JAMA Network Open最新文献

{"title":"Timing of Antenatal Corticosteroid Administration and Neonatal Outcomes.","authors":"Nir Melamed, Kellie E Murphy, Christy Pylypjuk, Rebecca Sherlock, Guillaume Ethier, Eugene W Yoon, Prakesh S Shah","doi":"10.1001/jamanetworkopen.2025.11315","DOIUrl":"10.1001/jamanetworkopen.2025.11315","url":null,"abstract":"<p><strong>Importance: </strong>Antenatal corticosteroids (ACS) are accepted to be most effective in reducing prematurity-related neonatal mortality and morbidity when administered 1 to 7 days before birth. However, precise data on the optimal timing of administration are scarce.</p><p><strong>Objective: </strong>To investigate the association between ACS administration to birth interval as a continuous variable and neonatal outcomes among preterm neonates.</p><p><strong>Design, setting, and participants: </strong>This national retrospective cohort study was conducted from 2018 to 2021 at level III neonatal intensive care units participating in the Canadian Neonatal Network. Participants included singleton and twin neonates born from 23 weeks 0 days' to 31 weeks 6 days' gestation. Data were analyzed from November 29, 2023, to March 8, 2024.</p><p><strong>Exposure: </strong>ACS administration to birth interval.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was neonatal mortality. The secondary outcome was a composite of mortality or severe neurologic injury. Associations of the ACS administration to birth interval with the study outcomes were modeled using restricted cubic splines with 5 knots.</p><p><strong>Results: </strong>A total of 7950 neonates met the study criteria, from 7124 pregnancies (mean [SD] maternal age, 31.1 [5.7] years). Compared with individuals who received ACS, those who did not were younger and had lower rates of nulliparity, twin pregnancy, hypertension, and gestational diabetes. The overall rates of neonatal mortality and the composite outcome were 8% (670 of 7950) and 14% (1132 of 7950), respectively. ACS exposure was associated with reduced neonatal mortality as early as 2 hours after administration (adjusted risk ratio [ARR], 0.83 [95% CI, 0.70-1.00]). The reduction in mortality risk increased to a plateau 12 hours following exposure (ARR, 0.56 [95% CI, 0.40-0.78]), remained stable for the first 2 weeks following exposure, and gradually decreased after that. The association with reduced mortality was no longer observed at 4 weeks after administration (ARR, 0.82 [95% CI, 0.56-1.20]), and the ARR approached the null 5 weeks after administration (ARR, 0.99 [95% CI, 0.56-1.73]). This pattern was not affected by gestational age at birth or the number of fetuses.</p><p><strong>Conclusions and relevance: </strong>In this cohort of neonates born from 23 weeks 0 days' gestation to 31 weeks 6 days' gestation, ACS administration was associated with a reduction in neonatal mortality as early as 2 hours after the administration of the first dose. The interval associated with the greatest reduction in neonatal mortality was between 12 hours and 14 days before birth, which was wider than the currently accepted optimal interval of 1 to 7 days. These findings may have important clinical implications for the management of pregnancies at risk of preterm birth, particularly regarding the administration of ACS even i","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511315"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoxygenation With and Without Positive End-Expiratory Pressure in Lung-Healthy Volunteers: A Randomized Clinical Trial.","authors":"Giulia Roveri, Anna Camporesi, Alex Hofer, Simon Kahlen, Franziska Breidt, Simon Rauch","doi":"10.1001/jamanetworkopen.2025.11569","DOIUrl":"10.1001/jamanetworkopen.2025.11569","url":null,"abstract":"<p><strong>Importance: </strong>Optimal preoxygenation is critical in emergency medicine to prevent desaturation during airway management, especially in high-risk populations. Identifying the most effective preoxygenation device across diverse patient groups remains a clinical priority.</p><p><strong>Objective: </strong>To compare the efficacy of 3 preoxygenation devices-nonrebreather mask (NRM), bag-valve mask (BVM), and BVM with positive end-expiratory pressure (BVM plus PEEP)-in lung-healthy volunteers.</p><p><strong>Design, setting, and participants: </strong>This crossover randomized clinical trial was conducted from May 26 to 31, 2024, at Eurac Research, Bolzano, Italy. Volunteer participants included lung-healthy adults with normal weight (NM), adults with overweight or obesity (OW-OB), and children aged 6 to 12 years.</p><p><strong>Exposures: </strong>Preoxygenation using each device (NRM, BVM, BVM plus PEEP) with 15 L/min of oxygen for a duration of 3 minutes in a randomized order.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was expiratory oxygen concentration (Feo2) at the end of preoxygenation. Secondary outcomes included ventilation in dependent lung regions assessed using electrical impedance tomography, noninvasive continuous monitoring of oxygenation status (oxygenation reserve index [ORI]) at the end of preoxygenation, and the time taken for ORI to return to baseline values.</p><p><strong>Results: </strong>The study included 53 participants, 39 male (74%) and 14 female (26%), of whom 16 were adults with NW (mean [SD] age, 36 [11] years), 18 were adults with OW-OB (mean [SD] age, 45 [11] years), and 19 were children (mean [SD] age, 8 [3] years). Mean (SD) Feo2 at the end of preoxygenation was higher with BVM and BVM plus PEEP compared with NRM in adults with NW (72.1% [5.9%] and 75.6% [4.3%], respectively, vs 52.5% [6.1%]; P < .001), adults with OW-OB (65.8% [10.4%] and 73.0% [6.4%], respectively, vs 51.9% [6.1%]; P < .001), and children (64.6% [13.4%] and 67.5% [10.2%], respectively, vs 38.5% [7.5%]; P < .001). Ventilation in dependent lung regions was higher with BVM plus PEEP than NRM in adults with NW (BVM plus PEEP, 51.9 [9.3] vs NRM, 47.0 [5.7]; P = .03) and children (BVM plus PEEP, 53.0 [7.3] vs NRM, 47.7 [7.0]; P = .002). ORI at the end of preoxygenation was higher with BVM plus PEEP than with NRM in adults with OW-OB (BVM plus PEEP, 0.79 [0.13] vs NRM, 0.73 [0.13]; P < .001). Additionally, the mean (SE) time for ORI to return to baseline was longer with BVM plus PEEP compared with NRM in both adults with OW-OB (BVM plus PEEP, 196 [74] seconds vs NRM, 158 [53] seconds; P = .01) and children (BVM plus PEEP, 115 [59] seconds vs NRM, 62 [36] seconds; P < .001).</p><p><strong>Conclusions and relevance: </strong>In this crossover randomized clinical trial, preoxygenation with PEEP was more effective than preoxygenation without PEEP, resulting in higher Feo2 values and improved ventilation in dependent ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511569"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences With VA-Purchased Community Care for US Veterans With Mental Health Conditions.","authors":"Megan E Vanneman, Eric T Roberts, Yaming Li, Florentina E Sileanu, Utibe R Essien, Maria K Mor, Michael J Fine, Carolyn T Thorpe, Thomas R Radomski, Katie J Suda, Walid F Gellad","doi":"10.1001/jamanetworkopen.2025.11548","DOIUrl":"10.1001/jamanetworkopen.2025.11548","url":null,"abstract":"<p><strong>Importance: </strong>Veterans with mental health conditions (MHC) face unique challenges obtaining high-quality, coordinated health care. With a growing number of veterans receiving VA-purchased community care (CC) provided outside the Veterans Health Administration (VA), evidence is needed on how veterans in this high-prevalence, marginalized subgroup experience CC.</p><p><strong>Objective: </strong>To compare experiences with CC over time for US veterans with and without MHC.</p><p><strong>Design, setting, and participants: </strong>This retrospective, cross-sectional survey study analyzed responses to the Survey of Healthcare Experiences of Patients-Community Care Survey (SHEP-CCS) from 2016 to 2021. Ratings of CC were examined across 9 domains and compared for veterans with and without MHC, adjusting for differences in baseline characteristics using regression models. Data were analyzed from March 2023 to September 2024.</p><p><strong>Exposure: </strong>Diagnosis of MHC, defined as bipolar disorder, major depression, posttraumatic stress disorder, schizophrenia, or psychosis.</p><p><strong>Main outcomes and measures: </strong>Veterans' ratings of CC across 9 domains, overall satisfaction, overall clinician rating, clinician communication, eligibility determination, first appointment access, recent appointment access, nonappointment access, care coordination, and billing, were assessed on a scale of 1 to 100. Unadjusted annual ratings of care experiences were analyzed by survey domain. A series of 4 respondent-level linear regression models were examined for each domain and survey responses were pooled to test for differences in experiences between veterans with vs without MHC.</p><p><strong>Results: </strong>This study included 231 869 veterans, including 62 911 veterans with MHC (27.1%) and 168 958 without MHC (72.9%). Veterans with MHC had a mean (SD) age of 55.8 (14.7) years, 8327 were female (18.5%), and 24 792 had 3 or more comorbidities (29.9%). Veterans without MHC had a mean (SD) age of 62.5 (15.2) years, 11 277 were female (11.0%), and 49 689 had 3 or more comorbidities (24.0%). In fully adjusted models, veterans with vs without MHC had lower adjusted overall satisfaction with CC by -1.8 (95% CI, -2.3 to -1.3) points (P < .001). Ratings in all domains were lower for veterans with vs without MHC (-0.09 to -0.05 SDs of domain scores) (P < .001 for all comparisons). Although ratings improved from 2016 to 2021, significant differences persisted over time for veterans with vs without MHC for all domains.</p><p><strong>Conclusions and relevance: </strong>In this survey study of veterans receiving CC from 2016 to 2021, those diagnosed with MHC reported lower ratings of CC across all measured domains, and these differences persisted over time. These findings highlight where focused care coordination and quality improvement efforts could improve CC experiences for this vulnerable subpopulation of veterans.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511548"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure Therapy in Mixed Reality for Obsessive-Compulsive Disorder: A Randomized Clinical Trial.","authors":"Franziska Miegel, Lena Jelinek, Luzie Lohse, Steffen Moritz, Jannik Blömer, Kim Juckoff, Amir Yassari, Lara Rolvien","doi":"10.1001/jamanetworkopen.2025.11488","DOIUrl":"10.1001/jamanetworkopen.2025.11488","url":null,"abstract":"<p><strong>Importance: </strong>Exposure therapy in virtual reality (VR) is well established for anxiety disorders. While early studies show promise for VR-based exposure and response prevention (ERP) in obsessive-compulsive disorder (OCD), a key challenge of traditional VR is the weak sense of presence, deemed crucial for effectiveness.</p><p><strong>Objective: </strong>To evaluate the feasibility and efficacy of ERP in mixed reality (MERP).</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial (RCT) included 2 outpatient treatment groups, MERP vs self-guided ERP (SERP) from March 15, 2022, to October 26, 2024. Participants were required to be 18 to 80 years of age and have contamination-related OCD (C-OCD). Exclusion criteria consisted of schizophrenia or bipolar disorder, severe substance use disorder, acute suicidality, and ongoing inpatient treatment. Patients' symptom severity was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before (baseline) and after the 6-week intervention period as well as 3 months after posttreatment (follow-up).</p><p><strong>Intervention: </strong>Six sessions of MERP or SERP.</p><p><strong>Main outcomes and measures: </strong>Main outcome was the severity of OCD symptoms in the past 7 days on the Y-BOCS. Sense of presence and subjective appraisal were the secondary outcomes.</p><p><strong>Results: </strong>Thirty-six participants fulfilled inclusion criteria. Twenty-four participants (66.7%) were female; mean (SD) age was 35.42 (14.03) years. Both groups had severe OCD symptoms, with major depressive disorder as the most common comorbidity (23 [63.9%]). Twenty-nine participants (80.6%) completed the postintervention and follow-up assessments. At baseline, patients in the MERP group had a mean (SD) Y-BOCS score of 26.94 (5.83), while the SERP group had a mean (SD) score of 24.22 (4.12). The decline in patients' OCD symptoms (Y-BOCS) was similar in the MERP (mean difference, 3.15) and the SERP groups (mean difference, 1.47) (ηp2 = 0.002; 95% CI, -3.187 to 3.893). Significant improvements were observed within the MERP group from baseline to post treatment across several psychopathological variables, including OCD symptoms, with a medium to large effect (Cohen d, 0.584-0.931; 95% CI, 0.026-1.551). Sense of presence was moderate (mean [SD], ≤3.24 [≤2.07]). Subjective appraisal was heterogeneous.</p><p><strong>Conclusions: </strong>This RCT on MERP in C-OCD provided important insights. While there were no significant between-group differences, changes in psychopathology within the MERP group suggest some level of effectiveness. However, the limited impact indicates that the full potential of MERP has not yet been realized, and future research should aim to improve immersion and overall effectiveness.</p><p><strong>Trial registration: </strong>German Clinical Trial Registry: DRKS00020969.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511488"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and First Seizure Length in Electroconvulsive Therapy.","authors":"Alexander Sartorius, Charles H Kellner, Sebastian Karl, Randall T Espinoza","doi":"10.1001/jamanetworkopen.2025.12092","DOIUrl":"10.1001/jamanetworkopen.2025.12092","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512092"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Figure.","authors":"","doi":"10.1001/jamanetworkopen.2025.17382","DOIUrl":"10.1001/jamanetworkopen.2025.17382","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2517382"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectional and Marginal Debiasing in Prediction Models for Emergency Admissions.","authors":"Elle Lett, Shakiba Shahbandegan, Yuval Barak-Corren, Andrew M Fine, William G La Cava","doi":"10.1001/jamanetworkopen.2025.12947","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.12947","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Fair clinical prediction models are crucial for achieving equitable health outcomes. Intersectionality has been applied to develop algorithms that address discrimination among intersections of protected attributes (eg, Black women rather than Black persons or women separately), yet most fair algorithms default to marginal debiasing, optimizing performance across simplified patient subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the extent to which simplifying patient subgroups during training is associated with intersectional subgroup performance in emergency department (ED) admission models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prognostic study of admission prediction models used retrospective data from ED visits to Beth Israel Deaconess Medical Center Medical Information Mart for Intensive Care IV (MIMIC-IV; n = 160 016) from January 1, 2011, to December 31, 2019, and Boston Children's Hospital (BCH; n = 22 222) from June 1 through August 13, 2019. Statistical analysis was conducted from January 2022 to August 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was admission to an in-patient service. The accuracy of admission predictions among intersectional subgroups was measured under variations on model training with respect to optimizing for group level performance. Under different fairness definitions (calibration, error rate balance) and modeling methods (linear, nonlinear), overall performance and subgroup performance of marginal debiasing approaches were compared with intersectional debiasing approaches. Subgroups were defined by self-reported race and ethnicity and gender. Measures include area under the receiver operator characteristic curve (AUROC), area under the precision recall curve, subgroup calibration error, and false-negative rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The MIMIC-IV cohort included 160 016 visits (mean [SD] age, 53.0 [19.3] years; 57.4% female patients; 0.3% American Indian or Alaska Native patients, 3.7% Asian patients, 26.2% Black patients, 10.0% Hispanic or Latino patients, and 59.7% White patients; 29.5% admitted) and the BCH cohort included 22 222 visits (mean [SD] age, 8.2 [6.8] years; 52.1% male patients; 0.1% American Indian or Alaska Native patients, 4.0% Asian patients, 19.7% Black patients, 30.6% Hispanic or Latino patients, 0.2% Native Hawaiian or Pacific Islander patients, 37.7% White patients; 16.3% admitted). Among MIMIC-IV groups, intersectional debiasing was associated with a reduced subgroup calibration error from 0.083 to 0.065 (22.3%), while marginal fairness debiasing was associated with a reduced subgroup calibration error from 0.083 to 0.074 (11.3%; difference, 11.1%); among BCH groups, intersectional debiasing was associated with a reduced subgroup calibration error from 0.111 to 0.080 (28.3%), while marginal fairness debiasing was associated with a reduced subgroup calibration error from 0.111 to 0.086","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512947"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policies for Infection Prevention and Control in Home Health Care, 2019 vs 2023.","authors":"Jingjing Shang, Ji Won Lee, Andrew W Dick, Ashley M Chastain, U Gayani E Perera, Laurent G Glance, Patricia W Stone","doi":"10.1001/jamanetworkopen.2025.12450","DOIUrl":"10.1001/jamanetworkopen.2025.12450","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512450"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid Costs and Outcomes for Patients Treated in an Outpatient Telepsychiatry Clinic.","authors":"John L Havlik, Reza H Ghomi, Na An, Puneet Budhiraja, Eric R Arzubi","doi":"10.1001/jamanetworkopen.2025.8558","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8558","url":null,"abstract":"<p><strong>Importance: </strong>Evidence of cost savings attributable to indicated and timely care remain rare in psychiatry. Interventions to provide evidence-based psychiatric care to Medicaid patients that lower total costs of care are particularly challenging.</p><p><strong>Objective: </strong>To investigate Medicaid costs and care outcomes associated with use of an outpatient telepsychiatry clinic.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed Medicaid patients using and not using the services of an outpatient telepsychiatry clinic (Frontier Psychiatry, Billings, Montana) in 2022. Data analysis was performed from June to September 2024.</p><p><strong>Exposure: </strong>Receipt of care through an outpatient telepsychiatry clinic.</p><p><strong>Main outcomes and measures: </strong>Differences in Medicaid costs and cost subtypes between telepsychiatry patients and controls were assessed. Quality metrics, including inpatient hospitalizations, hospital readmissions, and admissions from the emergency department, were also compared.</p><p><strong>Results: </strong>In total, there were 2686 patients using the outpatient telepsychiatry clinic's services (1665 female [62.0%]; mean [SD] age, 30.55 [14.67] years) and 2686 propensity-matched controls (1665 female [62.0%]; mean [SD] age, 31.37 [15.92] years). Across categories examined, the telepsychiatry patients had care costs per member per month (PMPM) similar to those for propensity-matched control patients ($685.5 [95% CI, $632.9-$738.2] vs $734.0 [95% CI, $645.7-$822.3]; P = .10) over the study period. PMPM costs to Medicaid from the telepsychiatry clinic's patients were higher for professional services vs control patients ($464.0 [95% CI, $443.4-$484.5] vs $388.4 [95% CI, $368.1-$408.7]; P < .001) but were lower for inpatient hospitalization fees ($201.6 [95% CI, $146.2-$228.7] vs $260.6 [95% CI, $220.2-$341.5]; P = .04). Telepsychiatry clinic patients had a 38.0% lower mean annualized hospitalization rate per 1000 patients than controls (274.3 [95% CI, 237.1-311.6] hospitalizations per 1000 patients vs 442.6 [95% CI, 396.5-488.7] hospitalizations per 1000 patients; P < .001) and a 17.9% lower rate of admissions from the emergency department (patients vs controls, 299.7 admissions [47.7%] vs 519.0 admissions [58.1%]).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of 5372 patients, use of an outpatient telepsychiatry clinic's services was associated with decreases in inpatient hospitalization rates and lower rates of admissions from the emergency department, with similar costs to Medicaid. These findings suggest that outpatient telepsychiatry care could play an important role in reducing hospital admissions among patients enrolled in Medicaid.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258558"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination Therapy in Metastatic Hormone-Sensitive Prostate Cancer-Are We Moving Fast Enough?","authors":"Pedro C Barata, Jorge A Garcia","doi":"10.1001/jamanetworkopen.2025.9442","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.9442","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259442"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}