Week-in-Review | January 31, 2026
Dear DGIM,
Congratulations to Eric Roberts, Rachel Werner, and Pete Groeneveld. Eric and Rachel’s article in the NEJM received a 2026 Top Ten Clinical Research Achievement recognition and Pete’s article was a Top Ten Finalist. The Dean’s office hosted a flash mob celebration for the seven papers from Penn that made this top 20 list. Mike Parmacek is especially proud since six of the seven papers came from the Department of Medicine.
Rani Nandiwada published an article in JGIM with colleagues from around the country on how to optimize the resident continuity clinic experience, with the goal of encouraging more residents to pursue primary care and improving the quality of care for resident patients to reduce attending–resident disparities in patient outcomes. Recommendations focus on improving resident continuity, access to interdisciplinary teams, and increased outpatient educational conferences. Rani notes, “Overall, our resident clinics here do well based on these national recommendations.” While this is encouraging, there is still room for improvement: too few of our residents enter primary care, and despite our best efforts, disparities persist between resident and attending quality metrics.
Sofia Kaparis (undergraduate student), Jalpa Doshi, Carmen Guerra, and colleagues published a scoping review in Blood Reviews examining barriers and facilitators to CAR T-cell therapies that likely contribute to racial and ethnic disparities in use of this revolutionary treatment, despite evidence showing efficacy across all racial/ethnic groups. Identified barriers include lengthy insurance authorization processes, high out-of-pocket costs, limited geographic access to treatment centers, long manufacturing timelines with limited slots, knowledge gaps among referring oncologists, and overall financial burden. Recommended solutions include standardizing pre-approval systems and coverage policies, decentralizing CAR T-cell production, expanding administration sites, increasing education for referring oncologists, and providing assistance programs to help offset costs. As is often the case with newer, expensive therapies, access lags behind innovation. We need to find ways to bring these breakthroughs to all populations more quickly.
Aaron Schwartz recently released a working paper from work funded in part by a DGIM Slap grant. The study compared large language model (LLM) decision support for community health extension workers in two outpatient clinics in Nigeria with care plans created by blinded on-site physicians. Health extension workers evaluated patients, submitted an initial care plan, received LLM feedback, and were then given the option to revise their plan. Afterward, each patient was seen by an on-site physician who independently created a care plan. A blinded physician reviewer then evaluated the extension workers’ assisted and unassisted plans without knowing which was which. Extension workers changed their prescribing in more than 50% of cases after receiving LLM feedback and overwhelmingly felt the LLM helped them provide better care. However, independent review found that LLM assistance did not improve diagnostic accuracy, reduce incorrect or unnecessary medications, or improve inappropriate care instructions. The LLM did reduce basic missing elements in care plans but also increased non-useful testing. Overall, it’s a promising idea that does not yet seem ready for primetime.
Bob Burke has a new article in JAMA Internal Medicine that provides guidance on supporting older adults who need assistance after hospital discharge—an area that is often confusing for clinicians, as well as for patients and caregivers. The paper offers a concise summary of available options, evidence-based considerations for clinicians and patients, and practical guidance for shared decision-making.
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