JAMA Network Open最新文献

{"title":"Cost-Effectiveness of Team-Based Coaching With Surveillance for Prevention of Acute Kidney Injuries.","authors":"David Xiao, Sharon E Davis, Caroline M Godfrey, Hanxuan Yu, Elizabeth Sullivan, Jinyi Zhu, Ashley A Leech, Kevin C Cox, Iben Ricket, Michael E Matheny, Jeremiah R Brown, Stephen A Deppen","doi":"10.1001/jamanetworkopen.2025.2503","DOIUrl":"10.1001/jamanetworkopen.2025.2503","url":null,"abstract":"<p><strong>Importance: </strong>More than 10% of US patients undergoing endovascular procedures experience contrast-associated acute kidney injuries (AKIs), resulting in increased costs and health deficits. Prevention protocols reduce AKIs, but uptake and adherence vary greatly, and the cost-effectiveness of these interventions is unknown.</p><p><strong>Objective: </strong>To analyze the cost-effectiveness of 4 implementation interventions for AKI prevention in patients undergoing cardiac catheterizations.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation used a Markov decision model with 3-year horizon was constructed to simulate quality-adjusted life years (QALYs) and costs after AKI prevention protocol implementation for patients undergoing cardiac catheterization. Data from the IMPROVE AKI trial, a cluster-randomized trial conducted across 20 US Department of Veterans Affairs medical centers from 2019 to 2021, were used for probabilities, with economic and utility data derived from literature. Patients aged 18 years or older, who underwent cardiac coronary angiography for diagnostic or treatment of pathology were included. Patients with a history of dialysis (hemodialysis or peritoneal dialysis) were excluded. Data were analyzed from January to June 2024.</p><p><strong>Exposure: </strong>Interventions compared were assistance, assistance with surveillance, collaborative, and collaborative with surveillance.</p><p><strong>Main outcomes and measures: </strong>QALYs and cost in dollars discounted at 3% per year and incremental cost-effectiveness ratio (ICER) using willingness-to-pay threshold of $100 000 per QALY. One-way and probabilistic sensitivity analyses were performed.</p><p><strong>Results: </strong>Among 122 803 patients, 13 047 experienced AKIs (10.6%). Patient characteristics were balanced across 4 groups with an overall median (IQR) age of 70 (65-74) years, 119 119 males (97%), 25 789 Black patients (21%), 88 418 White patients (72%), and 8596 for all other racial and ethnic groups (7%). AKI incidences were 13.3% (95% CI, 11.0%-15.6%) in assistance, 11.4% (95% CI, 9.5%-13.3%) in assistance with surveillance, 12.7% (95% CI, 11.1%-14.4%) in collaborative, and 7.9% (95% CI, 6.4%-9.5%) in collaborative with surveillance. Intervention costs per patient were $12.74 (IQR, $9.56-$15.93) for collaborative with surveillance, $3.97 (IQR, $2.98-$4.96) for collaborative, $3.36 for assistance with surveillance, and $2.69 for assistance. Drivers for total cost of interventions were costs of AKI and subsequent permanent kidney disease. ICERs revealed collaborative with surveillance as economically dominant. Compared with assistance, collaborative with surveillance saved $742.75 while improving cost-effectiveness by 0.02 QALYs per person. Results were robust to sensitivity analyses.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation of implementation strategies for AKI prevention, virtual le","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252503"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763936","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":"Repeated Access to Patient Portal While Awaiting Test Results and Patient-Initiated Messaging.","authors":"Bryan D Steitz, Robert W Turer, Liz Salmi, Uday Suresh, Scott MacDonald, Catherine M DesRoches, Adam Wright, Jeremy Louissaint, S Trent Rosenbloom","doi":"10.1001/jamanetworkopen.2025.4019","DOIUrl":"10.1001/jamanetworkopen.2025.4019","url":null,"abstract":"<p><strong>Importance: </strong>Patients have immediate access to test results in the patient portal, which can cause worry. Identifying behaviors associated with worry while awaiting results may allow health systems to support patients and reduce message volumes.</p><p><strong>Objective: </strong>To describe characteristics of patients who refresh their portal while awaiting test results and measure the association between refresh behavior and patient-initiated messaging.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study was performed at Vanderbilt University Medical Center, which uses a MyChart-based patient portal. All adult patients (aged ≥18 years) who received outpatient test results between January 1, 2022, and December 31, 2023, were included.</p><p><strong>Exposures: </strong>Use of the patient portal to review test results.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of patients who refreshed the portal while awaiting test results. Tests were stratified into low-sensitivity (eg, basic metabolic panel) and high-sensitivity (eg, tissue biopsy) groups using validated categories based on each test's likelihood of being misinterpreted or causing distress. Portal access logs were used to identify refresh behaviors, in which patients accessed the portal seeking new results. Secondary outcomes included the association between patient characteristics and refresh behavior and between refresh behavior and messaging as measured using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 968 774 results were reviewed by 290 349 patients (mean [SD] age, 47.8 [18.0] years; 66.3% female). Patients refreshed their portal for 25.9% of results. Patients more commonly refreshed for high-sensitivity results (25 280 of 64 356 [39.3%]) compared with low sensitivity results (225 516 of 904 418 [24.9%]) (P < .001). Patients who enabled notifications had higher odds of refreshing for high-sensitivity results (odds ratio, 1.11; 95% CI, 1.06-1.17) and low-sensitivity results (odds ratio, 1.54; 95% CI, 1.49-1.59). Each refresh for high-sensitivity results was associated with a lower increase in the probability of messaging within 24 hours (mean marginal effect, 0.41; 95% CI, 0.34-0.49) compared with refreshing for low-sensitivity results (mean marginal effect, 1.03; 95% CI, 0.96-1.11).</p><p><strong>Conclusion and relevance: </strong>This cross-sectional study found an association of patients' refresh activity for low-sensitivity results with patient-initiated messaging after review. These findings suggest that refresh behavior, a potential measure of worry, may be a characteristic of patient attitudes and preferences rather than the test.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254019"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803196","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":"Moving Closer to Personalized Cancer Prevention Strategies by Assessing Comorbidity and Multimorbidity.","authors":"Siran M Koroukian, Uriel Kim, Johnie Rose","doi":"10.1001/jamanetworkopen.2025.3476","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.3476","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253476"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795210","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":"Perceived Contributors to Job Quality and Retention at Home Care Cooperatives.","authors":"Geoffrey M Gusoff, Miguel A Cuevas, Catherine Sarkisian, Madeline R Sterling, Ariel C Avgar, Gery W Ryan","doi":"10.1001/jamanetworkopen.2025.4457","DOIUrl":"10.1001/jamanetworkopen.2025.4457","url":null,"abstract":"<p><strong>Importance: </strong>To safely age at home, millions of older adults rely on the services of home care workers (HCWs), a workforce marked by poor working conditions, high turnover, and critical worker shortages. Home care cooperatives-businesses co-owned and controlled by HCWs-have demonstrated significantly lower turnover and higher job quality than traditional home care businesses, but the factors associated with these outcomes have not been investigated.</p><p><strong>Objective: </strong>To identify potential factors associated with higher job quality and lower turnover at home care cooperatives.</p><p><strong>Design, setting, and participants: </strong>In this qualitative study, semistructured interviews were conducted in English from November 2023 to June 2024. To be eligible for the study, participants had to be 18 years old or older, speak English, and currently be employed by a home care cooperative. Interviews were conducted remotely over Zoom with individual HCWs and staff from home care cooperatives from across the US. Data were analyzed from May to July 2024.</p><p><strong>Exposure: </strong>Employment at a home care cooperative.</p><p><strong>Main outcomes and measures: </strong>Interviews were audio recorded and transcribed. A thematic analysis approach was used to code interviews and identify major themes and subthemes, informed by a conceptual model of direct care worker job outcomes.</p><p><strong>Results: </strong>A total of 23 HCWs and 9 staff members (14 participants aged 20-39 years [44%]; 8 [25%] African American, 4 [13%] Latinx, and 17 [53%] non-Latinx White) from 5 home care cooperatives participated in the study. Participants identified 4 key aspects of the cooperative work environment they perceived to be contributing to higher job quality and lower turnover compared with traditional agencies: (1) greater workplace control regarding patient care, case assignments, and organizational policies; (2) stronger community support and camaraderie; (3) a deeper culture of respect in which HCWs felt more valued; and (4) higher overall compensation in the form of wages, benefits, or profit sharing.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of HCWs and staff at home care cooperatives, participants perceived cooperatives' relatively high levels of HCW control, community, respect, and compensation to be important contributors to HCWs' retention in the field. The participatory structure and practices of home care cooperatives in these areas may represent novel approaches for home care agencies to reduce HCW turnover and improve job quality to address critical workforce shortages.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254457"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795216","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":"Spending on Glucagon-Like Peptide-1 Receptor Agonists Among US Adults.","authors":"Stavros Tsipas, Tamkeen Khan, Fleetwood Loustalot, Klodiana Myftari, Gregory Wozniak","doi":"10.1001/jamanetworkopen.2025.2964","DOIUrl":"10.1001/jamanetworkopen.2025.2964","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252964"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763873","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":"Errors in Abstract and Methods.","authors":"","doi":"10.1001/jamanetworkopen.2025.9310","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.9310","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e259310"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803182","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":"Perspectives on AI and Novel Technologies Among Older Adults, Clinicians, Payers, Investors, and Developers.","authors":"Nancy L Schoenborn, Kacey Chae, Jacqueline Massare, Sato Ashida, Peter Abadir, Alicia I Arbaje, Mathias Unberath, Phillip Phan, Thomas K M Cudjoe","doi":"10.1001/jamanetworkopen.2025.3316","DOIUrl":"10.1001/jamanetworkopen.2025.3316","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Artificial intelligence (AI) and novel technologies, such as remote sensors, robotics, and decision support algorithms, offer the potential for improving the health and well-being of older adults, but the priorities of key partners across the technology innovation continuum are not well understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the priorities and suggested applications for AI and novel technologies for older adults among key partners.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This qualitative study comprised individual interviews using grounded theory conducted from May 24, 2023, to January 24, 2024. Recruitment occurred via referrals through the Johns Hopkins Artificial Intelligence and Technology Collaboratory for Aging Research. Participants included adults aged 60 years or older or their caregivers, clinicians, leaders in health systems or insurance plans (ie, payers), investors, and technology developers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;To assess priority areas, older adults, caregivers, clinicians, and payers were asked about the most important challenges faced by older adults and their caregivers, and investors and technology developers were asked about the most important opportunities associated with older adults and technology. All participants were asked for suggestions regarding AI and technology applications. Payers, investors, and technology developers were asked about end user engagement, and all groups except technology developers were asked about suggestions for technology development. Interviews were analyzed using qualitative thematic analysis. Distinct priority areas were identified, and the frequency and type of priority areas were compared by participant groups to assess the extent of overlap in priorities across groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants included 15 older adults or caregivers (mean age, 71.3 years [range, 65-93 years]; 4 men [26.7%]), 15 clinicians (mean age, 50.3 years [range, 33-69 years]; 8 men [53.3%]), 8 payers (mean age, 51.6 years [range, 36-65 years]; 5 men [62.5%]), 5 investors (mean age, 42.4 years [range, 31-56 years]; 5 men [100%]), and 6 technology developers (mean age, 42.0 years [range, 27-62 years]; 6 men [100%]). There were different priorities across key partners, with the most overlap between older adults or caregivers and clinicians and the least overlap between older adults or caregivers and investors and technology developers. Participants suggested novel applications, such as using reminders for motivating self-care or social engagement. There were few to no suggestions that addressed activities of daily living, which was the most frequently reported priority for older adults or caregivers. Although all participants agreed on the importance of engaging end users, engagement challenges included regulatory barriers and stronger influence of payers relative to other end users.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclus","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253316"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780158","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 Abstract, Results, and Figure.","authors":"","doi":"10.1001/jamanetworkopen.2025.10141","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.10141","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e2510141"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803175","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":"Geographic Disparities in Oral Cancer Survival From 10 Population-Based Cancer Registries in India.","authors":"Krishnan Sathishkumar, Jayasankar Sankarapillai, Stephen Santhappan, Aleyamma Mathew, Rekha A Nair, Nitin Gangane, Sushma Khuraijam, Debanjana Barman, Shashank Pandya, Gautam Majumdar, Vinay Deshmane, Eric Zomawia, Ashok T Sherpa, Preethi George, Swapna Maliye, Tashnin Rahman, Anand Shah, Shravani Koyande, Lalawmpuii Pachuau, Priya D Pradhan, Shalin Lily Giboy, Prashant Mathur","doi":"10.1001/jamanetworkopen.2025.3910","DOIUrl":"10.1001/jamanetworkopen.2025.3910","url":null,"abstract":"<p><strong>Importance: </strong>India accounts for more than one-third of oral cancer (OC) cases globally. Cancer survival measures the effectiveness of the health care system's cancer control efforts and the proportion of people who survive during a specified time.</p><p><strong>Objective: </strong>To estimate the 5-year survival rates among patients with OC diagnosed in India and assess the association of survival with age, place of residence, histologic type, and clinical extent of OC.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study evaluated survival of patients diagnosed with primary OC (International Classification of Diseases for Oncology, Third Revision, codes C01-C06) between January 1, 2012, and December 31, 2015, and followed up until June 30, 2021. Patients were included from 10 population-based cancer registries (PBCRs). Data were analyzed between March 15 and August 20, 2024.</p><p><strong>Exposures: </strong>Demographic factors (patient age, sex, and place of residence) and disease factors (clinical extent of disease and histologic type).</p><p><strong>Main outcomes and measures: </strong>The main outcome was 5-year age-standardized relative survival (ASRS) for OC among male and female patients. A multivariable Cox proportional hazards model estimated hazard ratio (HR) and 95% CI, adjusting for covariates.</p><p><strong>Results: </strong>Data from the 10 PBCRs encompassed 14 059 patients of all ages (median age, 55 [IQR, 45-65] years; 10 380 male [73.8%]) diagnosed with OC. The overall 5-year ASRS rate for OC was 37.2% (range, 20.9%-58.4%). The estimated ASRS rates at 5 years were 36.0% (range, 20.7%-59.3%) for male and 39.6% (range, 21.4%-54.8%) for female patients. Ahmedabad urban had the highest 5-year ASRS at 58.4% (95% CI, 56.3%-60.4%) for both sexes, while Manipur had the lowest rates at 20.9% (95% CI, 14.9%-27.6%). Survival rates differed significantly between rural areas (34.1%; 95% CI, 31.4%-36.9%) and urban areas (48.5%; 95% CI, 47.4%-49.7%). Pooled data from Kollam and Thiruvananthapuram revealed that individuals 65 years or older (HR, 1.76; 95% CI, 1.44-2.14) and those with distant metastasis (HR, 3.95; 95% CI, 2.78-5.60) had a significantly higher risk of death.</p><p><strong>Conclusions and relevance: </strong>In this cohort study from India, significant survival disparities were observed among patients with OC based on demographic factors and clinical characteristics. Survival rates were lower in rural areas compared with urban regions, underscoring the inequalities in quality of care and services and emphasizing the need to improve OC survival rates in India.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253910"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803186","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":"Psilocybin Dispensaries and Advertising-Buyer Beware.","authors":"Paul R Hutson","doi":"10.1001/jamanetworkopen.2025.2858","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2858","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252858"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752740","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}