self-limited conditions that will improve on their own, “some have critical life-threatening conditions that require care and hospitalization. The worry is that these patients experience poorer outcomes,” Pines said. “The authors showed that this is increasingly the case in Canada. The same is likely true in the US.”
The study was funded by the Canadian Institutes of Health Research. McNaughton and Pines declared no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Higher rates of leaving the emergency department (ED) without being seen are linked to increased short-term mortality or hospitalization, according to a cohort study in Ontario, Canada.
“We found that after 2020, there was a 14% higher risk for death or hospitalization within 7 days” among patients who left without being seen (LWBS), Candace McNaughton, MD, PhD, associate professor of medicine at the University of Toronto and scientist at Sunnybrook Research Institute, both in Toronto, Ontario, Canada, told this news organization.
“When we looked at death by itself, there was a 46% higher risk after 2020,” she said. “Even 30 days after a LWBS ED visit, there was still a 5% increased risk for death/hospitalization and a 24% increased risk for death.”
The study was published in the Journal of the American College of Emergency Physicians Open.
LWBS Rates Increased
Researchers used linked administrative data to analyze temporal trends in monthly rates of ED and LWBS visits for adults in Ontario from 2014 to 2023.
They compared the composite outcome of 7-day all-cause mortality or hospitalization following an LWBS ED visit in April 2022‒March 2023 (recent period) with that following an LWBS ED visit in April 2014‒March 2020 (baseline period), after adjustment for age, sex, and Charlson Comorbidity Index (CCI).
In the two periods, patient characteristics were similar across age, sex, neighborhood-level income quartile, history of being unhoused, rurality, CCI, day, time, and mode of arrival. The median age was 40 years for the baseline period and 42 years for the recent period.
Temporal trends showed sustained increases in monthly LWBS rates after 2020, despite fewer monthly ED visits. The rate of LWBS ED visits after April 1, 2020, exceeded the baseline period’s single-month LWBS maximum of 4% in 15 of 36 months.
The rate of 7-day all-cause mortality or hospitalization was 3.4% in the recent period vs 2.9% in the baseline period (adjusted risk ratio [aRR], 1.14), despite similar rates of post-ED outpatient visits (7-day recent and baseline, 38.9% and 39.7%, respectively).
Similar trends were seen at 30 days for all-cause mortality or hospitalization (6.2% in the recent period vs 5.8% at baseline; aRR, 1.05) despite similar rates of post-ED outpatient visits (59.4% and 59.7%, respectively).
After April 1, 2020, monthly ED visits and the proportion of patients who LWBS varied widely.
The proportion of LWBS visits categorized as emergent on the Canadian Triage and Acuity Scale was higher during the recent period (12.9% vs 9.2% in the baseline period), and fewer visits were categorized as semiurgent (22.6% vs 31.9%, respectively). This finding suggested a higher acuity of illness among patients who LWBS in the recent period.
LWBS Visits ‘Not Benign’
Results of a preplanned subgroup analysis examining the risk for all-cause mortality after an LWBS visit were “particularly notable,” the authors wrote, with a 46% higher adjusted risk for death at 7 days and 24% higher adjusted risk at 30 days.
The observational study had several limitations, however. The authors could not draw conclusions regarding direct causes of the increased risk for severe short-term adverse health outcomes after an LWBS ED visit, and residual confounding is possible. Cause-of-death information was not available to generate hypotheses for future studies of potential causes. Furthermore, the findings may not be generalizable to systems without universal access to healthcare.
Nevertheless, the findings are a “concerning signal [and] should prompt interventions to address system- and population-level causes,” the authors wrote.
“Unfortunately, because of politics, since 2020, ED closures in Ontario have become more and more common and seem to be affecting more and more Ontarians,” said McNaughton. “It would be surprising if ED closure didn’t play some role in our findings.”
She added, “It is important to note that people in our study were relatively young, with a median age in their 40s; this makes our findings all the more concerning. Clinicians should be aware that LWBS ED visits are not necessarily benign, particularly when rates of LWBS ED visits are high.”
Unanswered Questions
The study raised the following questions that the authors are or will be investigating, according to McNaughton:
- Which patients are at greatest risk for bad outcomes if they leave the ED without being seen, and why?
- How much of the findings might be related to recent ED closures, longer ED wait times, or other factors? Are there geographic variations in risk?
- What can be done in the ED to prevent LWBS ED visits, and what can be changed outside the ED to prevent LWBS ED visits? For example, what can hospitals do to reduce boarding in the ED? If patients leave without being seen, should they be contacted to try to meet their health needs in other ways?
- What worked in terms of maintaining access to outpatient medical care, despite the considerable disruptions starting in 2020, and how can continued success be ensured?
To address the current situation, McNaughton said, “We need consistent, predictable, and sustained investment in our public healthcare system. We need long-term, consistent funding for primary care, ED care, as well as hospital and long-term care.”
“It takes years to recruit and train the teams of people necessary to provide the high-quality medical care that Canadians have a right to. There are no shortcuts,” she concluded.
‘Tragic Situation’
American College of Emergency Physicians (ACEP) spokesperson Jesse Pines, MD, chief of clinical innovation at US Acute Care Solutions; clinical professor of emergency medicine at George Washington University in Washington, DC; and professor of emergency medicine at Drexel University in Philadelphia, commented on the study for this news organization.
“Similar to what the authors found in their report, LWBS and other metrics — specifically boarding — have progressively increased in the United States, in particular, since the early part of 2021,” he said. “The primary factor in the US driving this, and one that ACEP is trying to address on a national scale, is the boarding of admitted patients.”
When the number of boarded patients increases, there is less space in the ED for new patients, and waits increase, Pines explained. Some patients leave without being seen, and a subset of those patients experience poor outcomes. “It’s a tragic situation that is worsening.”
“Emergency physicians like me always worry when patients leave without being seen,” he said. While some of those patients have self-limited conditions that will improve on their own, “some have critical life-threatening conditions that require care and hospitalization. The worry is that these patients experience poorer outcomes,” Pines said. “The authors showed that this is increasingly the case in Canada. The same is likely true in the US.”
The study was funded by the Canadian Institutes of Health Research. McNaughton and Pines declared no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Higher rates of leaving the emergency department (ED) without being seen are linked to increased short-term mortality or hospitalization, according to a cohort study in Ontario, Canada.
“We found that after 2020, there was a 14% higher risk for death or hospitalization within 7 days” among patients who left without being seen (LWBS), Candace McNaughton, MD, PhD, associate professor of medicine at the University of Toronto and scientist at Sunnybrook Research Institute, both in Toronto, Ontario, Canada, told this news organization.
“When we looked at death by itself, there was a 46% higher risk after 2020,” she said. “Even 30 days after a LWBS ED visit, there was still a 5% increased risk for death/hospitalization and a 24% increased risk for death.”
The study was published in the Journal of the American College of Emergency Physicians Open.
LWBS Rates Increased
Researchers used linked administrative data to analyze temporal trends in monthly rates of ED and LWBS visits for adults in Ontario from 2014 to 2023.
They compared the composite outcome of 7-day all-cause mortality or hospitalization following an LWBS ED visit in April 2022‒March 2023 (recent period) with that following an LWBS ED visit in April 2014‒March 2020 (baseline period), after adjustment for age, sex, and Charlson Comorbidity Index (CCI).
In the two periods, patient characteristics were similar across age, sex, neighborhood-level income quartile, history of being unhoused, rurality, CCI, day, time, and mode of arrival. The median age was 40 years for the baseline period and 42 years for the recent period.
Temporal trends showed sustained increases in monthly LWBS rates after 2020, despite fewer monthly ED visits. The rate of LWBS ED visits after April 1, 2020, exceeded the baseline period’s single-month LWBS maximum of 4% in 15 of 36 months.
The rate of 7-day all-cause mortality or hospitalization was 3.4% in the recent period vs 2.9% in the baseline period (adjusted risk ratio [aRR], 1.14), despite similar rates of post-ED outpatient visits (7-day recent and baseline, 38.9% and 39.7%, respectively).
Similar trends were seen at 30 days for all-cause mortality or hospitalization (6.2% in the recent period vs 5.8% at baseline; aRR, 1.05) despite similar rates of post-ED outpatient visits (59.4% and 59.7%, respectively).
After April 1, 2020, monthly ED visits and the proportion of patients who LWBS varied widely.
The proportion of LWBS visits categorized as emergent on the Canadian Triage and Acuity Scale was higher during the recent period (12.9% vs 9.2% in the baseline period), and fewer visits were categorized as semiurgent (22.6% vs 31.9%, respectively). This finding suggested a higher acuity of illness among patients who LWBS in the recent period.
LWBS Visits ‘Not Benign’
Results of a preplanned subgroup analysis examining the risk for all-cause mortality after an LWBS visit were “particularly notable,” the authors wrote, with a 46% higher adjusted risk for death at 7 days and 24% higher adjusted risk at 30 days.
The observational study had several limitations, however. The authors could not draw conclusions regarding direct causes of the increased risk for severe short-term adverse health outcomes after an LWBS ED visit, and residual confounding is possible. Cause-of-death information was not available to generate hypotheses for future studies of potential causes. Furthermore, the findings may not be generalizable to systems without universal access to healthcare.
Nevertheless, the findings are a “concerning signal [and] should prompt interventions to address system- and population-level causes,” the authors wrote.
“Unfortunately, because of politics, since 2020, ED closures in Ontario have become more and more common and seem to be affecting more and more Ontarians,” said McNaughton. “It would be surprising if ED closure didn’t play some role in our findings.”
She added, “It is important to note that people in our study were relatively young, with a median age in their 40s; this makes our findings all the more concerning. Clinicians should be aware that LWBS ED visits are not necessarily benign, particularly when rates of LWBS ED visits are high.”
Unanswered Questions
The study raised the following questions that the authors are or will be investigating, according to McNaughton:
- Which patients are at greatest risk for bad outcomes if they leave the ED without being seen, and why?
- How much of the findings might be related to recent ED closures, longer ED wait times, or other factors? Are there geographic variations in risk?
- What can be done in the ED to prevent LWBS ED visits, and what can be changed outside the ED to prevent LWBS ED visits? For example, what can hospitals do to reduce boarding in the ED? If patients leave without being seen, should they be contacted to try to meet their health needs in other ways?
- What worked in terms of maintaining access to outpatient medical care, despite the considerable disruptions starting in 2020, and how can continued success be ensured?
To address the current situation, McNaughton said, “We need consistent, predictable, and sustained investment in our public healthcare system. We need long-term, consistent funding for primary care, ED care, as well as hospital and long-term care.”
“It takes years to recruit and train the teams of people necessary to provide the high-quality medical care that Canadians have a right to. There are no shortcuts,” she concluded.
‘Tragic Situation’
American College of Emergency Physicians (ACEP) spokesperson Jesse Pines, MD, chief of clinical innovation at US Acute Care Solutions; clinical professor of emergency medicine at George Washington University in Washington, DC; and professor of emergency medicine at Drexel University in Philadelphia, commented on the study for this news organization.
“Similar to what the authors found in their report, LWBS and other metrics — specifically boarding — have progressively increased in the United States, in particular, since the early part of 2021,” he said. “The primary factor in the US driving this, and one that ACEP is trying to address on a national scale, is the boarding of admitted patients.”
When the number of boarded patients increases, there is less space in the ED for new patients, and waits increase, Pines explained. Some patients leave without being seen, and a subset of those patients experience poor outcomes. “It’s a tragic situation that is worsening.”
“Emergency physicians like me always worry when patients leave without being seen,” he said. While some of those patients have self-limited conditions that will improve on their own, “some have critical life-threatening conditions that require care and hospitalization. The worry is that these patients experience poorer outcomes,” Pines said. “The authors showed that this is increasingly the case in Canada. The same is likely true in the US.”
The study was funded by the Canadian Institutes of Health Research. McNaughton and Pines declared no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Using AI to ID Osteoporosis: A Medico-Legal Minefield?
Could an artificial intelligence (AI)–driven tool that mines medical records for suspected cases of osteoporosis be so successful that it becomes a potential liability? Yes, according to Christopher White, PhD, executive director of Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research, and Enterprise, a research translation center in Liverpool, Australia.
In a thought-provoking presentation at the Endocrine Society’s AI in Healthcare Virtual Summit, White described the results after his fracture liaison team at Prince of Wales Hospital in Randwick, Australia, tried to plug the “osteoporosis treatment gap” by mining medical records to identify patients with the disorder.
‘Be Careful What You Wish For’
White and colleagues developed a robust standalone database over 20 years that informed fracture risk among patients with osteoporosis in Sydney. The database included all relevant clinical information, as well as bone density measurements, on about 30,000 patients and could be interrogated for randomized controlled trial recruitment.
However, a “crisis” occurred around 2011, when the team received a recruitment request for the first head-to-head comparison of alendronate with romosozumab. “We had numerous postmenopausal women in the age range with the required bone density, but we hadn’t captured the severity of their vertebral fracture or how many they actually had,” White told the this news organization. For recruitment into the study, participants must have had at least two moderate or severe vertebral fractures or a proximal vertebral fracture that was sustained between 3 and 24 months before recruitment.
White turned to his hospital’s mainframe, which had coding data and time intervals for patients who were admitted with vertebral or hip fractures. He calculated how many patients who met the study criteria had been discharged and how many of those he thought he’d be able to capture through the mainframe. He was confident he would have enough, but he was wrong. He underrecruited and could not participate in the trial.
Determined not to wind up in a similar situation in the future, he investigated and found that other centers were struggling with similar problems. This led to a collaboration with four investigators who were using AI and Advanced Encryption Standard (AES) coding to identify patients at risk for osteoporotic fractures. White, meanwhile, had developed a natural language processing tool called XRAIT that also identified patients at fracture risk. A study comparing the two electronic search programs, which screen medical records for fractures, found that both reliably identified patients who had had a fracture. White and his colleagues concluded that hybrid tools combining XRAIT and AES would likely improve the identification of patients with osteoporosis who would require follow-up or might participate in future trials.
Those patients were not being identified sooner for multiple reasons, White explained. Sometimes, the radiologist would report osteoporosis, but it wouldn’t get coded. Or, in the emergency department, a patient with a fracture would be treated and then sent home, and the possibility of osteoporosis wasn’t reported.
“As we went deeper and deeper with our tools into the medical record, we found more and more patients who hadn’t been coded or reported but who actually had osteoporosis,” White said. “It was incredibly prevalent.”
But the number of patients identified was more than the hospital could comfortably handle.
Ironically, he added, “To my relief and probably not to the benefit of the patients, there was a system upgrade of the radiology reporting system, which was incompatible with the natural language processing technology that I had installed. The AI was turned off at that point, but I had a look over the edge and into the mine pit.”
“The lesson learned,” White told this news organization, is “If you mine the medical record for unidentified patients before you know what to do with the output, you create a medico-legal minefield. You need to be careful what you wish for with technology, because it may actually come true.”
Grappling With the Treatment Gap
An (over)abundance of patients is likely contributing to the “osteoporosis treatment gap” that Australia’s fracture liaison services, which handle many of these patients, are grappling with. One recent meta-analysis showed that not all eligible patients are treated and that not all patients who are treated actually start treatment. Another study showed that only a minority of patients — anywhere between 20% and 40% — who start are still persisting at about 3 years, White said.
Various types of fracture liaison services exist, he noted. The model that has been shown to best promote adherence is the one requiring clinicians to “identify, educate [usually, the primary care physician], evaluate, start treatment, continue treatment, and follow-up at 12 months for to confirm that there is adherence.”
What’s happening now, he said, is that the technology is identifying a high number of vertebral crush fractures, and there’s no education or evaluation. “The radiologist just refers the patient to a primary care physician and hopes for the best. AI isn’t contributing to solving the treatment gap problem; it’s amplifying it. It’s ahead of the ability of organizations to accommodate the findings.”
Solutions, he said, would require support at the top of health systems and organizations, and funding to proceed; data surveys concentrating on vertical integration of the medical record to follow patients wherever they are — eg, hospital, primary care — in their health journeys; a workflow with synchronous diagnosis and treatment planning, delivery, monitoring, and payment; and clinical and community champions advocating and “leading the charge in health tech.”
Furthermore, he advised, organizations need to be “very, very careful with safety and security — that is, managing the digital risks.”
“Oscar Wilde said there are two tragedies in life: One is not getting what one wants, and the other is getting it,” White concluded. “In my career, we’ve moved on from not knowing how to treat osteoporosis to knowing how to treat it. And that is both an asset and a liability.”
A version of this article first appeared on Medscape.com.
Could an artificial intelligence (AI)–driven tool that mines medical records for suspected cases of osteoporosis be so successful that it becomes a potential liability? Yes, according to Christopher White, PhD, executive director of Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research, and Enterprise, a research translation center in Liverpool, Australia.
In a thought-provoking presentation at the Endocrine Society’s AI in Healthcare Virtual Summit, White described the results after his fracture liaison team at Prince of Wales Hospital in Randwick, Australia, tried to plug the “osteoporosis treatment gap” by mining medical records to identify patients with the disorder.
‘Be Careful What You Wish For’
White and colleagues developed a robust standalone database over 20 years that informed fracture risk among patients with osteoporosis in Sydney. The database included all relevant clinical information, as well as bone density measurements, on about 30,000 patients and could be interrogated for randomized controlled trial recruitment.
However, a “crisis” occurred around 2011, when the team received a recruitment request for the first head-to-head comparison of alendronate with romosozumab. “We had numerous postmenopausal women in the age range with the required bone density, but we hadn’t captured the severity of their vertebral fracture or how many they actually had,” White told the this news organization. For recruitment into the study, participants must have had at least two moderate or severe vertebral fractures or a proximal vertebral fracture that was sustained between 3 and 24 months before recruitment.
White turned to his hospital’s mainframe, which had coding data and time intervals for patients who were admitted with vertebral or hip fractures. He calculated how many patients who met the study criteria had been discharged and how many of those he thought he’d be able to capture through the mainframe. He was confident he would have enough, but he was wrong. He underrecruited and could not participate in the trial.
Determined not to wind up in a similar situation in the future, he investigated and found that other centers were struggling with similar problems. This led to a collaboration with four investigators who were using AI and Advanced Encryption Standard (AES) coding to identify patients at risk for osteoporotic fractures. White, meanwhile, had developed a natural language processing tool called XRAIT that also identified patients at fracture risk. A study comparing the two electronic search programs, which screen medical records for fractures, found that both reliably identified patients who had had a fracture. White and his colleagues concluded that hybrid tools combining XRAIT and AES would likely improve the identification of patients with osteoporosis who would require follow-up or might participate in future trials.
Those patients were not being identified sooner for multiple reasons, White explained. Sometimes, the radiologist would report osteoporosis, but it wouldn’t get coded. Or, in the emergency department, a patient with a fracture would be treated and then sent home, and the possibility of osteoporosis wasn’t reported.
“As we went deeper and deeper with our tools into the medical record, we found more and more patients who hadn’t been coded or reported but who actually had osteoporosis,” White said. “It was incredibly prevalent.”
But the number of patients identified was more than the hospital could comfortably handle.
Ironically, he added, “To my relief and probably not to the benefit of the patients, there was a system upgrade of the radiology reporting system, which was incompatible with the natural language processing technology that I had installed. The AI was turned off at that point, but I had a look over the edge and into the mine pit.”
“The lesson learned,” White told this news organization, is “If you mine the medical record for unidentified patients before you know what to do with the output, you create a medico-legal minefield. You need to be careful what you wish for with technology, because it may actually come true.”
Grappling With the Treatment Gap
An (over)abundance of patients is likely contributing to the “osteoporosis treatment gap” that Australia’s fracture liaison services, which handle many of these patients, are grappling with. One recent meta-analysis showed that not all eligible patients are treated and that not all patients who are treated actually start treatment. Another study showed that only a minority of patients — anywhere between 20% and 40% — who start are still persisting at about 3 years, White said.
Various types of fracture liaison services exist, he noted. The model that has been shown to best promote adherence is the one requiring clinicians to “identify, educate [usually, the primary care physician], evaluate, start treatment, continue treatment, and follow-up at 12 months for to confirm that there is adherence.”
What’s happening now, he said, is that the technology is identifying a high number of vertebral crush fractures, and there’s no education or evaluation. “The radiologist just refers the patient to a primary care physician and hopes for the best. AI isn’t contributing to solving the treatment gap problem; it’s amplifying it. It’s ahead of the ability of organizations to accommodate the findings.”
Solutions, he said, would require support at the top of health systems and organizations, and funding to proceed; data surveys concentrating on vertical integration of the medical record to follow patients wherever they are — eg, hospital, primary care — in their health journeys; a workflow with synchronous diagnosis and treatment planning, delivery, monitoring, and payment; and clinical and community champions advocating and “leading the charge in health tech.”
Furthermore, he advised, organizations need to be “very, very careful with safety and security — that is, managing the digital risks.”
“Oscar Wilde said there are two tragedies in life: One is not getting what one wants, and the other is getting it,” White concluded. “In my career, we’ve moved on from not knowing how to treat osteoporosis to knowing how to treat it. And that is both an asset and a liability.”
A version of this article first appeared on Medscape.com.
Could an artificial intelligence (AI)–driven tool that mines medical records for suspected cases of osteoporosis be so successful that it becomes a potential liability? Yes, according to Christopher White, PhD, executive director of Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research, and Enterprise, a research translation center in Liverpool, Australia.
In a thought-provoking presentation at the Endocrine Society’s AI in Healthcare Virtual Summit, White described the results after his fracture liaison team at Prince of Wales Hospital in Randwick, Australia, tried to plug the “osteoporosis treatment gap” by mining medical records to identify patients with the disorder.
‘Be Careful What You Wish For’
White and colleagues developed a robust standalone database over 20 years that informed fracture risk among patients with osteoporosis in Sydney. The database included all relevant clinical information, as well as bone density measurements, on about 30,000 patients and could be interrogated for randomized controlled trial recruitment.
However, a “crisis” occurred around 2011, when the team received a recruitment request for the first head-to-head comparison of alendronate with romosozumab. “We had numerous postmenopausal women in the age range with the required bone density, but we hadn’t captured the severity of their vertebral fracture or how many they actually had,” White told the this news organization. For recruitment into the study, participants must have had at least two moderate or severe vertebral fractures or a proximal vertebral fracture that was sustained between 3 and 24 months before recruitment.
White turned to his hospital’s mainframe, which had coding data and time intervals for patients who were admitted with vertebral or hip fractures. He calculated how many patients who met the study criteria had been discharged and how many of those he thought he’d be able to capture through the mainframe. He was confident he would have enough, but he was wrong. He underrecruited and could not participate in the trial.
Determined not to wind up in a similar situation in the future, he investigated and found that other centers were struggling with similar problems. This led to a collaboration with four investigators who were using AI and Advanced Encryption Standard (AES) coding to identify patients at risk for osteoporotic fractures. White, meanwhile, had developed a natural language processing tool called XRAIT that also identified patients at fracture risk. A study comparing the two electronic search programs, which screen medical records for fractures, found that both reliably identified patients who had had a fracture. White and his colleagues concluded that hybrid tools combining XRAIT and AES would likely improve the identification of patients with osteoporosis who would require follow-up or might participate in future trials.
Those patients were not being identified sooner for multiple reasons, White explained. Sometimes, the radiologist would report osteoporosis, but it wouldn’t get coded. Or, in the emergency department, a patient with a fracture would be treated and then sent home, and the possibility of osteoporosis wasn’t reported.
“As we went deeper and deeper with our tools into the medical record, we found more and more patients who hadn’t been coded or reported but who actually had osteoporosis,” White said. “It was incredibly prevalent.”
But the number of patients identified was more than the hospital could comfortably handle.
Ironically, he added, “To my relief and probably not to the benefit of the patients, there was a system upgrade of the radiology reporting system, which was incompatible with the natural language processing technology that I had installed. The AI was turned off at that point, but I had a look over the edge and into the mine pit.”
“The lesson learned,” White told this news organization, is “If you mine the medical record for unidentified patients before you know what to do with the output, you create a medico-legal minefield. You need to be careful what you wish for with technology, because it may actually come true.”
Grappling With the Treatment Gap
An (over)abundance of patients is likely contributing to the “osteoporosis treatment gap” that Australia’s fracture liaison services, which handle many of these patients, are grappling with. One recent meta-analysis showed that not all eligible patients are treated and that not all patients who are treated actually start treatment. Another study showed that only a minority of patients — anywhere between 20% and 40% — who start are still persisting at about 3 years, White said.
Various types of fracture liaison services exist, he noted. The model that has been shown to best promote adherence is the one requiring clinicians to “identify, educate [usually, the primary care physician], evaluate, start treatment, continue treatment, and follow-up at 12 months for to confirm that there is adherence.”
What’s happening now, he said, is that the technology is identifying a high number of vertebral crush fractures, and there’s no education or evaluation. “The radiologist just refers the patient to a primary care physician and hopes for the best. AI isn’t contributing to solving the treatment gap problem; it’s amplifying it. It’s ahead of the ability of organizations to accommodate the findings.”
Solutions, he said, would require support at the top of health systems and organizations, and funding to proceed; data surveys concentrating on vertical integration of the medical record to follow patients wherever they are — eg, hospital, primary care — in their health journeys; a workflow with synchronous diagnosis and treatment planning, delivery, monitoring, and payment; and clinical and community champions advocating and “leading the charge in health tech.”
Furthermore, he advised, organizations need to be “very, very careful with safety and security — that is, managing the digital risks.”
“Oscar Wilde said there are two tragedies in life: One is not getting what one wants, and the other is getting it,” White concluded. “In my career, we’ve moved on from not knowing how to treat osteoporosis to knowing how to treat it. And that is both an asset and a liability.”
A version of this article first appeared on Medscape.com.
Broken Sleep Linked to MASLD
TOPLINE:
Fragmented sleep — that is, increased wakefulness and reduced sleep efficiency — is a sign of metabolic dysfunction–associated steatotic liver disease (MASLD), a study using actigraphy showed.
METHODOLOGY:
- Researchers assessed sleep-wake rhythms in 35 patients with MASLD (median age, 58 years; 66% were men; 80% with metabolic syndrome) and 16 matched healthy controls (median age, 61 years; 50% were men) using data collected 24/7 via actigraphy for 4 weeks.
- Sub-analyses were conducted with MASLD comparator groups: 16 patients with MASH, 8 with MASH with cirrhosis, and 11 with non-MASH–related cirrhosis.
- All participants visited the clinic at baseline, week 2, and week 4 to undergo a clinical investigation and complete questionnaires about their sleep.
- A standardized sleep hygiene education session was conducted at week 2.
TAKEAWAY:
- Actigraphy data from patients with MASLD did not reveal significant differences in bedtime, sleep-onset latency, sleep duration, wake-up time, or time in bed compared with controls.
- However, compared with controls, those with MASLD woke 55% more often at night (8.5 vs 5.5), lay awake 113% longer after having first fallen asleep (45.4 minutes vs 21.3 minutes), and slept more often and longer during the day (decreased sleep efficiency).
- Subgroup analyses showed that actigraphy-measured sleep patterns and quality were similarly impaired in patients with MASH, MASH with cirrhosis, and non–MASH-related cirrhosis.
- Patients with MASLD self-reported their fragmented sleep as shorter sleep with a delayed onset. In sleep diaries, 32% of patients with MASLD reported sleep disturbances caused by psychological stress, compared with only 6.25% of controls and 9% of patients with cirrhosis.
- The sleep education session did not change the actigraphy measures or the sleep parameters assessed with sleep questionnaires at the end of the study.
IN PRACTICE:
“We concluded from our data that sleep fragmentation plays a role in the pathogenesis of human MASLD. Whether MASLD causes sleep disorders or vice versa remains unknown. The underlying mechanism presumably involves genetics, environmental factors, and the activation of immune responses — ultimately driven by obesity and metabolic syndrome,” said corresponding author.
SOURCE:
The study, led by Sofia Schaeffer, PhD, University of Basel, Switzerland, was published online in Frontiers in Network Physiology.
LIMITATIONS:
The study had several limitations. There was a significant difference in body mass index between patients with MASLD (median, 31) and controls (median, 23.5), representing a potential confounder that could explain the differences in sleep behavior. Undetected obstructive sleep apnea could also be a confounding factor. The small number of participants limited the interpretation and generalization of the data, especially in the MASLD subgroups.
DISCLOSURES:
This study was supported by a grant from the University of Basel. One coauthor received a research grant from the University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland. Another coauthor was employed by NovoLytiX. Schaeffer and the remaining coauthors declared that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
Fragmented sleep — that is, increased wakefulness and reduced sleep efficiency — is a sign of metabolic dysfunction–associated steatotic liver disease (MASLD), a study using actigraphy showed.
METHODOLOGY:
- Researchers assessed sleep-wake rhythms in 35 patients with MASLD (median age, 58 years; 66% were men; 80% with metabolic syndrome) and 16 matched healthy controls (median age, 61 years; 50% were men) using data collected 24/7 via actigraphy for 4 weeks.
- Sub-analyses were conducted with MASLD comparator groups: 16 patients with MASH, 8 with MASH with cirrhosis, and 11 with non-MASH–related cirrhosis.
- All participants visited the clinic at baseline, week 2, and week 4 to undergo a clinical investigation and complete questionnaires about their sleep.
- A standardized sleep hygiene education session was conducted at week 2.
TAKEAWAY:
- Actigraphy data from patients with MASLD did not reveal significant differences in bedtime, sleep-onset latency, sleep duration, wake-up time, or time in bed compared with controls.
- However, compared with controls, those with MASLD woke 55% more often at night (8.5 vs 5.5), lay awake 113% longer after having first fallen asleep (45.4 minutes vs 21.3 minutes), and slept more often and longer during the day (decreased sleep efficiency).
- Subgroup analyses showed that actigraphy-measured sleep patterns and quality were similarly impaired in patients with MASH, MASH with cirrhosis, and non–MASH-related cirrhosis.
- Patients with MASLD self-reported their fragmented sleep as shorter sleep with a delayed onset. In sleep diaries, 32% of patients with MASLD reported sleep disturbances caused by psychological stress, compared with only 6.25% of controls and 9% of patients with cirrhosis.
- The sleep education session did not change the actigraphy measures or the sleep parameters assessed with sleep questionnaires at the end of the study.
IN PRACTICE:
“We concluded from our data that sleep fragmentation plays a role in the pathogenesis of human MASLD. Whether MASLD causes sleep disorders or vice versa remains unknown. The underlying mechanism presumably involves genetics, environmental factors, and the activation of immune responses — ultimately driven by obesity and metabolic syndrome,” said corresponding author.
SOURCE:
The study, led by Sofia Schaeffer, PhD, University of Basel, Switzerland, was published online in Frontiers in Network Physiology.
LIMITATIONS:
The study had several limitations. There was a significant difference in body mass index between patients with MASLD (median, 31) and controls (median, 23.5), representing a potential confounder that could explain the differences in sleep behavior. Undetected obstructive sleep apnea could also be a confounding factor. The small number of participants limited the interpretation and generalization of the data, especially in the MASLD subgroups.
DISCLOSURES:
This study was supported by a grant from the University of Basel. One coauthor received a research grant from the University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland. Another coauthor was employed by NovoLytiX. Schaeffer and the remaining coauthors declared that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
Fragmented sleep — that is, increased wakefulness and reduced sleep efficiency — is a sign of metabolic dysfunction–associated steatotic liver disease (MASLD), a study using actigraphy showed.
METHODOLOGY:
- Researchers assessed sleep-wake rhythms in 35 patients with MASLD (median age, 58 years; 66% were men; 80% with metabolic syndrome) and 16 matched healthy controls (median age, 61 years; 50% were men) using data collected 24/7 via actigraphy for 4 weeks.
- Sub-analyses were conducted with MASLD comparator groups: 16 patients with MASH, 8 with MASH with cirrhosis, and 11 with non-MASH–related cirrhosis.
- All participants visited the clinic at baseline, week 2, and week 4 to undergo a clinical investigation and complete questionnaires about their sleep.
- A standardized sleep hygiene education session was conducted at week 2.
TAKEAWAY:
- Actigraphy data from patients with MASLD did not reveal significant differences in bedtime, sleep-onset latency, sleep duration, wake-up time, or time in bed compared with controls.
- However, compared with controls, those with MASLD woke 55% more often at night (8.5 vs 5.5), lay awake 113% longer after having first fallen asleep (45.4 minutes vs 21.3 minutes), and slept more often and longer during the day (decreased sleep efficiency).
- Subgroup analyses showed that actigraphy-measured sleep patterns and quality were similarly impaired in patients with MASH, MASH with cirrhosis, and non–MASH-related cirrhosis.
- Patients with MASLD self-reported their fragmented sleep as shorter sleep with a delayed onset. In sleep diaries, 32% of patients with MASLD reported sleep disturbances caused by psychological stress, compared with only 6.25% of controls and 9% of patients with cirrhosis.
- The sleep education session did not change the actigraphy measures or the sleep parameters assessed with sleep questionnaires at the end of the study.
IN PRACTICE:
“We concluded from our data that sleep fragmentation plays a role in the pathogenesis of human MASLD. Whether MASLD causes sleep disorders or vice versa remains unknown. The underlying mechanism presumably involves genetics, environmental factors, and the activation of immune responses — ultimately driven by obesity and metabolic syndrome,” said corresponding author.
SOURCE:
The study, led by Sofia Schaeffer, PhD, University of Basel, Switzerland, was published online in Frontiers in Network Physiology.
LIMITATIONS:
The study had several limitations. There was a significant difference in body mass index between patients with MASLD (median, 31) and controls (median, 23.5), representing a potential confounder that could explain the differences in sleep behavior. Undetected obstructive sleep apnea could also be a confounding factor. The small number of participants limited the interpretation and generalization of the data, especially in the MASLD subgroups.
DISCLOSURES:
This study was supported by a grant from the University of Basel. One coauthor received a research grant from the University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland. Another coauthor was employed by NovoLytiX. Schaeffer and the remaining coauthors declared that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
A version of this article first appeared on Medscape.com.
Coffee Consumption Linked to Specific Gut Bacterium
TOPLINE:
METHODOLOGY:
- The researchers selected coffee as a model to investigate the interplay between specific foods and the intestinal microbial community.
- They conducted a multicohort, multiomic analysis of US and UK populations with detailed dietary information from 22,867 participants, which they then integrated with public data from 211 cohorts comprising 54,198 participants.
- They conducted various in vitro experiments to expand and validate their findings, including adding coffee to media containing the L asaccharolyticus species that had been isolated from human feces.
TAKEAWAY:
- L asaccharolyticus is highly prevalent, with about fourfold higher average abundance in coffee drinkers, and its growth is stimulated in vitro by coffee supplementation.
- The link between coffee consumption and the microbiome was highly reproducible across different populations (area under the curve, 0.89), driven largely by the presence and abundance of L asaccharolyticus.
- Similar associations were found in analyses of data from 25 countries. The prevalence of the bacterium was high in European countries with high per capita coffee consumption, such as Luxembourg, Denmark, and Sweden, and very low in countries with low per capita coffee consumption, such as China, Argentina, and India.
- Plasma metabolomics on 438 samples identified several metabolites enriched among coffee drinkers, with quinic acid and its potential derivatives associated with both coffee and L asaccharolyticus.
IN PRACTICE:
“Our study provides insights into how the gut microbiome potentially mediates the chemistry — and thus health benefits — of coffee,” the study authors wrote. “The microbial mechanisms underlying the metabolism of coffee are a step towards mapping the role of specific foods on the gut microbiome, and similar patterns of microorganism–food interactions for other dietary elements should be sought with systematic epidemiologic and metagenomic investigations.”
SOURCE:
Paolo Manghi, PhD, University of Trento, Italy, led the study, which was published online in Nature Microbiology.
LIMITATIONS:
The authors relied on food questionnaires to assess coffee intake. The study is observational, and the clinical implications are unknown.
DISCLOSURES:
This work was supported by ZOE, a biotech company, and TwinsUK, an adult twin registry funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation, the National Institute for Health and Care Research — Clinical Research Network and Biomedical Research Centre based at Guy’s and St. Thomas’ NHS Foundation Trust in partnership with King’s College London. Manghi had no competing interests. Several other coauthors reported financial relationships with ZOE, and three are cofounders of the company.
A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- The researchers selected coffee as a model to investigate the interplay between specific foods and the intestinal microbial community.
- They conducted a multicohort, multiomic analysis of US and UK populations with detailed dietary information from 22,867 participants, which they then integrated with public data from 211 cohorts comprising 54,198 participants.
- They conducted various in vitro experiments to expand and validate their findings, including adding coffee to media containing the L asaccharolyticus species that had been isolated from human feces.
TAKEAWAY:
- L asaccharolyticus is highly prevalent, with about fourfold higher average abundance in coffee drinkers, and its growth is stimulated in vitro by coffee supplementation.
- The link between coffee consumption and the microbiome was highly reproducible across different populations (area under the curve, 0.89), driven largely by the presence and abundance of L asaccharolyticus.
- Similar associations were found in analyses of data from 25 countries. The prevalence of the bacterium was high in European countries with high per capita coffee consumption, such as Luxembourg, Denmark, and Sweden, and very low in countries with low per capita coffee consumption, such as China, Argentina, and India.
- Plasma metabolomics on 438 samples identified several metabolites enriched among coffee drinkers, with quinic acid and its potential derivatives associated with both coffee and L asaccharolyticus.
IN PRACTICE:
“Our study provides insights into how the gut microbiome potentially mediates the chemistry — and thus health benefits — of coffee,” the study authors wrote. “The microbial mechanisms underlying the metabolism of coffee are a step towards mapping the role of specific foods on the gut microbiome, and similar patterns of microorganism–food interactions for other dietary elements should be sought with systematic epidemiologic and metagenomic investigations.”
SOURCE:
Paolo Manghi, PhD, University of Trento, Italy, led the study, which was published online in Nature Microbiology.
LIMITATIONS:
The authors relied on food questionnaires to assess coffee intake. The study is observational, and the clinical implications are unknown.
DISCLOSURES:
This work was supported by ZOE, a biotech company, and TwinsUK, an adult twin registry funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation, the National Institute for Health and Care Research — Clinical Research Network and Biomedical Research Centre based at Guy’s and St. Thomas’ NHS Foundation Trust in partnership with King’s College London. Manghi had no competing interests. Several other coauthors reported financial relationships with ZOE, and three are cofounders of the company.
A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- The researchers selected coffee as a model to investigate the interplay between specific foods and the intestinal microbial community.
- They conducted a multicohort, multiomic analysis of US and UK populations with detailed dietary information from 22,867 participants, which they then integrated with public data from 211 cohorts comprising 54,198 participants.
- They conducted various in vitro experiments to expand and validate their findings, including adding coffee to media containing the L asaccharolyticus species that had been isolated from human feces.
TAKEAWAY:
- L asaccharolyticus is highly prevalent, with about fourfold higher average abundance in coffee drinkers, and its growth is stimulated in vitro by coffee supplementation.
- The link between coffee consumption and the microbiome was highly reproducible across different populations (area under the curve, 0.89), driven largely by the presence and abundance of L asaccharolyticus.
- Similar associations were found in analyses of data from 25 countries. The prevalence of the bacterium was high in European countries with high per capita coffee consumption, such as Luxembourg, Denmark, and Sweden, and very low in countries with low per capita coffee consumption, such as China, Argentina, and India.
- Plasma metabolomics on 438 samples identified several metabolites enriched among coffee drinkers, with quinic acid and its potential derivatives associated with both coffee and L asaccharolyticus.
IN PRACTICE:
“Our study provides insights into how the gut microbiome potentially mediates the chemistry — and thus health benefits — of coffee,” the study authors wrote. “The microbial mechanisms underlying the metabolism of coffee are a step towards mapping the role of specific foods on the gut microbiome, and similar patterns of microorganism–food interactions for other dietary elements should be sought with systematic epidemiologic and metagenomic investigations.”
SOURCE:
Paolo Manghi, PhD, University of Trento, Italy, led the study, which was published online in Nature Microbiology.
LIMITATIONS:
The authors relied on food questionnaires to assess coffee intake. The study is observational, and the clinical implications are unknown.
DISCLOSURES:
This work was supported by ZOE, a biotech company, and TwinsUK, an adult twin registry funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation, the National Institute for Health and Care Research — Clinical Research Network and Biomedical Research Centre based at Guy’s and St. Thomas’ NHS Foundation Trust in partnership with King’s College London. Manghi had no competing interests. Several other coauthors reported financial relationships with ZOE, and three are cofounders of the company.
A version of this article first appeared on Medscape.com.
Plant-Based Food Prioritized Over Meat in Dietary Guidelines Report
The scientific report that offers evidence-based guidance for the next iteration of the Dietary Guidelines for Americans has been submitted to federal agencies, and the document — which already has generated controversy because of its emphasis on plant-based foods — is now open for public comment.
“We saw something over and over again — when you look at a population level, diets for which the predominant composition was plants performed better when it came to health outcomes,” advisory committee member Cheryl Anderson, PhD, MPH, who is a professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, said in an interview. “There’s a pretty consistent body of literature showing benefits of fruits, vegetables, and legumes and reductions in salt, added sugars, and saturated fats.”
Clinicians should read and comment on the report, said Anderson.
“Commenting sends the right signal that they are interested in what’s needed for nutrition education,” she said. “It will also activate a conversation with the people who are writing the guidelines.”
Instructions for submitting comments online through February 10, 2025, and for participating in the oral comment meeting on January 16, 2025, are posted online.
The Department of Agriculture (USDA) and the Department of Health & Human Services will use the report as a key resource, alongside the public comments and agency input, as they jointly develop the Dietary Guidelines for Americans, 2025-2030.
Meat Given a Back Seat
Overall, the advisory committee defined a “healthy dietary pattern” as one that is “higher in vegetables, fruits, legumes (ie, beans, peas, lentils), nuts, whole grains, fish/seafood, and vegetable oils higher in unsaturated fat — and lower in red and processed meats, sugar-sweetened foods and beverages, refined grains, and saturated fat.”
The report emphasizes “plain drinking water” as the primary beverage for people to consume and states that sugar-sweetened beverage consumption should be limited.
It recommends limiting total saturated fat intake to less than 10% of daily calories and replacing it with unsaturated fat, particularly polyunsaturated fats.
Notably, the report advocates increasing the consumption of beans, peas, and lentils and decreasing starchy vegetables (such as potatoes), as well as reducing total protein foods by reducing meat, poultry, and eggs. This recommendation and the report’s broad emphasis on plant-based foods have drawn criticism, mainly from the food industry.
Also likely to be controversial are the recommendations to move beans, peas, and lentils from the vegetable group to the protein group and the proposed reorganization of the order of the protein foods group to list beans, peas, and lentils first, followed by nuts, seeds, and soy products; then seafood; and finally meats, poultry, and eggs.
Gastroenterologists and dietitians should support the emphasis on plant-based protein sources, water for hydration, and the importance of personalized nutrition plans, including culturally diverse and ethnic food options, said Stephanie Gold, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai and a gastroenterologist at Mount Sinai Hospital, both in New York City.
“The newly proposed 2025 Dietary Guidelines are approaching a Mediterranean-style diet by focusing on plant-based protein sources while limiting red meat and saturated fats, as well as added sugar. By including these legumes in the protein category (not only as a starchy vegetable), the proposed guideline recognizes both the health benefits and sustainability of plant-based proteins,” Gold said in an interview.
Although the report recognizes “the potential negative impact and the varying definitions of ultra-processed foods, it does not provide concrete recommendations regarding intake, and perhaps, this could be an area of focus going forward,” she added.
Anderson noted that the science around ultra-processed food is “underdeveloped.” However, the definition of a healthy diet “has never suggested that we have foods that are extremely processed in it.”
“Right now, there’s a lot of interest in ultra-processed foods and what they mean for health, but the science is going to need to catch up with that interest,” Anderson said.
What’s Next
The release of the scientific report is part of a five-step process to develop the new guidelines that included input from the public during the report’s development. According to the USDA, the advisory committee received approximately 9900 public comments, more than any other previous committee.
Once the new dietary guidelines are complete, Anderson said, “clinicians have an opportunity to really lean into a science-based framework to talk about overall health concerns and reducing the burden of diet-related illnesses with their patients.”
Meanwhile, they can voice their approval or concerns about the scientific report.
Anderson and Gold reported no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
The scientific report that offers evidence-based guidance for the next iteration of the Dietary Guidelines for Americans has been submitted to federal agencies, and the document — which already has generated controversy because of its emphasis on plant-based foods — is now open for public comment.
“We saw something over and over again — when you look at a population level, diets for which the predominant composition was plants performed better when it came to health outcomes,” advisory committee member Cheryl Anderson, PhD, MPH, who is a professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, said in an interview. “There’s a pretty consistent body of literature showing benefits of fruits, vegetables, and legumes and reductions in salt, added sugars, and saturated fats.”
Clinicians should read and comment on the report, said Anderson.
“Commenting sends the right signal that they are interested in what’s needed for nutrition education,” she said. “It will also activate a conversation with the people who are writing the guidelines.”
Instructions for submitting comments online through February 10, 2025, and for participating in the oral comment meeting on January 16, 2025, are posted online.
The Department of Agriculture (USDA) and the Department of Health & Human Services will use the report as a key resource, alongside the public comments and agency input, as they jointly develop the Dietary Guidelines for Americans, 2025-2030.
Meat Given a Back Seat
Overall, the advisory committee defined a “healthy dietary pattern” as one that is “higher in vegetables, fruits, legumes (ie, beans, peas, lentils), nuts, whole grains, fish/seafood, and vegetable oils higher in unsaturated fat — and lower in red and processed meats, sugar-sweetened foods and beverages, refined grains, and saturated fat.”
The report emphasizes “plain drinking water” as the primary beverage for people to consume and states that sugar-sweetened beverage consumption should be limited.
It recommends limiting total saturated fat intake to less than 10% of daily calories and replacing it with unsaturated fat, particularly polyunsaturated fats.
Notably, the report advocates increasing the consumption of beans, peas, and lentils and decreasing starchy vegetables (such as potatoes), as well as reducing total protein foods by reducing meat, poultry, and eggs. This recommendation and the report’s broad emphasis on plant-based foods have drawn criticism, mainly from the food industry.
Also likely to be controversial are the recommendations to move beans, peas, and lentils from the vegetable group to the protein group and the proposed reorganization of the order of the protein foods group to list beans, peas, and lentils first, followed by nuts, seeds, and soy products; then seafood; and finally meats, poultry, and eggs.
Gastroenterologists and dietitians should support the emphasis on plant-based protein sources, water for hydration, and the importance of personalized nutrition plans, including culturally diverse and ethnic food options, said Stephanie Gold, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai and a gastroenterologist at Mount Sinai Hospital, both in New York City.
“The newly proposed 2025 Dietary Guidelines are approaching a Mediterranean-style diet by focusing on plant-based protein sources while limiting red meat and saturated fats, as well as added sugar. By including these legumes in the protein category (not only as a starchy vegetable), the proposed guideline recognizes both the health benefits and sustainability of plant-based proteins,” Gold said in an interview.
Although the report recognizes “the potential negative impact and the varying definitions of ultra-processed foods, it does not provide concrete recommendations regarding intake, and perhaps, this could be an area of focus going forward,” she added.
Anderson noted that the science around ultra-processed food is “underdeveloped.” However, the definition of a healthy diet “has never suggested that we have foods that are extremely processed in it.”
“Right now, there’s a lot of interest in ultra-processed foods and what they mean for health, but the science is going to need to catch up with that interest,” Anderson said.
What’s Next
The release of the scientific report is part of a five-step process to develop the new guidelines that included input from the public during the report’s development. According to the USDA, the advisory committee received approximately 9900 public comments, more than any other previous committee.
Once the new dietary guidelines are complete, Anderson said, “clinicians have an opportunity to really lean into a science-based framework to talk about overall health concerns and reducing the burden of diet-related illnesses with their patients.”
Meanwhile, they can voice their approval or concerns about the scientific report.
Anderson and Gold reported no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
The scientific report that offers evidence-based guidance for the next iteration of the Dietary Guidelines for Americans has been submitted to federal agencies, and the document — which already has generated controversy because of its emphasis on plant-based foods — is now open for public comment.
“We saw something over and over again — when you look at a population level, diets for which the predominant composition was plants performed better when it came to health outcomes,” advisory committee member Cheryl Anderson, PhD, MPH, who is a professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, said in an interview. “There’s a pretty consistent body of literature showing benefits of fruits, vegetables, and legumes and reductions in salt, added sugars, and saturated fats.”
Clinicians should read and comment on the report, said Anderson.
“Commenting sends the right signal that they are interested in what’s needed for nutrition education,” she said. “It will also activate a conversation with the people who are writing the guidelines.”
Instructions for submitting comments online through February 10, 2025, and for participating in the oral comment meeting on January 16, 2025, are posted online.
The Department of Agriculture (USDA) and the Department of Health & Human Services will use the report as a key resource, alongside the public comments and agency input, as they jointly develop the Dietary Guidelines for Americans, 2025-2030.
Meat Given a Back Seat
Overall, the advisory committee defined a “healthy dietary pattern” as one that is “higher in vegetables, fruits, legumes (ie, beans, peas, lentils), nuts, whole grains, fish/seafood, and vegetable oils higher in unsaturated fat — and lower in red and processed meats, sugar-sweetened foods and beverages, refined grains, and saturated fat.”
The report emphasizes “plain drinking water” as the primary beverage for people to consume and states that sugar-sweetened beverage consumption should be limited.
It recommends limiting total saturated fat intake to less than 10% of daily calories and replacing it with unsaturated fat, particularly polyunsaturated fats.
Notably, the report advocates increasing the consumption of beans, peas, and lentils and decreasing starchy vegetables (such as potatoes), as well as reducing total protein foods by reducing meat, poultry, and eggs. This recommendation and the report’s broad emphasis on plant-based foods have drawn criticism, mainly from the food industry.
Also likely to be controversial are the recommendations to move beans, peas, and lentils from the vegetable group to the protein group and the proposed reorganization of the order of the protein foods group to list beans, peas, and lentils first, followed by nuts, seeds, and soy products; then seafood; and finally meats, poultry, and eggs.
Gastroenterologists and dietitians should support the emphasis on plant-based protein sources, water for hydration, and the importance of personalized nutrition plans, including culturally diverse and ethnic food options, said Stephanie Gold, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai and a gastroenterologist at Mount Sinai Hospital, both in New York City.
“The newly proposed 2025 Dietary Guidelines are approaching a Mediterranean-style diet by focusing on plant-based protein sources while limiting red meat and saturated fats, as well as added sugar. By including these legumes in the protein category (not only as a starchy vegetable), the proposed guideline recognizes both the health benefits and sustainability of plant-based proteins,” Gold said in an interview.
Although the report recognizes “the potential negative impact and the varying definitions of ultra-processed foods, it does not provide concrete recommendations regarding intake, and perhaps, this could be an area of focus going forward,” she added.
Anderson noted that the science around ultra-processed food is “underdeveloped.” However, the definition of a healthy diet “has never suggested that we have foods that are extremely processed in it.”
“Right now, there’s a lot of interest in ultra-processed foods and what they mean for health, but the science is going to need to catch up with that interest,” Anderson said.
What’s Next
The release of the scientific report is part of a five-step process to develop the new guidelines that included input from the public during the report’s development. According to the USDA, the advisory committee received approximately 9900 public comments, more than any other previous committee.
Once the new dietary guidelines are complete, Anderson said, “clinicians have an opportunity to really lean into a science-based framework to talk about overall health concerns and reducing the burden of diet-related illnesses with their patients.”
Meanwhile, they can voice their approval or concerns about the scientific report.
Anderson and Gold reported no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
Lung CT Can Detect Coronary Artery Disease, Predict Death
“The high prevalence of asymptomatic coronary artery disease (83%) was surprising, as was the prevalence of extensive CAC (30%),” principal investigator Gary Small, MBChB, PhD, a cardiologist at the University of Ottawa Heart Institute in Ontario, Canada, said in an interview.
“The size of effect was also surprising, as was the persistence of the effect even in the presence of elevated mortality risk from other causes,” he said. “Extensive coronary disease was associated with a twofold increase in risk for death or cardiovascular events over 4 years of follow-up,” even after adjustment for risk for death from cancer and other comorbidities such as chronic obstructive pulmonary disease.
“CAC as reported on chest CT exams is often ignored and not factored into clinical practice,” he noted. “The presence of CAC, however, provides a very real and very personal perspective on an individual’s cardiovascular risk. It is a true example of personalized medicine.”
The study was published online in The Canadian Medical Association Journal.
Potential Risk Reduction
In March 2017, Ontario Health launched a pilot low-dose CT lung cancer screening program for high-risk individuals between the ages of 55 and 74 years, Small explained. As CAC, a marker of coronary artery disease, is seen easily during such a scan, the researchers analyzed the lung CTs to determine the prevalence of coronary artery disease and whether CAC was associated with increased risk.
The team quantified CAC using an estimated Agatston score and identified the composite primary outcome of all-cause death and cardiovascular events using linked electronic medical record data from Ottawa Hospital up to December 2023. Among the 1486 people who underwent screening (mean age, 66 years; 52% men; 68% current smokers), CAC was detected in 1232 (82.9%). CAC was mild to moderate in 793 participants (53.4%) and extensive in 439 (29.5%). No CAC was detected in 254 (17.1%) participants.
At follow-up, 78 participants (5.2%) experienced the primary composite outcome, including 39 (8.9%) with extensive CAC, 32 (4.0%) with mild to moderate CAC, and 7 (2.8%) with no CAC.
A total of 49 deaths occurred, including 16 cardiovascular deaths and 19 cancer deaths, of which 10 were from lung cancer. Cardiovascular events included sudden cardiac death (eight participants), fatal stroke (six participants), and one each from heart failure and peripheral vascular disease.
On multivariable analysis, extensive CAC was associated with the composite primary outcome (adjusted hazard ratio [aHR], 2.13), all-cause mortality (aHR, 2.39), and cardiovascular events (aHR, 2.06).
Extensive CAC remained predictive of cardiovascular events even after adjustment for noncardiovascular death as a competing risk (HR, 2.05).
“Our data highlight to lung cancer screening professionals the prevalence of this silent risk factor and re-emphasize the importance of this finding [ie, CAC] as an opportunity for risk reduction,” Small said.
“In terms of next steps, the journey toward cardiovascular risk reduction begins with a clear report of CAC on the lung cancer screening record,” he noted. “Following this step, professionals involved in the lung cancer screening program might consider a local management pathway to ensure that this opportunity for health improvement is not lost or ignored. Preventive medicine of this type would typically involve primary care.”
Managing Other Findings
Commenting on the study, Anna Bader, MD, assistant professor of radiology and biomedical imaging at the Yale School of Medicine in New Haven, Connecticut, said that “low-dose CT for lung cancer screening offers valuable insights beyond nodule detection, with CAC being among the most significant incidental findings.”
However, she added, a “robust mechanism” to effectively manage other findings — such as thoracic aortic disease, low bone density, and abnormalities in the thyroid or upper abdominal organs — without overdiagnosis, is needed. A mechanism also is needed to notify cardiologists or primary care providers about severe CAC findings.
Challenges that need to be overcome before such mechanisms can be put in place, she said, “include ensuring standardized CAC reporting, avoiding overburdening healthcare providers, mitigating the risk of excessive downstream testing, and ensuring equitable access to follow-up care for underserved and rural communities.”
Providers involved in lung cancer screening “must be trained to recognize the importance of CAC findings and act upon them,” she added. “Awareness campaigns or continuing medical education modules could address this.”
Multidisciplinary lung cancer screening programs can help with patient education, she noted. “Clear communication about potential findings, including the significance of incidental CAC, should be prioritized and addressed proactively, ideally before the exam, to enhance patient understanding and engagement.”
Matthew Tomey, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, said that, “as a practicing cardiologist, I find it very helpful to look at my patients’ recent or past CT scans to look for vascular calcification. Whether or not a scan is specifically protocoled as a cardiac study, we can often appreciate vascular calcification when it is present. I would encourage every physician involved in helping their patients to prevent heart disease to take advantage of looking at any prior CT scans for evidence of vascular calcification.
“Systems of care to facilitate recognition of patients with incidentally discovered vascular calcification would be welcome and, on a large scale, could help prevent cardiovascular events,” he noted. “Such a system might involve facilitating referral to a prevention specialist. It could involve evidence-based guidance for referring physicians who ordered scans.”
Like Bader, he noted the importance of patient education, adding that it could be quite powerful. “We should be doing more to empower our patients to understand the findings of their imaging and to give them actionable, evidence-based guidance on how they can promote their own cardiovascular health,” he concluded.
No funding for the study was reported. Small reported receiving a research grant for amyloid research from Pfizer and honoraria from Pfizer and Alnylam (all paid to the institution, outside the submitted work). Bader and Tomey declared no relevant conflicts.
A version of this article first appeared on Medscape.com.
“The high prevalence of asymptomatic coronary artery disease (83%) was surprising, as was the prevalence of extensive CAC (30%),” principal investigator Gary Small, MBChB, PhD, a cardiologist at the University of Ottawa Heart Institute in Ontario, Canada, said in an interview.
“The size of effect was also surprising, as was the persistence of the effect even in the presence of elevated mortality risk from other causes,” he said. “Extensive coronary disease was associated with a twofold increase in risk for death or cardiovascular events over 4 years of follow-up,” even after adjustment for risk for death from cancer and other comorbidities such as chronic obstructive pulmonary disease.
“CAC as reported on chest CT exams is often ignored and not factored into clinical practice,” he noted. “The presence of CAC, however, provides a very real and very personal perspective on an individual’s cardiovascular risk. It is a true example of personalized medicine.”
The study was published online in The Canadian Medical Association Journal.
Potential Risk Reduction
In March 2017, Ontario Health launched a pilot low-dose CT lung cancer screening program for high-risk individuals between the ages of 55 and 74 years, Small explained. As CAC, a marker of coronary artery disease, is seen easily during such a scan, the researchers analyzed the lung CTs to determine the prevalence of coronary artery disease and whether CAC was associated with increased risk.
The team quantified CAC using an estimated Agatston score and identified the composite primary outcome of all-cause death and cardiovascular events using linked electronic medical record data from Ottawa Hospital up to December 2023. Among the 1486 people who underwent screening (mean age, 66 years; 52% men; 68% current smokers), CAC was detected in 1232 (82.9%). CAC was mild to moderate in 793 participants (53.4%) and extensive in 439 (29.5%). No CAC was detected in 254 (17.1%) participants.
At follow-up, 78 participants (5.2%) experienced the primary composite outcome, including 39 (8.9%) with extensive CAC, 32 (4.0%) with mild to moderate CAC, and 7 (2.8%) with no CAC.
A total of 49 deaths occurred, including 16 cardiovascular deaths and 19 cancer deaths, of which 10 were from lung cancer. Cardiovascular events included sudden cardiac death (eight participants), fatal stroke (six participants), and one each from heart failure and peripheral vascular disease.
On multivariable analysis, extensive CAC was associated with the composite primary outcome (adjusted hazard ratio [aHR], 2.13), all-cause mortality (aHR, 2.39), and cardiovascular events (aHR, 2.06).
Extensive CAC remained predictive of cardiovascular events even after adjustment for noncardiovascular death as a competing risk (HR, 2.05).
“Our data highlight to lung cancer screening professionals the prevalence of this silent risk factor and re-emphasize the importance of this finding [ie, CAC] as an opportunity for risk reduction,” Small said.
“In terms of next steps, the journey toward cardiovascular risk reduction begins with a clear report of CAC on the lung cancer screening record,” he noted. “Following this step, professionals involved in the lung cancer screening program might consider a local management pathway to ensure that this opportunity for health improvement is not lost or ignored. Preventive medicine of this type would typically involve primary care.”
Managing Other Findings
Commenting on the study, Anna Bader, MD, assistant professor of radiology and biomedical imaging at the Yale School of Medicine in New Haven, Connecticut, said that “low-dose CT for lung cancer screening offers valuable insights beyond nodule detection, with CAC being among the most significant incidental findings.”
However, she added, a “robust mechanism” to effectively manage other findings — such as thoracic aortic disease, low bone density, and abnormalities in the thyroid or upper abdominal organs — without overdiagnosis, is needed. A mechanism also is needed to notify cardiologists or primary care providers about severe CAC findings.
Challenges that need to be overcome before such mechanisms can be put in place, she said, “include ensuring standardized CAC reporting, avoiding overburdening healthcare providers, mitigating the risk of excessive downstream testing, and ensuring equitable access to follow-up care for underserved and rural communities.”
Providers involved in lung cancer screening “must be trained to recognize the importance of CAC findings and act upon them,” she added. “Awareness campaigns or continuing medical education modules could address this.”
Multidisciplinary lung cancer screening programs can help with patient education, she noted. “Clear communication about potential findings, including the significance of incidental CAC, should be prioritized and addressed proactively, ideally before the exam, to enhance patient understanding and engagement.”
Matthew Tomey, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, said that, “as a practicing cardiologist, I find it very helpful to look at my patients’ recent or past CT scans to look for vascular calcification. Whether or not a scan is specifically protocoled as a cardiac study, we can often appreciate vascular calcification when it is present. I would encourage every physician involved in helping their patients to prevent heart disease to take advantage of looking at any prior CT scans for evidence of vascular calcification.
“Systems of care to facilitate recognition of patients with incidentally discovered vascular calcification would be welcome and, on a large scale, could help prevent cardiovascular events,” he noted. “Such a system might involve facilitating referral to a prevention specialist. It could involve evidence-based guidance for referring physicians who ordered scans.”
Like Bader, he noted the importance of patient education, adding that it could be quite powerful. “We should be doing more to empower our patients to understand the findings of their imaging and to give them actionable, evidence-based guidance on how they can promote their own cardiovascular health,” he concluded.
No funding for the study was reported. Small reported receiving a research grant for amyloid research from Pfizer and honoraria from Pfizer and Alnylam (all paid to the institution, outside the submitted work). Bader and Tomey declared no relevant conflicts.
A version of this article first appeared on Medscape.com.
“The high prevalence of asymptomatic coronary artery disease (83%) was surprising, as was the prevalence of extensive CAC (30%),” principal investigator Gary Small, MBChB, PhD, a cardiologist at the University of Ottawa Heart Institute in Ontario, Canada, said in an interview.
“The size of effect was also surprising, as was the persistence of the effect even in the presence of elevated mortality risk from other causes,” he said. “Extensive coronary disease was associated with a twofold increase in risk for death or cardiovascular events over 4 years of follow-up,” even after adjustment for risk for death from cancer and other comorbidities such as chronic obstructive pulmonary disease.
“CAC as reported on chest CT exams is often ignored and not factored into clinical practice,” he noted. “The presence of CAC, however, provides a very real and very personal perspective on an individual’s cardiovascular risk. It is a true example of personalized medicine.”
The study was published online in The Canadian Medical Association Journal.
Potential Risk Reduction
In March 2017, Ontario Health launched a pilot low-dose CT lung cancer screening program for high-risk individuals between the ages of 55 and 74 years, Small explained. As CAC, a marker of coronary artery disease, is seen easily during such a scan, the researchers analyzed the lung CTs to determine the prevalence of coronary artery disease and whether CAC was associated with increased risk.
The team quantified CAC using an estimated Agatston score and identified the composite primary outcome of all-cause death and cardiovascular events using linked electronic medical record data from Ottawa Hospital up to December 2023. Among the 1486 people who underwent screening (mean age, 66 years; 52% men; 68% current smokers), CAC was detected in 1232 (82.9%). CAC was mild to moderate in 793 participants (53.4%) and extensive in 439 (29.5%). No CAC was detected in 254 (17.1%) participants.
At follow-up, 78 participants (5.2%) experienced the primary composite outcome, including 39 (8.9%) with extensive CAC, 32 (4.0%) with mild to moderate CAC, and 7 (2.8%) with no CAC.
A total of 49 deaths occurred, including 16 cardiovascular deaths and 19 cancer deaths, of which 10 were from lung cancer. Cardiovascular events included sudden cardiac death (eight participants), fatal stroke (six participants), and one each from heart failure and peripheral vascular disease.
On multivariable analysis, extensive CAC was associated with the composite primary outcome (adjusted hazard ratio [aHR], 2.13), all-cause mortality (aHR, 2.39), and cardiovascular events (aHR, 2.06).
Extensive CAC remained predictive of cardiovascular events even after adjustment for noncardiovascular death as a competing risk (HR, 2.05).
“Our data highlight to lung cancer screening professionals the prevalence of this silent risk factor and re-emphasize the importance of this finding [ie, CAC] as an opportunity for risk reduction,” Small said.
“In terms of next steps, the journey toward cardiovascular risk reduction begins with a clear report of CAC on the lung cancer screening record,” he noted. “Following this step, professionals involved in the lung cancer screening program might consider a local management pathway to ensure that this opportunity for health improvement is not lost or ignored. Preventive medicine of this type would typically involve primary care.”
Managing Other Findings
Commenting on the study, Anna Bader, MD, assistant professor of radiology and biomedical imaging at the Yale School of Medicine in New Haven, Connecticut, said that “low-dose CT for lung cancer screening offers valuable insights beyond nodule detection, with CAC being among the most significant incidental findings.”
However, she added, a “robust mechanism” to effectively manage other findings — such as thoracic aortic disease, low bone density, and abnormalities in the thyroid or upper abdominal organs — without overdiagnosis, is needed. A mechanism also is needed to notify cardiologists or primary care providers about severe CAC findings.
Challenges that need to be overcome before such mechanisms can be put in place, she said, “include ensuring standardized CAC reporting, avoiding overburdening healthcare providers, mitigating the risk of excessive downstream testing, and ensuring equitable access to follow-up care for underserved and rural communities.”
Providers involved in lung cancer screening “must be trained to recognize the importance of CAC findings and act upon them,” she added. “Awareness campaigns or continuing medical education modules could address this.”
Multidisciplinary lung cancer screening programs can help with patient education, she noted. “Clear communication about potential findings, including the significance of incidental CAC, should be prioritized and addressed proactively, ideally before the exam, to enhance patient understanding and engagement.”
Matthew Tomey, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, said that, “as a practicing cardiologist, I find it very helpful to look at my patients’ recent or past CT scans to look for vascular calcification. Whether or not a scan is specifically protocoled as a cardiac study, we can often appreciate vascular calcification when it is present. I would encourage every physician involved in helping their patients to prevent heart disease to take advantage of looking at any prior CT scans for evidence of vascular calcification.
“Systems of care to facilitate recognition of patients with incidentally discovered vascular calcification would be welcome and, on a large scale, could help prevent cardiovascular events,” he noted. “Such a system might involve facilitating referral to a prevention specialist. It could involve evidence-based guidance for referring physicians who ordered scans.”
Like Bader, he noted the importance of patient education, adding that it could be quite powerful. “We should be doing more to empower our patients to understand the findings of their imaging and to give them actionable, evidence-based guidance on how they can promote their own cardiovascular health,” he concluded.
No funding for the study was reported. Small reported receiving a research grant for amyloid research from Pfizer and honoraria from Pfizer and Alnylam (all paid to the institution, outside the submitted work). Bader and Tomey declared no relevant conflicts.
A version of this article first appeared on Medscape.com.
FROM THE CANADIAN MEDICAL ASSOCIATION JOURNAL
Telehealth Vs In-Person Diabetes Care: Is One Better?
Adults with diabetes who participated in telehealth visits reported similar levels of care, trust in the healthcare system, and patient-centered communication compared to those who had in-person visits, a cross-sectional study suggested.
The authors urged continued integration of telehealth into diabetes care beyond December 31, 2024, when the pandemic public health emergency ends, potentially limiting such services.
The study “provides population-level evidence that telehealth can deliver care quality comparable to in-person visits in diabetes management,” lead author Young-Rock Hong, PhD, MPH, an assistant professor in the University of Florida, Gainesville, told this news organization.
“Perhaps the most meaningful finding was the high utilization of telephone-only visits among older adults,” he said. “This has important policy implications, particularly as some insurers and healthcare systems have pushed to restrict telehealth coverage to video-only visits.”
“Maintaining telephone visit coverage is crucial for equitable access, especially for older adults who may be less comfortable with video technology; those with limited internet access; or patients facing other barriers to video visits,” he explained.
The study was published online in BMJ Open.
Video-only, Voice-only, Both
The researchers did a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey that includes information on health communication and knowledge and perceptions about all health conditions among US adults aged ≥ 18 years.
Participants had a self-reported diagnosis of type 1 or type 2 diabetes. The mean age was 59.4 years; 50% were women; and 53% were non-Hispanic White individuals.
Primary and secondary outcomes were use of telehealth in the last 12-months; telehealth modality; overall perception of quality of care; perceived trust in the healthcare system; and patient-centered communication score.
In the analysis of 1116 participants representing 33.6 million individuals, 48.1% reported telehealth use in the past 12 months.
Telehealth users were more likely to be younger and women with higher household incomes and health insurance coverage; live in metropolitan areas; and have multiple chronic conditions, poorer perceived health status, and more frequent physician visits than nonusers.
After adjustment, adults aged ≥ 65 years had a significantly lower likelihood of telehealth use than those ages 18-49 years (odds ratio [OR], 0.43).
Higher income and more frequent healthcare visits were predictors of telehealth usage, with no significant differences across race, education, or location.
Those with a household income between $35,000 and $74,999 had more than double the likelihood of telehealth use (OR, 2.14) than those with incomes below $35,000.
Among telehealth users, 39.3% reported having video-only; 35%, phone (voice)-only; and 25.7%, both modalities. Among those aged ≥ 65 years, 55.5% used phone calls only and 25.5% used video only. In contrast, those aged 18-49 years had higher rates of video-only use (36.1%) and combined video/phone use (31.2%).
Healthcare provider recommendation (68.1%) was the most common reason for telehealth use, followed by convenience (57.7%), avoiding potential COVID-19 exposure (48.1%), and obtaining advice about the need for in-person care (23.6%).
Nonusers said they preferred in-person visits and also cited privacy concerns and technology challenges.
Patient-reported quality-of-care outcomes were comparable between telehealth users and nonusers, with no significant differences by telehealth modality or area of residence (urban or rural).
Around 70% of individuals with diabetes in both groups rated their quality of care as “excellent” and “very good;” fewer than 10% rated their care as “fair” and “poor.”
Similarly, trust in the healthcare system was comparable between users and nonusers: 41.3% of telehealth users 41% of nonusers reported trusting the healthcare system “very much.” Patient-centered communication scores were also similar between users and nonusers.
Telehealth appears to be a good option from the providers’ perspective as well, according to the authors. A previous study by the team found more than 80% of US physicians intended to continue telehealth beyond the pandemic.
“The recent unanimous bipartisan passage of the Telehealth Modernization Act by the House Energy & Commerce Committee signals strong political support for extending telehealth flexibilities through 2026,” Hong said. “The bill addresses key access issues by permanently removing geographic restrictions, expanding eligible providers, and maintaining audio-only coverage — provisions that align with our study’s findings about the importance of telephone visits, particularly for older adults and underserved populations.”
There is concern that extending telehealth services might increase Medicare spending by over $2 billion, he added. “While this may be a valid concern, there is a need for more robust evidence regarding the overall value of telehealth services — ie, the ‘benefits’ they provide relative to their costs and outcomes.”
Reassuring, but More Research Needed
COVID prompted “dramatic shifts” in care delivery from in-person to telehealth, Kevin Peterson, MD, MPH, American Diabetes Association vice president of primary care told this news organization. “The authors’ findings provide reassurance that these changes provided for additional convenience in care delivery without being associated with compromises in patient-reported care quality.”
However, he said, “the study does not necessarily capture representative samples of rural and underserved populations, making the impact of telehealth on health equity difficult to determine.” In addition, although patient-perceived care quality did not change with telehealth delivery, the study “does not address impacts on safety, clinical outcomes, equity, costs, or other important measures.”
Furthermore, he noted, “this is an association study that occurred during the dramatic changes brought about by COVID. It may not represent provider or patient preferences that characterize the role of telehealth under more normal circumstances.”
For now, clinicians should be aware that “initial evidence suggests that telehealth can be integrated into care without significantly compromising the patient’s perception of the quality of care,” he concluded.
No funding was declared. Hong and Peterson reported no conflicts of interest.
A version of this article first appeared on Medscape.com.
Adults with diabetes who participated in telehealth visits reported similar levels of care, trust in the healthcare system, and patient-centered communication compared to those who had in-person visits, a cross-sectional study suggested.
The authors urged continued integration of telehealth into diabetes care beyond December 31, 2024, when the pandemic public health emergency ends, potentially limiting such services.
The study “provides population-level evidence that telehealth can deliver care quality comparable to in-person visits in diabetes management,” lead author Young-Rock Hong, PhD, MPH, an assistant professor in the University of Florida, Gainesville, told this news organization.
“Perhaps the most meaningful finding was the high utilization of telephone-only visits among older adults,” he said. “This has important policy implications, particularly as some insurers and healthcare systems have pushed to restrict telehealth coverage to video-only visits.”
“Maintaining telephone visit coverage is crucial for equitable access, especially for older adults who may be less comfortable with video technology; those with limited internet access; or patients facing other barriers to video visits,” he explained.
The study was published online in BMJ Open.
Video-only, Voice-only, Both
The researchers did a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey that includes information on health communication and knowledge and perceptions about all health conditions among US adults aged ≥ 18 years.
Participants had a self-reported diagnosis of type 1 or type 2 diabetes. The mean age was 59.4 years; 50% were women; and 53% were non-Hispanic White individuals.
Primary and secondary outcomes were use of telehealth in the last 12-months; telehealth modality; overall perception of quality of care; perceived trust in the healthcare system; and patient-centered communication score.
In the analysis of 1116 participants representing 33.6 million individuals, 48.1% reported telehealth use in the past 12 months.
Telehealth users were more likely to be younger and women with higher household incomes and health insurance coverage; live in metropolitan areas; and have multiple chronic conditions, poorer perceived health status, and more frequent physician visits than nonusers.
After adjustment, adults aged ≥ 65 years had a significantly lower likelihood of telehealth use than those ages 18-49 years (odds ratio [OR], 0.43).
Higher income and more frequent healthcare visits were predictors of telehealth usage, with no significant differences across race, education, or location.
Those with a household income between $35,000 and $74,999 had more than double the likelihood of telehealth use (OR, 2.14) than those with incomes below $35,000.
Among telehealth users, 39.3% reported having video-only; 35%, phone (voice)-only; and 25.7%, both modalities. Among those aged ≥ 65 years, 55.5% used phone calls only and 25.5% used video only. In contrast, those aged 18-49 years had higher rates of video-only use (36.1%) and combined video/phone use (31.2%).
Healthcare provider recommendation (68.1%) was the most common reason for telehealth use, followed by convenience (57.7%), avoiding potential COVID-19 exposure (48.1%), and obtaining advice about the need for in-person care (23.6%).
Nonusers said they preferred in-person visits and also cited privacy concerns and technology challenges.
Patient-reported quality-of-care outcomes were comparable between telehealth users and nonusers, with no significant differences by telehealth modality or area of residence (urban or rural).
Around 70% of individuals with diabetes in both groups rated their quality of care as “excellent” and “very good;” fewer than 10% rated their care as “fair” and “poor.”
Similarly, trust in the healthcare system was comparable between users and nonusers: 41.3% of telehealth users 41% of nonusers reported trusting the healthcare system “very much.” Patient-centered communication scores were also similar between users and nonusers.
Telehealth appears to be a good option from the providers’ perspective as well, according to the authors. A previous study by the team found more than 80% of US physicians intended to continue telehealth beyond the pandemic.
“The recent unanimous bipartisan passage of the Telehealth Modernization Act by the House Energy & Commerce Committee signals strong political support for extending telehealth flexibilities through 2026,” Hong said. “The bill addresses key access issues by permanently removing geographic restrictions, expanding eligible providers, and maintaining audio-only coverage — provisions that align with our study’s findings about the importance of telephone visits, particularly for older adults and underserved populations.”
There is concern that extending telehealth services might increase Medicare spending by over $2 billion, he added. “While this may be a valid concern, there is a need for more robust evidence regarding the overall value of telehealth services — ie, the ‘benefits’ they provide relative to their costs and outcomes.”
Reassuring, but More Research Needed
COVID prompted “dramatic shifts” in care delivery from in-person to telehealth, Kevin Peterson, MD, MPH, American Diabetes Association vice president of primary care told this news organization. “The authors’ findings provide reassurance that these changes provided for additional convenience in care delivery without being associated with compromises in patient-reported care quality.”
However, he said, “the study does not necessarily capture representative samples of rural and underserved populations, making the impact of telehealth on health equity difficult to determine.” In addition, although patient-perceived care quality did not change with telehealth delivery, the study “does not address impacts on safety, clinical outcomes, equity, costs, or other important measures.”
Furthermore, he noted, “this is an association study that occurred during the dramatic changes brought about by COVID. It may not represent provider or patient preferences that characterize the role of telehealth under more normal circumstances.”
For now, clinicians should be aware that “initial evidence suggests that telehealth can be integrated into care without significantly compromising the patient’s perception of the quality of care,” he concluded.
No funding was declared. Hong and Peterson reported no conflicts of interest.
A version of this article first appeared on Medscape.com.
Adults with diabetes who participated in telehealth visits reported similar levels of care, trust in the healthcare system, and patient-centered communication compared to those who had in-person visits, a cross-sectional study suggested.
The authors urged continued integration of telehealth into diabetes care beyond December 31, 2024, when the pandemic public health emergency ends, potentially limiting such services.
The study “provides population-level evidence that telehealth can deliver care quality comparable to in-person visits in diabetes management,” lead author Young-Rock Hong, PhD, MPH, an assistant professor in the University of Florida, Gainesville, told this news organization.
“Perhaps the most meaningful finding was the high utilization of telephone-only visits among older adults,” he said. “This has important policy implications, particularly as some insurers and healthcare systems have pushed to restrict telehealth coverage to video-only visits.”
“Maintaining telephone visit coverage is crucial for equitable access, especially for older adults who may be less comfortable with video technology; those with limited internet access; or patients facing other barriers to video visits,” he explained.
The study was published online in BMJ Open.
Video-only, Voice-only, Both
The researchers did a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey that includes information on health communication and knowledge and perceptions about all health conditions among US adults aged ≥ 18 years.
Participants had a self-reported diagnosis of type 1 or type 2 diabetes. The mean age was 59.4 years; 50% were women; and 53% were non-Hispanic White individuals.
Primary and secondary outcomes were use of telehealth in the last 12-months; telehealth modality; overall perception of quality of care; perceived trust in the healthcare system; and patient-centered communication score.
In the analysis of 1116 participants representing 33.6 million individuals, 48.1% reported telehealth use in the past 12 months.
Telehealth users were more likely to be younger and women with higher household incomes and health insurance coverage; live in metropolitan areas; and have multiple chronic conditions, poorer perceived health status, and more frequent physician visits than nonusers.
After adjustment, adults aged ≥ 65 years had a significantly lower likelihood of telehealth use than those ages 18-49 years (odds ratio [OR], 0.43).
Higher income and more frequent healthcare visits were predictors of telehealth usage, with no significant differences across race, education, or location.
Those with a household income between $35,000 and $74,999 had more than double the likelihood of telehealth use (OR, 2.14) than those with incomes below $35,000.
Among telehealth users, 39.3% reported having video-only; 35%, phone (voice)-only; and 25.7%, both modalities. Among those aged ≥ 65 years, 55.5% used phone calls only and 25.5% used video only. In contrast, those aged 18-49 years had higher rates of video-only use (36.1%) and combined video/phone use (31.2%).
Healthcare provider recommendation (68.1%) was the most common reason for telehealth use, followed by convenience (57.7%), avoiding potential COVID-19 exposure (48.1%), and obtaining advice about the need for in-person care (23.6%).
Nonusers said they preferred in-person visits and also cited privacy concerns and technology challenges.
Patient-reported quality-of-care outcomes were comparable between telehealth users and nonusers, with no significant differences by telehealth modality or area of residence (urban or rural).
Around 70% of individuals with diabetes in both groups rated their quality of care as “excellent” and “very good;” fewer than 10% rated their care as “fair” and “poor.”
Similarly, trust in the healthcare system was comparable between users and nonusers: 41.3% of telehealth users 41% of nonusers reported trusting the healthcare system “very much.” Patient-centered communication scores were also similar between users and nonusers.
Telehealth appears to be a good option from the providers’ perspective as well, according to the authors. A previous study by the team found more than 80% of US physicians intended to continue telehealth beyond the pandemic.
“The recent unanimous bipartisan passage of the Telehealth Modernization Act by the House Energy & Commerce Committee signals strong political support for extending telehealth flexibilities through 2026,” Hong said. “The bill addresses key access issues by permanently removing geographic restrictions, expanding eligible providers, and maintaining audio-only coverage — provisions that align with our study’s findings about the importance of telephone visits, particularly for older adults and underserved populations.”
There is concern that extending telehealth services might increase Medicare spending by over $2 billion, he added. “While this may be a valid concern, there is a need for more robust evidence regarding the overall value of telehealth services — ie, the ‘benefits’ they provide relative to their costs and outcomes.”
Reassuring, but More Research Needed
COVID prompted “dramatic shifts” in care delivery from in-person to telehealth, Kevin Peterson, MD, MPH, American Diabetes Association vice president of primary care told this news organization. “The authors’ findings provide reassurance that these changes provided for additional convenience in care delivery without being associated with compromises in patient-reported care quality.”
However, he said, “the study does not necessarily capture representative samples of rural and underserved populations, making the impact of telehealth on health equity difficult to determine.” In addition, although patient-perceived care quality did not change with telehealth delivery, the study “does not address impacts on safety, clinical outcomes, equity, costs, or other important measures.”
Furthermore, he noted, “this is an association study that occurred during the dramatic changes brought about by COVID. It may not represent provider or patient preferences that characterize the role of telehealth under more normal circumstances.”
For now, clinicians should be aware that “initial evidence suggests that telehealth can be integrated into care without significantly compromising the patient’s perception of the quality of care,” he concluded.
No funding was declared. Hong and Peterson reported no conflicts of interest.
A version of this article first appeared on Medscape.com.
FROM BMJ OPEN