Hospital care at home benefits medically complex, socially vulnerable patients

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.  
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1. Hospital care at home benefits medically complex, socially vulnerable patients

Current acute hospital care at home waiver expires December 2024

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2264

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A study of more than 5,000 adults found that acute hospital care at home (AHCaH) may provide important benefits to a diverse group of medically complex and socially vulnerable patients. Hospital care at home also was associated with low mortality, escalation, and readmission rates. However, the current AHCaH waiver issued by the Centers for Medicare & Medicaid Services (CMS) is set to expire in December 2024. The report is published in Annals of Internal Medicine.

 

Hospitalization is the standard of care for acute illness, but hospital care is often expensive, unsafe, and uncomfortable. Prior research has shown that compared with traditional inpatient hospital care, patients cared for in AHCaH have improved experiences and physical activity levels, with lower rates of mortality, readmission, and discharge to skilled-nursing facilities. In November 2020, the Centers for Medicare & Medicaid Services issued the AHCaH waiver, creating a regulatory and payment pathway for hospitals to deliver AHCaH. However, this waiver is set to expire in December 2024.

 

Researchers from Brigham and Women’s Hospital and Harvard Medical School analyzed data for 5,132 patients receiving AHCaH between July 2022 and June 2023. Of the patients studied, 42.5 percent had heart failure, 43.3 percent had chronic obstructive pulmonary disease, 22.1 percent had cancer, and 16.1 percent had dementia. AHCaH was associated with low rates of mortality, escalation, skilled nursing facility use, and readmission. According to the authors, their data provide preliminary evidence on national uptake and suggest that AHCaH is an important care model to manage acute illness, including among socially vulnerable and medically complex patients. They suggest that these data should help inform ongoing policy deliberations.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, David M. Levine, MD, MPH, MA, please email Haley Bridger at hbridger@mgb.org.

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2. In real world study, BNT162b2 bivalent vaccine provides substantial protection against severe illness from Delta and Omicron variants in pediatric patients

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1754       

URL goes live when the embargo lifts   

In a real-world study, the BNT162b2 bivalent vaccine proved to be highly effective against COVID-19 during the Delta period. There was a moderate decline in effectiveness against the Omicron variant after 4 months, but the vaccine still provided significant protection against severe outcomes, including hospital admissions. The vaccine was safe, with no indication of heart-related complications. The findings are published in Annals of Internal Medicine.

 

Researchers from the University of Pennsylvania Perelman School of Medicine used electronic health record data from a national network of U.S. pediatric medical centers to assess the real-world effectiveness of BNT162b2 among children and adolescents during the periods when the Delta and Omicron variants of SARS-CoV-2 were predominant. The researchers used a novel comparative effectiveness research method and adjusted for underreporting issues in vaccination status.

 

The researchers found that during the Delta variant period, the BNT162b2 vaccine showed an estimated effectiveness of 98.4 percent against getting infected with COVID-19 among adolescents. The effectiveness didn't significantly decrease after receiving the first vaccine dose. During the Omicron variant period, the effectiveness against documented infection among children dropped to 74.3 percent. However, the vaccine seemed to provide significant protection against more severe infection and hospital admission due to COVID-19. Among adolescents, the effectiveness against Omicron infection was 85.5 percent, with higher effectiveness against more severe outcomes. The effectiveness of the vaccine against the Omicron variant declined four months after the first dose but then stabilized. An analysis did not find an increased risk of heart-related complications after vaccination.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Yong Chen, PhD, please email ychen123@pennmedicine.upenn.edu.

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3. Two doses of the herpes zoster vaccine provides strong and lasting protection against shingles

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2023    
 URL goes live when the embargo lifts   
 A real-world study of the recombinant zoster vaccine (RZV) found that two doses provided strong and lasting protection against  herpes zoster , or shingles, even in patients at higher risk for the disease , such as those taking corticosteroids. The findings are published in Annals of Internal Medicine.

 

Shingles is a painful rash with complications that include persistent burning pain at the site of the initial rash, known as postherpetic neuralgia. The incidence and severity of shingles increase markedly with age and immunocompromising conditions. A 2-dose series of RZV has been shown to be very effective in clinical trials, but the long-term effectiveness has not been extensively studied in real-world settings.

 

Researchers from Kaiser Permanente Northern California studied data from the Vaccine Safety Datalink to evaluate the real-world effectiveness of RZV against acquiring shingles. The outcome was incident shingles defined by a diagnosis with an antiviral prescription. The researchers used a Cox regression model to compare the risk of getting shingles in people who were vaccinated versus those who were not. Other factors that could affect the risk, such as age or other health conditions were accounted for in the model. The researchers found that the RZV vaccine provided a high level of protection that didn't decrease much over 4 years. Among people taking corticosteroids, medications that can weaken the immune system, the vaccine still showed substantial effectiveness. According to the authors, this is important because people on corticosteroids are at a higher risk of getting shingles. The study also revealed that the effectiveness of just one dose of the vaccine decreased after a year, supporting the current recommendation for people to get a second dose. These findings support the existing guideline recommending a two-dose regimen for optimal protection.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Ousseny Zerbo, PhD, please e-mail ousseny.x.zerbo@kp.org.

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