Week-in-Review | September 22, 2025
Dear DGIM,
Congratulations to Maggie Lowenstien. She just got notice that her first R01 was funded. The funding will allow Maggie and her collaborators to look at the effectiveness and implementation of a program that supports people with opioid use disorder and homelessness after hospitalization. The program is a partnership between Penn, Temple, Jefferson, and Project HOME and the service delivery is philanthropically funded by the Estadt-Lubert Collaborative. The goal of the research is to provide a rigorous look at the impact of the intervention on linkage to OUD treatment, acute care utilization and housing. I look forward to reporting back on the results.
Congratulations to Ashish Thakrar. He will be joining the American Society of Addiction Medicine’s National Practice Guideline Committee for the Treatment of Opioid Use Disorder. This is an important committee that makes national recommendations that become the standard of care.
Policy Update: last year Jalpa Doshi published a paper in Health Affairs finding that nearly one in five patients abandon their first insurer-approved PrEP prescription at the pharmacy, with most never returning to fill it later in the year and those who forgo PrEP face a threefold higher risk of contracting HIV within one year. An accompanying cost-simulation analysis underscored how sensitive PrEP initiation is to patient cost sharing: at $0 out-of-pocket cost, only 6% of patients abandon PrEP; at just $10, the abandonment risk more than doubles; and at costs above $500, 43% abandon PrEP. This was the first national, population-level evidence quantifying how even modest out-of-pocket costs limit PrEP use and increase HIV risk. This work was recently cited as key evidence in nine amici curiae briefs submitted to the Supreme Court. These briefs used Jalpa’s findings to illustrate the real-world negative consequences of striking down no-cost PrEP coverage and to caution the Court about unintended public health ramifications of a decision that threatened the ACA’s no-cost preventive services mandate. In June, the Supreme Court upheld the USPSTF’s authority and preserved no-cost PrEP coverage - a major victory for HIV prevention and preventive health more broadly. This is health services research at its best – informing national policy aimed at improving the health of populations.
Matt Miller sent along a retirement report. His ACP COVID-19 group has submitted to the Annals of Internal Medicine “Version 3 of Practice Points for Outpatient Treatment of Symptomatic COVID-19.” He also serves on ACP's Clinical Guidelines Committee. A recent two-day meeting focused on drafting new Breast Cancer Screening guidelines and a systemic review of Pharmacologic treatments for Vasomotor Symptoms in Postmenopausal Patients. Matt attended virtually from the Volta region of Ghana, where he has been volunteering with Pagus: Africa. So while he may have retired as a Penn Medicine doctor he is clearing continuing to use his skills for good.
Marilyn Schapira and Peter Groeneveld have a new article in Cancer with many Penn colleagues evaluating new persistent opioid use in the year following curative intent surgical treatment among opioid naive Veterans with early stage cancer across a range of common cancer types (primarily lung, colorectal, bladder, and prostate). They found new persistent opioid use in 1 out of 10 Veterans. This was higher among Veterans exposed to greater opioid MME in the treatment period (1 month prior to 2 weeks post-treatment), those who received chemotherapy, and those with bladder cancer. This paper highlighting post-operative risk of long term opioid use has received a fair amount of attention. It is a reminder that we should consider limiting post-op opioids even for cancer patients.
Kira Ryskina has a paper in JAMA Network Open asking the question "Is the nursing home patient panel size of a physician or advanced practitioner associated with outcomes of patients admitted to nursing homes for post-acute care?” This question is important because many clinicians who see patients in nursing homes practice in other settings and see very few nursing home patients per year. Kira and her colleagues find that physicians and APPs who practice in nursing homes have a wide range of panel sizes and, as expected, over half of the clinician workforce sees fewer than 10 patients per year. The good news is that a providers nursing home panel size (aka “patient volume”) was not associated with patient outcomes (rehospitalization, ED visits, successful discharge back to the community and improvements in functional status). Considering that interventions targeting clinician volume such as minimum patient thresholds are not feasible in the nursing home setting, Kira calls this a “positive result”.
Kira Ryskina also has an article in Health Services Research with Rachel Werner, Rebecca Brown (geriatrics) and Jason Karlawish (geriatrics) looking at the impact of SNFists on outcomes of patients with dementia admitted for short term rehab to SNF. They conducted a within-SNF difference-in-differences analysis with cross-temporal matching looking at functional improvement at SNF discharge, measured using a validated activities of daily living (ADL) score. Secondary outcomes included unplanned rehospitalization, ED visits, observational stays within 30 days of SNF admission, successful discharge to the community, SNF length of stay, admission into long-term nursing home care within 6 months of SNF discharge, and 30- and 60-day Medicare payments for professional and facility services. Unlike prior studies that found SNFists were associated with better outcomes in nursing home, similar to the above study, the results of this study were null - there was no difference between the clinicians who focused practice on SNFs vs. clinicians who split time between different care settings. They are currently conducting interviews with facilities and clinicians to unpack these conflicting results for patients with dementia. One issue they’re trying to address with secondary analyses is how direct care staffing over the course of the stay affects the results.
Maxim Yaskolko, a brand new PSOM student, has an article out from work he did with Corie Rhodes and Shivan Mehta (GI) as an undergraduate. The article, in JGIM reports on the scaling of program to improve breast cancer screening rates that included – centralized outreach, bulk orders, and text messages. Almost 25,000 patients received outreach and the 6 month mammogram completion rated was 18.5% (which was less than the 23% rate seen in the trial of the same bundle). Not reading the portal bulk message and being insured by Medicaid was associated with not completing mammogram screening in six months. Getting a text message and having an active order for a mammogram was associated with completing one withing six months. Active orders were particularly important for completion for Black patients and patients insured by Medicare or Medicaid. This evaluation, in general, shows a successful scaling of a program tested in a pragmatic trial. It also highlights the importance of bulk orders.
The Wood Clinic has been very productive this last month. Both Erin McGrath and Nicole Scaramella had babies. Erin gave birth on 9/3 to Calvin Daniel Takoushian. Erin says that their dog Roscoe is slowly warming up to the idea of a new family member. Nicole gave birth to Matteo Vojnika on 8/29 and he is reveling in all his new pajamas that were gifted to him.
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