JAMA Network Open最新文献

{"title":"Safe Gun Storage and Youth Suicide-The Sum of Their Regrets.","authors":"Jeffrey W Swanson","doi":"10.1001/jamanetworkopen.2025.19271","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.19271","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519271"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575441","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":"Estimated Out-of-Pocket Costs for Patients With Common Cancers and Private Insurance.","authors":"Liam Rose, Ganesh Rajasekar, Anjali Nambiar, Alexa Pohl, Kathryn J Ruddy, Katherine Arnow, Manali Patel, Arden M Morris","doi":"10.1001/jamanetworkopen.2025.21575","DOIUrl":"10.1001/jamanetworkopen.2025.21575","url":null,"abstract":"<p><strong>Importance: </strong>Cancer imposes a substantial economic burden on patients that may be worse in patients with higher-stage disease due to the need for more therapy.</p><p><strong>Objective: </strong>To investigate the out-of-pocket costs (OOPCs) attributable to the initial treatment of common cancers among privately insured individuals diagnosed at different stages.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used administrative claims data of a large national insurer in the US linked to the Surveillance, Epidemiology, and End Results (SEER) cancer registry to compare OOPCs of individuals diagnosed with breast, colorectal, and lung cancer at different stages with OOPCs of similar individuals without cancer using difference-in-differences methods. Individuals living in the US between 2008 and 2022, aged younger than 65 years, insured through a large national private health insurer, and with 6 or more months of continuous enrollment were included. Data were analyzed from June 2024 through February 2025.</p><p><strong>Exposure: </strong>The presence or absence of an incident cancer diagnosis and disease stage from the SEER registry diagnosed from 2008 to 2019.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was OOPCs among individuals with breast, colorectal, and lung cancer diagnosed at different disease stages compared with those with no cancer diagnosis.</p><p><strong>Results: </strong>The cohort consisted of 46 158 patients (mean [SD] age at diagnosis, 46 [12] years; 30 733 female [66.6%]; 2543 Asian [5.5%], 4114 Black [8.9%], 3590 Hispanic [7.8%], and 31 099 White [67.4%]), including 19 656 patients with cancer and 26 502 patients without cancer in the control group. Among patients with cancer, 14 581 patients had breast cancer, 2842 patients had colorectal cancer, and 2233 patients had lung cancer. An incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month (95% CI, $528.01-$627.04 per month) for the 6 months after the diagnosis. Cost monotonically increased with stage at diagnosis (mean OOPC increase range, $462.01 per month [95% CI, $417.92-$506.11 per month] for stage 0 to $719.97 per month [95% CI, $626.11-$813.83 per month] for stage 4).</p><p><strong>Conclusions and relevance: </strong>In this study of individuals with private insurance, patients faced high OOPCs after an incident diagnosis of cancer, with patients with more advanced cancer having the highest OOPCs. Further research is needed to determine the clinical and financial effects of increased OOPCs for patients with cancer.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521575"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674808","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":"Smoking Cessation and Symptom Burden in Patients After Oncologic Surgery.","authors":"Katherine K S Rieth, AnaPaula Cupertino, Michael Shen, Hongying Sun, Luke Peppone","doi":"10.1001/jamanetworkopen.2025.22769","DOIUrl":"10.1001/jamanetworkopen.2025.22769","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2522769"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690329","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":"Tracking Psychopathology Dimensions Through Passive Smartphone Sensing-Promises, Pitfalls, and Pathways to Clinical Integration.","authors":"Christian A Webb, Hadar Fisher","doi":"10.1001/jamanetworkopen.2025.19054","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.19054","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519054"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553580","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":"Surgeons' Contributions to Antibiotic Stewardship and Resistance Prevention.","authors":"Gabriel Birgand, Nicolas Jacquet, Hubert Johanet, Niki Christou, Patrick Castel, Patrice Baillet, Céline Pulcini","doi":"10.1001/jamanetworkopen.2025.21165","DOIUrl":"10.1001/jamanetworkopen.2025.21165","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521165"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642584","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":"External Validation of an EHR-Based Model for Risk of Patient No-Show in Primary Care.","authors":"Afiba Manza-A Agovi, Mirsada Serdarevic, Aaron W Gehr, Caitlin T Thompson, Wentao Li, Jeff Claassen, Matthew Cvitanovich, Rohit P Ojha","doi":"10.1001/jamanetworkopen.2025.21637","DOIUrl":"10.1001/jamanetworkopen.2025.21637","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521637"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649476","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":"Emergency Department Visits for Cannabis Hyperemesis Syndrome Among Adolescents.","authors":"Michael S Toce, Michael C Monuteaux, Michael D Fishman, Joel D Hudgins","doi":"10.1001/jamanetworkopen.2025.20492","DOIUrl":"10.1001/jamanetworkopen.2025.20492","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2520492"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626314","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":"Maternal Morbidity With Expectant Management of Life-Limiting Fetal Conditions.","authors":"Anjali Nambiar, Elaine Larissa Duryea, Lisa Renee Thiele, Patricia Santiago-Munoz, David B Nelson, Catherine Y Spong, Courtney C Baker","doi":"10.1001/jamanetworkopen.2025.21883","DOIUrl":"10.1001/jamanetworkopen.2025.21883","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521883"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659261","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":"Measuring Goal-Concordant Care Using Electronic Clinical Notes.","authors":"Catherine L Auriemma, Anne Song, Lake Walsh, Jason Han, Sophia Yapalater, Alexander Bain, Lindsay Haines, Stefania Scott, Casey Whitman, Stephanie Parks Taylor, Gary E Weissman, Matthew J Gonzales, Roshanthi Weerasinghe, Staci J Wendt, Katherine R Courtright","doi":"10.1001/jamanetworkopen.2025.18967","DOIUrl":"10.1001/jamanetworkopen.2025.18967","url":null,"abstract":"<p><strong>Importance: </strong>Goal-concordant care (GCC) is recognized as the highest quality of care and most important outcome measure for serious illness research, yet practical methods for measuring it are lacking.</p><p><strong>Objective: </strong>To measure GCC using clinical notes in patients' medical records.</p><p><strong>Design, setting, and participants: </strong>This longitudinal cohort study involved a retrospective medical record review in 3 urban hospitals in a single health system. Participants included adults with a hospital encounter of 3 or more days between April 1 and July 31, 2019, and 50% or higher predicted 6-month mortality risk. Data abstraction occurred from July 2021 through June 2022.</p><p><strong>Exposure: </strong>Acute care hospitalization and a 50% or higher predicted 6-month mortality risk.</p><p><strong>Main outcomes and measures: </strong>Pairs of clinicians independently reviewed clinical notes from admission through 6 months or death to classify the care received during each epoch between patients' documented goals of care (GOC) discussions, into 1 of 4 categories: (1) comfort focused, (2) maintain or improve function, (3) life extension, or (4) unclear. The GOC discussions had been previously classified using the same 4 categories. The primary study outcome was GCC, defined as the alignment of classification of care received and GOC. Secondary outcomes included goal-discordant care, if GOC and care-received classifications were misaligned, and uncertain concordance, if either care received or GOC was classified as unclear or GOC were not documented. Interrater reliability for classification of care received was assessed using Cohen κ statistics.</p><p><strong>Results: </strong>Among 109 patients (53 female [49%]), the median (IQR) age was 70 (63-79) years. The most common serious illnesses were cardiac disease (76 patients [70%]), metastatic cancer (50 patients [45%]), and chronic kidney disease (42 patients [39%]). Interrater reliability for care-received classification was almost perfect (95% interrater agreement, Cohen κ = 0.92; 95% CI, 0.86-0.99). A total of 398 epochs of care were identified, 198 (50%) of which were classified as goal concordant. Of the remaining 200 epochs, 74 (19%) were classified as goal discordant and 126 (32%) of uncertain concordance. During at least 1 epoch of care over the 6-month follow-up, 85 patients (78%) received care of uncertain concordance and 43 (39%) received goal-discordant care.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of seriously ill adults, GCC was measured using clinical notes alone. These findings can inform automated text-based classification methods to improve the efficiency and scalability of this method and facilitate pragmatic and reliable measurement of GCC in serious illness research and quality improvement efforts.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518967"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553561","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":"Marginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors.","authors":"Leo E Akioyamen, Atul Sivaswamy, Olivia Haldenby, Husam Abdel-Qadir, Maneesh Sud, David A Alter, Clare L Atzema, Peter C Austin, Cynthia A Jackevicius, Moira K Kapral, Harlan M Krumholz, Karen Tu, Harindra C Wijeysundera, Dennis T Ko","doi":"10.1001/jamanetworkopen.2025.18826","DOIUrl":"10.1001/jamanetworkopen.2025.18826","url":null,"abstract":"<p><strong>Importance: </strong>Neighborhood characteristics may be independently associated with survival after acute myocardial infarction (AMI).</p><p><strong>Objective: </strong>To examine the association of living in a marginalized neighborhood with mortality and care for younger AMI survivors (aged <65 years) in a universal health care system.</p><p><strong>Design, setting, and participants: </strong>Population-based retrospective cohort using clinical and administrative databases in Ontario, Canada. Participants were younger patients hospitalized for their first AMI who received invasive evaluation and survived to 7 days after discharge between April 1, 2010, and March 1, 2019. Statistical analysis was performed between May 27, 2022, and March 31, 2025.</p><p><strong>Exposures: </strong>Neighborhood marginalization, a metric comprising material deprivation, residential instability, and dependency.</p><p><strong>Main outcomes and measures: </strong>All-cause death, all-cause hospitalizations, and subsequent AMIs. Proportional hazards regression models were used to quantify the association of marginalization with outcomes over 3 years.</p><p><strong>Results: </strong>Among 65 464 AMI patients (median age, 56 [IQR, 50-61] years; 22.9% female), increasing neighborhood marginalization was associated with higher rates of mortality beginning 30 days after discharge and persisting over time. At 3 years, mortality rates ranged from 2.2% in the least marginalized neighborhood quintile (Q1) to 5.2% in the most marginalized (Q5). Adjusted hazard ratios for mortality over 3 years of follow-up were significantly higher in patients from marginalized neighborhoods and ranged from 1.13 (95% CI, 0.95-1.35) in Q2 to 1.52 (95% CI, 1.29-1.80) in Q5. Over 1 year, differences were observed between Q1 and Q5 in visits to primary care physicians (Q1, 96.1%; Q5, 91.6%) and cardiologists (Q1, 88.0%; Q5, 75.7%), as well as diagnostic testing.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of younger AMI survivors with universal health care, living in marginalized neighborhoods was associated with adverse outcomes. The observed differences in health service utilization among marginalized patients warrant further investigation to better understand the underlying structural and systemic factors.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518826"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12223890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540176","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}