JAMA Internal Medicine

Listen to JAMA Internal Medicine authors Lauren A. Eberly, MD, MPH, and Kurt Hager, MD, discuss their recently published research with Eve Rittenberg, MD. https://ja.ma/4wqk4P9

A cross-sectional study using US Department of Veterans Affairs data analyzed over 1.5 million emergency department visits for chest pain, shortness of breath, or abdominal pain to assess practice pattern and outcome differences by physician sex. Female physicians ordered more laboratory and radiology tests and admitted a higher proportion of patients compared with male physicians, though differences were modest. No significant differences were observed in 30-day mortality or frequency of short inpatient stays. The additional tests ordered by female physicians did not result in higher test positivity, suggesting similar appropriateness. These findings indicate small but measurable sex-based differences in diagnostic and admission practices among emergency physicians, with unclear impact on quality of care. https://ja.ma/4wvqZGO

A cohort study of more than 6100 patients discharged after hospitalization for heart failure evaluated real-world patterns of use for guideline-directed medical therapy, including beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors. While half of patients received at least one new heart failure medication at discharge, only 54% of new prescriptions were filled within 7 days and an additional 20% were delayed until up to 90 days postdischarge. At 6 months, only 42% of patients were adherent and 51% were persistent with all recommended therapies, indicating substantial gaps in initiation and continued use that may impact heart failure outcomes. Findings support the need for interventions focused on supporting medication adherence and persistence across the care continuum after discharge for #HeartFailure. https://ja.ma/4wCmUk7

A qualitative study involving 38 primary care physicians across 13 US states examined the impact of anti-immigrant policies implemented since January 2025 on physicians caring for immigrant patients. Physicians described experiencing moral injury driven by conflicts between their professional and ethical values and the systemic restrictions on health care for immigrants, compounded for those with immigrant identities. These policies led to patient fear, disruptions in care access, and adverse physical and mental health outcomes for both immigrant and US citizen patients, while health care system responses—including restricting care or remaining silent—often intensified clinician distress. Physician engagement in advocacy, adaptive care delivery, and supportive health system practices helped mitigate moral injury, suggesting that institutional responses can influence workforce well-being and patient care in the current policy environment. https://ja.ma/44SyGus

💬 Editorial: Female physicians in VA emergency departments ordered more diagnostic tests and admitted more patients than male physicians, but test appropriateness and outcomes were similar. https://ja.ma/4fy9ZZ5

A pragmatic randomized clinical trial evaluated the effect of a culturally and medically tailored meal program (MUTTON-HF) incorporating traditional Navajo foods on clinical outcomes in adults with #HeartFailure living in rural Navajo Nation. Among 206 participants, individuals assigned to 8 weeks of locally sourced Indigenous meals had a significantly lower risk of hospitalization or emergency department visit within 90 days compared with those receiving usual dietary advice. Secondary analyses showed reductions in heart failure hospitalizations, blood pressure, financial strain, and food insecurity, as well as improvements in quality of life and dietary intake. These results highlight the impact of #FoodIsMedicine interventions designed with community input and the importance of culturally responsive, community-based strategies to address nutrition insecurity and cardiovascular health inequities in #Indigenous communities. https://ja.ma/4fya0w7

A cluster randomized clinical trial evaluated whether placement of portable high-efficiency particulate air (HEPA) filters in communal areas and bedrooms of care homes reduced winter respiratory infection rates among older adult residents. Among 91 care homes in England with more than 1100 residents, there was no significant difference in respiratory infection rates per resident between homes with HEPA filters and those continuing usual prevention measures. Staff absenteeism and other outcomes, such as antibiotic use and infection outbreaks, were also similar between groups. These findings suggest portable HEPA filters did not reduce the burden of respiratory infections, and support the continued use of existing infection prevention measures in long-term care settings. https://ja.ma/3RY4knq

A cross-sectional study of 7,089 general internists and over 890,000 Medicare beneficiaries assessed the association between physician knowledge, as measured by the first-year American Board of Internal Medicine Longitudinal Knowledge Assessment (LKA), and the provision of low-value services (LVS) in outpatient practice. Patients cared for by physicians in the top LKA score quartile were 7.9% less likely to receive any of 25 low-value services—including unneeded imaging, screening, and diagnostic tests—compared with those seen by physicians in the lowest quartile, after adjustment for multiple patient and practice characteristics. The findings indicate that higher physician knowledge is associated with reduced use of low-value care and highlight opportunities for targeted educational interventions to improve healthcare value. https://ja.ma/4gBPNId

A retrospective cohort study of Medicare beneficiaries with cancer assessed the association between insurance type, Medicare Advantage (MA) vs traditional Medicare (TM), and cancer treatment selection, cost, and timeliness. Among 35,245 patients with 13 clinical cancer scenarios, MA beneficiaries had similar likelihood of receiving optimal guideline-recommended treatment and comparable time to treatment initiation compared to TM beneficiaries. However, cancer treatments initiated by MA beneficiaries were associated with lower estimated costs (about 6% less per patient), translating to mean savings of $931, without reductions in quality or delays in care. These findings indicate that MA plans may reduce cancer treatment costs through utilization management strategies, while maintaining access to evidence-based care. https://ja.ma/4vo2KsQ

💬 Viewpoint: Most lethal zoonotic viruses, including Andes virus, lack sufficient transmissibility for global spread. Balanced public health communication is essential to prevent undue alarm. https://ja.ma/4fesLVp