Internal Medicine

AI-enabled ECG screening modestly boosts advanced cirrhosis detection in primary care

In this pragmatic cluster-randomized trial, 98 primary care teams received either access to an ECG-based machine learning model or usual care. Among 15,596 adults with routine ECGs, ECG-ML access doubled 180-day diagnoses of advanced chronic liver disease (1.0% vs 0.5%; OR 2.09, 95% CI 1.22-3.55). Among ECG-ML–positive patients, advanced disease detection was quadrupled in the intervention arm (4.4% vs 1.1%; OR 4.37, 95% CI 1.94-9.88). Detection of any fibrosis also increased overall (1.7% vs 0.5%; OR 3.17) and in ECG-ML–positive patients (8.4% vs 1.1%; OR 8.03). 1

Visit disruptions during early COVID modestly worsened BP control in a safety-net system

This observational study followed 73,889 adults aged ≥50 with hypertension or diabetes plus another comorbidity in New York City's safety-net system. During the March–October 2020 shutdown, 12.5% had no ambulatory or telehealth encounters and were classified as care-disrupted. Low pre-pandemic utilization, Medicaid coverage, and self-pay status independently predicted disruption, flagging groups needing targeted outreach. Difference-in-differences analysis showed a 3–percentage point greater decline in blood pressure control among disrupted patients versus those maintaining contact. 2

Having a usual primary care source improves 15-year survival in older adults

This retrospective cohort linked 2000 and 2005 NHIS data to National Death Index records for 10,873 US adults aged 65–84. Only 6.4% lacked a usual primary care source, yet this was associated with higher 15-year mortality. After adjustment, having primary care was associated with lower mortality (aHR 0.84, 95% CI 0.72-0.98). Median survival was at least 2.1 years longer with primary care (>15 years vs 12.9 years without). 3

Housing and transportation needs drive acute care use in Medicare and Medicaid beneficiaries

This retrospective cohort examined 166,682 Medicare and Medicaid patients screened for six health-related social needs in an Accountable Health Communities program. All six needs were associated with emergency department use, with strongest adjusted odds for housing instability (OR 1.25) and transportation barriers (OR 1.31). Housing instability and transportation needs also independently predicted higher inpatient admissions (OR 1.34 and 1.16, respectively). Roughly one-quarter of patients with housing or transportation needs had an ED visit within six months. 4