JAMA Internal Medicine最新文献

{"title":"Cognitive Decline and Household Firearm Storage Among Older Adults.","authors":"Kelsey M Conrick, Samantha Banks, Julia P Schleimer, Ali Rowhani-Rahbar","doi":"10.1001/jamainternmed.2026.0505","DOIUrl":"10.1001/jamainternmed.2026.0505","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815401","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":"Federal Enforcement Actions Against Medicare Advantage Plans.","authors":"Zihan Chen, Amal N Trivedi, Hayden Rooke-Ley, Jeffery Marr, David J Meyers","doi":"10.1001/jamainternmed.2026.1237","DOIUrl":"10.1001/jamainternmed.2026.1237","url":null,"abstract":"<p><strong>Importance: </strong>Enrollment in Medicare Advantage (MA) plans continues to increase, now covering more than half of Medicare beneficiaries and receiving more than $494 billion in annual federal payment. Therefore, robust oversight is essential to monitor plans' adherence to federal standards and initiate enforcement actions when necessary to ensure program integrity and protect beneficiaries.</p><p><strong>Objective: </strong>To examine Centers for Medicare & Medicaid Services (CMS) enforcement actions against MA contracts and characteristics of contracts and beneficiaries involved with enforcement actions.</p><p><strong>Design, setting, and participants: </strong>This is a cross-sectional study of CMS enforcement actions against MA contracts that were preferred provider organizations or health maintenance organizations from 2010 to 2023. Data were analyzed from May 2025 to January 2026.</p><p><strong>Exposures: </strong>Enforcement actions, including civil money penalties, suspension of enrollment, and contract termination.</p><p><strong>Main outcomes and measures: </strong>The outcomes of interest were number of enforcement actions and contracts affected and mean monetary penalties per MA enrollee.</p><p><strong>Results: </strong>There were 1173 unique MA contracts and 844 enforcement actions from 2010 to 2023. A total of 493 unique MA contracts (42.0%) received an enforcement action during the study period. Most of enforcement actions originated from program audit (544 actions [64.5%]). Enforcement activity varied widely across years: in 2012, 100 contracts (19.2%) received monetary penalties, while only 5 contracts (0.9%) received such penalties in 2019. Most enforcement actions were monetary penalties (737 actions [87.3%]), with far fewer enrollment suspensions (99 actions [11.7%]) and contract terminations (8 actions [0.9%]). Financial penalties peaked at $6.50 per enrollee in 2019 and remained less than $3 in other years. Compared with contracts that did not receive enforcement actions, contracts that were terminated had lower star ratings (mean [SD], 2.5 [0.5] stars vs 3.6 [0.6] stars) and enrolled a much lower share of White beneficiaries (44.7% vs 68.7%); suspended contracts enrolled more dually eligible beneficiaries (28.9% vs 18.8%).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that federal enforcement actions against MA plans were highly variable from year-to-year and imposed modest fines. Enforcement actions may be relatively modest in magnitude, raising concerns about their effectiveness in deterring nonadherence. The design of oversight and enforcement actions warrant further evaluation to determine what amount of enforcement actions are needed to protect patients and ensure plans meet federal standards.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815336","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":"I'm Concerned About Anxiety-What Do I Need to Know?","authors":"Robyn L Shepardson, Jeffrey S Khan, Jennifer S Funderburk","doi":"10.1001/jamainternmed.2026.0392","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.0392","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815330","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":"Regulating Private Equity in Clinical Care Delivery-Lessons From California and Oregon.","authors":"David T Zhu, Suhas Gondi, Robert Tyler Braun","doi":"10.1001/jamainternmed.2026.1209","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.1209","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815354","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":"Treatment of Anxiety for Adults in Primary Care Settings: A Review.","authors":"Robyn L Shepardson, Jeffrey S Khan, Katherine A Buckheit, Jennifer S Funderburk","doi":"10.1001/jamainternmed.2026.0395","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.0395","url":null,"abstract":"<p><strong>Importance: </strong>Anxiety disorders and symptoms are prevalent and burdensome, and patients are most likely to seek treatment in primary care settings. However, anxiety is underdetected and undertreated. This narrative review details behavioral and pharmacological treatment options that are feasible and effective in primary care.</p><p><strong>Observations: </strong>Screening for anxiety is recommended for primary care patients younger than 65 years. Given that anxiety often involves somatic symptoms, assessment should include patient-reported symptom measures, clinical interview, physical examination, and appropriate laboratory tests. For subthreshold symptoms (those that do not meet diagnostic criteria for anxiety disorders) and adjustment-related anxiety, starting with self-help and behavioral treatment is recommended. When deciding between behavioral, pharmacological, or combined treatment for anxiety disorders, consider the presentation, patient preferences, potential adverse effects, and treatment history, and engage in shared decision-making. Cognitive-behavioral therapy (CBT) is the first-line behavioral treatment for anxiety. Brief CBT in primary care delivered by embedded behavioral health clinicians is effective. First-line pharmacotherapy for anxiety disorders includes several selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, which tend to be well tolerated without considerable long-term adverse effects. The main decision for pharmacological treatment is between a daily medication and a short-acting medication taken as needed for intermittent symptoms or while awaiting the effect of a daily medication. Benzodiazepines are not recommended due to risk of adverse effects, especially with long-term use. The Collaborative Care Management model, which involves collaboration between primary care clinicians, consulting psychiatrists, and care managers who monitor patient progress and provide behavioral treatment, improves anxiety outcomes compared to usual primary care.</p><p><strong>Conclusions and relevance: </strong>Clinicians should recognize common anxiety presentations and understand how to differentiate between anxiety and other psychiatric or medical conditions. Referring patients to behavioral health specialists for CBT and/or prescribing recommended pharmacotherapy with Collaborative Care Management can help to reduce patient morbidity and improve functioning.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815508","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":"Which Nudges Matter Most for Scalable Influenza Vaccination?","authors":"Gang Lv, Xiangxiang Jiang, Z Kevin Lu","doi":"10.1001/jamainternmed.2026.1045","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.1045","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815471","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":"Firearm Safety and Responsibility Across the Lifespan.","authors":"Marian E Betz, Allison E Bond, David W Hancock","doi":"10.1001/jamainternmed.2026.0502","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.0502","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815379","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":"Ensuring a Sustainable Medicare Program Through Effective Oversight.","authors":"Michael Chernew, Ishani Ganguli","doi":"10.1001/jamainternmed.2026.1244","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.1244","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815346","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":"Which Nudges Matter Most for Scalable Influenza Vaccination?-Reply.","authors":"Kimberly J Waddell, Kristin A Linn, Shivan J Mehta","doi":"10.1001/jamainternmed.2026.1048","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.1048","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815582","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":"Extended-Release Buprenorphine During Pregnancy and the First Year After Birth-Protecting Pregnant People Through Ethical Research.","authors":"Mishka Terplan, Anne D Lyerly, Hendree Jones","doi":"10.1001/jamainternmed.2026.0068","DOIUrl":"10.1001/jamainternmed.2026.0068","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"544-545"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468035","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}