JAMA Network Open最新文献

{"title":"Error in Figure 1.","authors":"","doi":"10.1001/jamanetworkopen.2025.41442","DOIUrl":"10.1001/jamanetworkopen.2025.41442","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2541442"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232647","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 Author Name in Byline and Supplement.","authors":"","doi":"10.1001/jamanetworkopen.2025.40719","DOIUrl":"10.1001/jamanetworkopen.2025.40719","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2540719"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238647","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":"Receipt of PARP Inhibitors in Patients With Metastatic Prostate Cancer Harboring BRCA1/2 Alterations.","authors":"Micah Ostrowski, Yeonjung Jo, Chadi Hage Chehade, Zeynep Irem Ozay, Georges Gebrael, Nicolas Sayegh, Edwin Lin, Ayana Srivastava, Abigail Gordhamer, Richard Ji, Haoran Li, Vinay Mathew Thomas, Sumati Gupta, Irbaz Bin Riaz, Benjamin L Maughan, Soumyajit Roy, Neeraj Agarwal, Umang Swami","doi":"10.1001/jamanetworkopen.2025.34968","DOIUrl":"10.1001/jamanetworkopen.2025.34968","url":null,"abstract":"<p><strong>Importance: </strong>Patients with metastatic castration-resistant prostate cancer (mCRPC) harboring BRCA1/2 alterations are eligible to receive poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors as single agents or in combination with an androgen receptor pathway inhibitor after these agents showed survival improvement in their landmark clinical trials. However, data are limited regarding the uptake of PARP inhibitors in these patients.</p><p><strong>Objective: </strong>To investigate the use of PARP inhibitors in patients with mCRPC harboring BRCA1/2 alterations.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used the deidentified Flatiron-Health electronic health record-derived database of US community and academic practices to extract patient-level data. The data cutoff date was May 31, 2024. Patients with mCRPC with evidence of harboring BRCA1/2 alterations and alive after August 15, 2020 (ie, 3 months after the approval of the first PARP inhibitor, rucaparib, in mCRPC) were included. Statistical analysis was performed from September 2024 to May 2025.</p><p><strong>Exposures: </strong>Age, race and ethnicity, insurance status, and practice type at the time of mCRPC diagnosis.</p><p><strong>Main outcomes and measures: </strong>The receipt of PARP inhibitors. Multivariable logistic regression was conducted to assess the association between the exposures and the main outcome.</p><p><strong>Results: </strong>Of 24 105 patients with metastatic prostate cancer, 443 male patients (median [IQR] age, 72 [65-79] years) had mCRPC with BRCA1/2 alterations and were eligible and included in our analysis. Of these patients, 227 (51.2%) received a PARP inhibitor, whereas 216 (48.8%) did not. Compared with patients covered by a commercial health plan, those covered by Medicare were significantly more likely to receive a PARP inhibitor (odds ratio, 1.91; 95% CI, 1.02-3.66; P = .047). The odds of receiving a PARP inhibitor were not significantly higher in patients treated in community practice compared with those treated in academic centers (odds ratio, 1.64; 95% CI, 1.00-2.70; P = .05).</p><p><strong>Conclusions and relevance: </strong>This retrospective cohort study of patients with mCRPC and evidence of BRCA1/2 alterations found that approximately half of patients did not receive PARP inhibitors despite evidence of survival improvement in this population. These findings highlight the need to increase awareness of the survival data and access to life-prolonging therapies in patients with mCRPC.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534968"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206478","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":"Screen-Detected Breast Cancer Outcomes by Mammography Participation in Immediate Past Screening.","authors":"Xinhe Mao, Wei He, Jose Tapia, Natalie Holowko, Jenny Bergqvist, Keith Humphreys, Kamila Czene","doi":"10.1001/jamanetworkopen.2025.35330","DOIUrl":"10.1001/jamanetworkopen.2025.35330","url":null,"abstract":"<p><strong>Importance: </strong>Mammography screening is essential for the early detection of breast cancer; however, delayed detection among screen-detected breast cancers (SDBCs) is rarely studied.</p><p><strong>Objectives: </strong>To investigate whether women diagnosed with SDBC who missed the screening round immediately before the diagnostic round experience clinically significant delays in detection and whether tumor characteristics vary.</p><p><strong>Design, setting, and participants: </strong>This prospective register-based cohort study included all women diagnosed with SDBC in Stockholm, Sweden, between January 1, 1995, and February 28, 2020, with a follow-up until December 31, 2022. Data were analyzed from November 5, 2023, to May 27, 2024.</p><p><strong>Exposure: </strong>Nonparticipation in the screening immediately prior to the diagnostic round.</p><p><strong>Main outcomes and measures: </strong>Tumor characteristics and breast cancer-specific survival.</p><p><strong>Results: </strong>Among 8602 women with SDBC (median age at diagnosis, 61 [IQR, 55-66] years), 1482 (17.2%) did not attend the immediate past screening. Nonparticipants in the past screening were more likely to have larger tumors (adjusted odds ratio [AOR], 1.55 [95% CI, 1.37-1.76] for a tumor size ≥20 mm), lymph node involvement (AOR, 1.28 [95% CI, 1.12-1.45), and distant metastasis (AOR, 4.64 [95% CI, 2.10-10.29]) and less likely to have estrogen receptor-negative breast cancer (AOR, 0.74 [95% CI, 0.60-0.92]); however, there were no differences in progesterone receptor status (AOR, 0.96 [95% CI, 0.83-1.11]) or ERBB2 (formerly HER2 or HER2/neu) status (AOR, 1.00 [95% CI, 0.81-1.24]). In addition, these women experienced poorer breast cancer-specific survival, with an adjusted hazard ratio (AHR) of 1.33 (95% CI, 1.08-1.65). There was no association after adjusting for tumor characteristics (AHR, 1.11 [95% CI, 0.89-1.38]). Additionally, no association was found between nonparticipation in the second-to-last screening and tumor characteristics among those with screen-detected breast cancers (AHR, 0.98 [95% CI, 0.80-1.19] for stage II tumors or higher).</p><p><strong>Conclusions and relevance: </strong>The findings of this cohort study suggest that some women with SDBC experience delayed detection and have clinically relevant worse outcomes. Future research is needed to investigate whether advancing the next mammography screening invitation date could enhance early detection and improve breast cancer outcomes in this population.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535330"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212591","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 Funding/Support.","authors":"","doi":"10.1001/jamanetworkopen.2025.39577","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.39577","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2539577"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238775","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":"Out-of-State Acute Care Use Among Pediatric Medicaid Enrollees.","authors":"Kenneth A Michelson, Naveen Singamsetty, Andrew D Skol, Katherine E Remick, Emily M Bucholz, John A Graves, Danielle K Cory, Patrick D McMullen","doi":"10.1001/jamanetworkopen.2025.36236","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36236","url":null,"abstract":"<p><strong>Importance: </strong>For many US children, the nearest hospital may be out of state. Medicaid coverage differs by state, affecting access across state lines.</p><p><strong>Objective: </strong>To evaluate the frequency of out-of-state acute care use for pediatric patients.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed acute care hospital data for emergent and inpatient encounters among children younger than 16 years enrolled in Medicaid or the Children's Health Insurance Program (CHIP) in the 2021-2022 Transformed Medicaid Statistical Information System Analytic File database. Analyses were conducted January to July 2025.</p><p><strong>Exposure: </strong>Distance from a state border.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was out-of-state care. The percentages of encounters occurring out of state were measured by state, city, and zip code. Logistic regression was used to evaluate the association of out-of-state care use with the log distance from a patient's zip code to the border between states.</p><p><strong>Results: </strong>This analysis included 28 952 692 acute care patient encounters (median [IQR] age, 5.3 [2.0-10.8] years, 52.3% male). Out-of-state care occurred among 820 972 encounters (2.8% [95% CI, 2.8%-2.8%]). Maryland (61 468 of 389 539 [15.8% (95% CI, 15.7%-15.9%)]), Vermont (3625 of 31 101 [11.7% (95% CI, 11.3%-12.0%)]), and West Virginia (18 455 of 168 151 [11.0% (95% CI, 10.8%-11.1%)]) had the highest percentages of out-of-state care. The city from which the highest number of children accessed care out of state was Kansas City, Missouri (13 327 of 84 181 encounters [15.8% (95% CI, 15.6%-16.1%)]). Out-of-state care use was more common in rural areas (4.4% [95% CI, 4.3%-4.4%]) compared with urban areas (2.7% [95% CI, 2.7,%-2.7%]). For every 2-fold increase in distance from a state border, crossing a border for care was 34.2% (95% CI, 34.2%-34.3%) less likely. Among children within 1 mile of a state border, 10.0% (95% CI, 9.9%-10.0%) received care out of state.</p><p><strong>Conclusions and relevance: </strong>Findings from this cross-sectional study of Medicaid and CHIP enrollees indicated that out-of-state acute care use was uncommon overall but more common near state borders. Certain states and cities had high rates of out-of-state acute care use. Changes to Medicaid reimbursement could affect patients' ability to access cross-border care.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536236"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238830","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":"Long-Term Educational Outcomes of Individuals Born Preterm.","authors":"Tianna Loose, Ophelie Collet, Anne Monique Nuyt, Jean-Christophe Goulet-Pelletier, Frank C Worrell, Sylvana Côté, Thuy Mai Luu","doi":"10.1001/jamanetworkopen.2025.34918","DOIUrl":"10.1001/jamanetworkopen.2025.34918","url":null,"abstract":"<p><strong>Importance: </strong>Children born preterm may face neurodevelopmental challenges. Data on how this translates into long-term educational outcomes at the population level are scarce.</p><p><strong>Objective: </strong>To quantify relative contributions of preterm birth and sociodemographic factors to educational achievement and attainment.</p><p><strong>Design, setting, and participants: </strong>This case-control study included a birth cohort of all infants born preterm in Quebec, Canada, between 1976 and 1995, matched 1:2 with infants born term. Births before 37 weeks' gestations were considered preterm. The control cohort born between 37 and 42 weeks' gestation were matched by birth year, sex, and pregnancy type (singleton, twins). Administrative database linkages provided objective data for longitudinal follow-up to age 43 years. Individuals who died in 1976 to 2019 or without Quebec Ministry of Education records were excluded. Analyses were performed from February 2, 2023, to June 4, 2025.</p><p><strong>Exposure: </strong>Preterm birth, defined as extremely preterm (under 28 weeks), very preterm (28 to <32 weeks), or moderate-to-late preterm (32 to <37 weeks).</p><p><strong>Main outcomes and measures: </strong>Outcomes included high school performance (final high school average), high school graduation by age 22 years, and university degree at any age. Sociodemographic factors were extracted from the Quebec Births and Deaths registry. Socioeconomic status was derived using postal code and the Material and Social Deprivation Index.</p><p><strong>Results: </strong>Of 297 820 participants (160 980 male [54.0%]; 28 040 individuals [9.4%] born to mothers born outside Canada), 1915 (0.6%) were born extremely preterm, 13 225 (4.4%) very preterm, 83 105 (27.9%) moderate-to-late preterm, and 199 575 (67.0%) full term. Associations of preterm birth and final high school average were negligible among those who remained in school. Gestational age was associated with educational attainment in a dose-response pattern wherein individuals born extremely preterm were the most at risk for not graduating high school (OR, 1.80; 99% CI, 1.54-2.09) or not obtaining a university degree (OR, 1.68; 99% CI, 1.39-2.02). The contribution of preterm birth was small compared with male sex, maternal educational level, socioeconomic status, and migration related factors.</p><p><strong>Conclusions and relevance: </strong>In this case-control study, individuals born preterm were more likely than full-term counterparts to not complete high school, yet sociodemographic factors were more important than preterm status for educational attainment. Our findings substantiate the need for long-term follow-up and support to children born preterm and their families.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534918"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199557","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 Conclusions.","authors":"","doi":"10.1001/jamanetworkopen.2025.41245","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.41245","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2541245"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251009","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":"Cardiovascular Health Changes in Young Adults and Risk of Later-Life Cardiovascular Disease.","authors":"James W Guo, Hongyan Ning, Norrina B Allen, Amanda M Perak, James M Walker, Kelley Pettee Gabriel, Donald M Lloyd-Jones","doi":"10.1001/jamanetworkopen.2025.35573","DOIUrl":"10.1001/jamanetworkopen.2025.35573","url":null,"abstract":"<p><strong>Importance: </strong>Associations of midlife cardiovascular health (CVH), measured once, with incident cardiovascular disease (CVD) are well described. Less is known about patterns of young adulthood CVH, including its changes and associations with later-life CVD outcomes.</p><p><strong>Objective: </strong>To model patterns of change in population-level and individual-level CVH through young adulthood and to assess whether they are associated with incident CVD in later life.</p><p><strong>Design, setting, and participants: </strong>The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective longitudinal cohort study that enrolled Black and White participants at ages 18 to 30 years in 1985 and 1986 with subsequent follow-up examinations during the next 35 years at 4 urban US centers. Participants with at least 3 CVH measurements in young adulthood and subsequent follow-up with assessment of incident CVD events were included. Analyses were conducted from October 26, 2023, to May 15, 2024.</p><p><strong>Exposures: </strong>CVH was measured using the American Heart Association Life's Essential 8 score. Patterns of CVH change in young adulthood (from examinations at years 0 to 20) were modeled with population-level trajectories and assessed by individual-level CVH status changes.</p><p><strong>Main outcomes and measures: </strong>Incident CVD (myocardial infarction, heart failure, stroke, coronary revascularization, and CVD death) after year 20.</p><p><strong>Results: </strong>There were 4241 participants in young adulthood (2354 [55.5%] female, 2042 [48.1%] self-identified as Black and 2199 [51.9%] self-identified as White) with a mean (SD) baseline age of 24.9 (3.6) years. In the trajectory analysis, 4 distinct CVH trajectory patterns were identified. Compared with the persistently high CVH trajectory, the moderate-to-low declining and moderate declining CVH trajectories had substantially higher risk for incident CVD. AHRs for incident CVD events ranged from 2.15 (95% CI, 1.04-4.47) in the persistently moderate pattern to 9.96 (95% CI, 4.75-20.86) in the moderate-to-low declining pattern. In the CVH status change analysis (n = 2857), compared with stable moderate CVH in young adulthood, stable high CVH had a lower risk (adjusted hazard ratio [AHR], 0.25 [95% CI, 0.09-0.69]), and stable low CVH had a higher risk (AHR, 5.91 [95% CI, 2.38-14.66]) for incident CVD. Each 10-point decrease in Life's Essential 8 score between years 0 and 20 was associated with a 53% increase in CVD risk (AHR, 1.53 [95% CI, 1.31-1.78]).</p><p><strong>Conclusions and relevance: </strong>In this prospective cohort study of young adults, unfavorable patterns of CVH change through young adulthood were associated with marked elevations in risk for incident CVD. These data suggest that achieving and maintaining high CVH throughout young adulthood through strategies of primordial prevention are important for prevention of later-life CVD.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535573"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232651","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":"Rapid Diagnostic Stewardship and Blood Culture Use in a Pediatric Medical Center.","authors":"Esther Vaugon, Cristina Costales, Zein Assad, Thomas Barter, Leila C Posch, Etan Orgel, Deborah R Liu, Jennifer Dien Bard","doi":"10.1001/jamanetworkopen.2025.35580","DOIUrl":"10.1001/jamanetworkopen.2025.35580","url":null,"abstract":"<p><strong>Importance: </strong>A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.</p><p><strong>Objective: </strong>To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.</p><p><strong>Exposures: </strong>The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.</p><p><strong>Results: </strong>During the study period, a total of 18 132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino/a/x/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino/a/x/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, -24.1%; 95% CI, -38.4% to -8.9%; P = .01) and per 100 patient-days (cumulative change, -45.8%; 95% CI, -64.7% to -26.9%; P < .001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, -23.1% to 52.0%) and 27.8% (95% CI, -13.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, -27.5%; 95% CI, -7.6% to -47.6%; P = .02).</p><p><strong>Conclusions and relevance: </strong>The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535580"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232699","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}