Internal medicine physicians are specialists who promote health, emphasize disease prevention, manage complex acute and chronic conditions in adults, and receive extensive training in the diagnosis and treatment of diseases affecting all systems of the human body. As a result, internal medicine performance measures (PMs) target several topics. Many PMs are not based on high-certainty evidence of at least moderate net benefit and are burdensome, with low or no value to patient care. The American College of Physicians (ACP) wants to provide a national focus to improve the quality of health care in the United States. The ACP is a leader in the evidence-based world, being the only physician organization designated as a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Center, an Appraisal of Guidelines for Research and Evaluation (AGREE) Center, and a member of the Cochrane U.S. Network. Using a structured, stepwise, evidence-based approach, ACP identified the most important clinical topics evaluated and treated by internal medicine physicians. The ACP is also actively working toward recommending essential PMs for each core clinical topic that can be used to evaluate and improve patient care. This position paper describes ACP's method and results of identifying core clinical topics. It also offers a blueprint for defining core PMs and illustrating the principals through application to 2 core clinical topics. The ACP plans to apply this method on PMs for other core clinical topics.

Analyses of clinical trials find that an intensive systolic blood pressure (SBP) target of less than 120 mm Hg is cost-effective compared with a target of less than 140 mm Hg for patients at high cardiovascular disease risk. However, guidelines from the American College of Cardiology and American Heart Association recommend a target of less than 130 mm Hg, citing blood pressure measurement error in routine practice.

Optimal transfusion strategies for patients with acute myocardial infarction (AMI) are uncertain. The aim of this guideline is to provide recommendations for red blood cell transfusion in patients with AMI.

The U.S. health care system is experiencing numerous supply chain disruptions, including for important medications. Prescription drug shortages have been at record levels and have affected more drugs in recent years, especially generic sterile injectables and other low-margin medications. These shortages arise from a confluence of factors, including the complexity of the entire production and delivery supply chain, quality issues, outdated manufacturing facilities and practices, drug purchasing policies that prioritize lowest price over reliable production, changes in prescribing and usage patterns, geopolitical constraints, and market concentration, among other factors. When prescription drugs are in shortage, patients face negative health outcomes due to being unable to obtain necessary treatments, the stress associated with securing medications, and adverse effects from alternative treatments. Physicians also face substantial burden in navigating drug shortages because they must expend time and resources in identifying alternative treatment options and obtaining prior authorization for the coverage of alternative drugs, negatively affecting the patient-physician relationship. Policymakers, regulators, manufacturers, health systems, health professionals, and other relevant entities must collaborate to further efforts to ameliorate drug shortages and promote equitable access to treatments. In addition to short-term measures to address the immediate effect of drug shortages, policymakers, manufacturers, and drug purchasers should also undertake efforts to prevent future drug shortages by investing in, strengthening, and diversifying prescription drug supply chains and incentivizing procurement practices that emphasize reliable and sustainable production practices. Such efforts must be undergirded by policies to improve monitoring of and transparency into the prescription drug supply chain.

The growing complexity of cancer care may be driving an increase in subspecialized medical oncologists who focus on treating specific cancer types. However, little is known about trends in subspecialization among oncologists and differences in utilization of subspecialists.