Week-in-Review | September 22, 2025
Dear DGIM,
Congratulations to Bob Burke for his contribution in shaping a Special Collection on Age-Friendly Health as the Lead Guest Editor for the journal INQUIRY. The new collection includes an editorial by Bob, 14 original articles advancing research, implementation, and policy in Age-Friendly care, as well as a webinar.
Congratulations to Robin Canada, Leila Ndong (DHM) and team. Their Bach fund proposal for community engagement activities was selected for funding.
I (Judith Long) have an article in JAMA Network Open with collaborators from around the VA nationally. In this 600 person RCT we compared 6 months of bidirectional text messaging to story informed bidirectional text messaging support for Black Veterans with the diagnosis of HTN. It was a negative trial; however, there were improvements in most outcomes (including blood pressure) across both arms. This study was done during COVID when many similar populations developed worse BP control. My take home is bidirectional texting alone may be an adequate support intervention for Black Veterans with a HTN diagnosis.
Joseph Nwadiuko has a new paper out in BMJ Global Health covering an underreported phenomenon: countries with the most severe health workforce shortages are also suffering from high amounts of health worker unemployment. This often occurs because these countries have rapidly expanded training capacity beyond their capacity to support health workforce salaries. Which has led to an average physician unemployment rate of 27% across 13 reporting countries and nurse/midwife unemployment rate of 40% across 18 counties. Consequently, these countries have seen rising informal labor within health systems, protests, and government-mediated migration to other countries (with Saudi Arabia being a common beneficiary). Of note these trends predate US and UK declines in foreign aid. The short-term solution from Joseph’s perspective is global health fiscal support for health workforces in high need countries.
Atheen Venkataramani has a new working paper posted on the National Bureau of Economic Research website looking at the effects of the 1975 U.S. Extension of the Voting Rights Act (VRA). Atheen says the Act lifted all boats materially, but had very different impacts on health by race and age. The Extension spread the VRA to additional counties mostly in the South. Compared to those in counties not covered by the VRA, all children under five experienced declining mortality; however, mortality rose among all White people over five, and among non-White men over 50 and fell for non-White women over 50. These changes could not be explained by changes in the population or other social factors and Atheen suggests that some of the effects are likely due to psychosocial stress and retaliatory responses arising from perceived status threat. Atheen postulates the impact may be due to the deeply held zero-sum thinking ingrained in our society – nobody gets ahead without someone doing worse. Alas.
This week, Aaron Schwartz, Soohyun Kim, and Amol Navathe published a paper in JAMA Internal Medicine titled "Changes in Health Care Utilization and Low-Value Service Use After Risk-Based Contract Adoption in Medicare Advantage". They found that voluntary transition to risk-based payment contracts (upside-only or 2-sided) in Medicare Advantage was not associated with consistent changes in utilization or reductions in low-value service use. Aaron does not feel we should give up on these contracts but consider ways to redesign the contracts to include specific goals such as reducing targeted low-value serves. You can read a longer summary in this LDI blog post.
Goodbye Blockley Hall! DGIM’s research and business office moves this weekend. Come find us on the 7th floor of 3600 Civic Center Blvd starting next Wednesday, November 19th.
Keep the news coming.
Judith
Judith A. Long, MD
Sol Katz Professor of Medicine
Chief, Division of General Internal Medicine
University of Pennsylvania Perelman School of Medicine
Core Faculty, VA Center for Health Equity Research and Promotion
Corporal Michael J. Crescenz, VA Medical Center