Journal of General Internal Medicine最新文献

{"title":"SGLT2 Inhibitors and Prevention of Cardiovascular Events in Diabetes Patients with and Without Hypertension: A Nationwide Cohort Study.","authors":"Fu-Shun Yen, James Cheng-Chung Wei, Yao-Min Hung, Pei-Yun Li, Chih-Cheng Hsu, Chii-Min Hwu","doi":"10.1007/s11606-025-09847-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09847-2","url":null,"abstract":"<p><strong>Objective: </strong>The primary prevention of major adverse cardiovascular events by sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes without cardiovascular disease (CVD) remains unclear.</p><p><strong>Research design and methods: </strong>We used propensity score matching to identify 9520 pairs of SGLT2i users compared with DPP-4 inhibitor users in patients with hypertension and 3496 pairs in patients without hypertension using data from Taiwan's National Health Insurance Research Database for the period between January 1, 2008, and December 31, 2021. Cox proportional hazards models were used to assess the risk of outcomes between SGLT2i and DPP-4 inhibitor users.</p><p><strong>Results: </strong>Mean follow-up was 2.81 years for the cohort of patients with hypertension and 2.79 years for those without hypertension. Compared to the use of DPP-4 inhibitors, the use of SGLT2i was significantly associated with a reduced risk of developing stroke [aHR (95% CI) 0.56(0.47-0.66)], coronary artery disease [0.80(0.69-0.94)], heart failure [0.31(0.24-0.41)], and major adverse cardiovascular events (MACE) [0.62(0.56-0.70)] in patients with hypertension. Additionally, in patients without hypertension, SGLT2i use was significantly associated with a reduced risk of developing atrial fibrillation [aHR (95% CI) 0.48(0.25-0.91)].</p><p><strong>Conclusions: </strong>This nationwide cohort study demonstrates that in T2D patients without cardiovascular disease, SGLT2i use is associated with a lower risk of coronary heart disease, stroke, heart failure, and MACE in those with hypertension. In patients without hypertension, SGLT2i use was linked to a reduced risk of atrial fibrillation, suggesting its potential role in the primary prevention of cardiovascular events for T2D patients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision-Making. A Primer for Clinicians.","authors":"Glyn Elwyn, Pål Gulbrandsen, Hannah Leavitt, Eman Abukmail, Marla L Clayman, Adrian Edwards, Jeanette Finderup, Alana Fisher, Stuart W Grande, Pola Hahlweg, Tammy Hoffmann, Wen-Hsuan Hou, María José Hernández-Leal, Debra Leung, Weiwei Lu, Lars Mandelkow, Kristen E Pecanac, Arwen H Pieterse, Amy Price, Jannicke Rabben, Paula Riganti, Michael Sanatani, Fülöp Scheibler, Elise Schoefs, Owen A Taylor, Kathrene D Valentine, Richard Wexler","doi":"10.1007/s11606-025-09707-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09707-z","url":null,"abstract":"<p><strong>Importance: </strong>Shared decision-making is a widely promoted approach, yet clinicians, typically supportive in principle, find it difficult to implement because of concerns and barriers they commonly encounter in practice.</p><p><strong>Objective: </strong>To generate a primer that describes shared decision-making from the perspective of clinicians.</p><p><strong>Methods: </strong>We collaborated with clinicians, patient representatives, and health service researchers. We invited members of the International Society of Shared Decision Making to co-produce a primer for clinicians using a series of jointly edited online documents. We shared drafts with other clinicians and patients. Finally, we integrated the contributions until we had arrived at a consensus.</p><p><strong>Findings: </strong>Twenty-five people from 13 countries contributed; 9 had medical qualifications, 4 had nursing qualifications, and 12 others had a range of backgrounds. A total of 30 patients and clinicians provided further comments. The description differs from previous versions because it addresses the barriers that clinicians frequently mention. It describes how to overcome common challenges by emphasizing the importance of a clear invitation at initiation; it suggests how to manage patients' resistance to shouldering decisional responsibility; reinforces the need to allow time for deliberation, especially with other stakeholders; and reassures clinicians that consensus, albeit welcome, need not be the goal of shared decision-making.</p><p><strong>Conclusions and relevance: </strong>This primer portrays a reflective clinician who is aware of power asymmetry, patient vulnerability, risk communication, health literacy, agenda setting, and goal clarification. It envisages a clinician who is curious about personal perspectives and who can offer collaborative, iterative, and deliberative steps.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in Large Language Model Recommendations in Challenging Inpatient Management Scenarios.","authors":"Susan Landon, Thomas Savage, S Ryan Greysen, Eric Bressman","doi":"10.1007/s11606-025-09888-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09888-7","url":null,"abstract":"<p><strong>Importance: </strong> Large language models (LLMs) are entering clinical workflows, yet their behavior in routine bedside decisions that lack a single \"correct\" recommendation remains unclear.</p><p><strong>Objective: </strong>To describe variation within and across commercially available LLMs when confronted with common, judgment-dependent inpatient medicine management scenarios.</p><p><strong>Design: </strong>Cross-sectional simulation study. Four brief vignettes requiring a binary management decision were posed to each model in five independent sessions. Six LLMs were queried: five general-purpose (GPT-4o, GPT-o1, Claude 3.7 Sonnet, Grok 3, and Gemini 2.0 Flash) and one domain-specific (OpenEvidence).</p><p><strong>Exposures: </strong>Standardized prompts describing (1) transfusion at borderline hemoglobin, (2) resumption of anticoagulation after gastrointestinal bleed, (3) discharge readiness despite a modest creatinine rise, and (4) peri-procedural bridging in a high-risk patient on apixaban.</p><p><strong>Main measures: </strong>Primary outcomes were each model's overall recommendation (majority across five runs) and its internal consistency (proportion of identical recommendations across runs; range 0-1). Inter-model agreement was the proportion of models giving the same recommendation.</p><p><strong>Results: </strong>A total of 120 model-vignette interactions were analyzed. Inter-model recommendations diverged in every scenario: transfuse vs observe (67% vs 33% of models), restart vs hold anticoagulation (50% vs 50%), discharge vs delay (50% vs 50%), and bridge vs no-bridge (17% vs 83%). Across five repeated queries of the same vignette, some models changed recommendations in two of five runs (internal consistency as low as 0.60). OpenEvidence was the most internally consistent and concrete in its recommendations; every other model displayed internal variability in one or more vignettes.</p><p><strong>Conclusions: </strong>For nuanced inpatient management questions, widely used LLMs produced inter- and intra-model variation in their recommendations. Clinicians should view LLM output as one perspective among many, consider sampling multiple models or re-prompting, and retain final responsibility for bedside decisions. Prospective studies are needed to test designs that surface model uncertainty and support safe integration of generative AI into complex decision-making.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HALP and FI-Lab Scores in Hospitalized Older Adults: A Retrospective Comparative Study of Adverse Outcomes.","authors":"Masaaki Nagae, Hiroyuki Umegaki, Hirotaka Nakashima, Tatsuya Nishiuchi","doi":"10.1007/s11606-025-09889-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09889-6","url":null,"abstract":"<p><strong>Background: </strong>Early identification of poor prognosis in acutely hospitalized older adults is essential. Hemoglobin, albumin, lymphocyte, and platelet (HALP) scores have garnered attention as a predictor of poor prognosis in both cancer and non-cancer patients. The frailty index-laboratory (FI-lab) has also demonstrated utility as an indicator of unfavorable outcomes. Associations have been established between low HALP levels and high FI-lab scores with adverse outcomes. However, no study has yet compared these indicators to predict outcomes in hospitalized older adults.</p><p><strong>Methods: </strong>This retrospective cohort study involved older adults admitted to a 730-bed tertiary hospital. The study encompassed patients aged 65 years or older admitted to the general internal medicine department and discharged between August 2020 and July 2023. The HALP score and FI-lab were computed based on laboratory parameters derived from blood tests conducted upon admission. The study assessed outcomes including in-hospital mortality, in-hospital falls, discharge to home, and length of hospital stay.</p><p><strong>Results: </strong>A total of 1346 patients, of whom 11.6% died during hospitalization. The FI-lab score was more predictive of in-hospital death than the HALP score. In Cox regression survival analysis, higher FI-lab scores (hazard ratio 1.70, 95% confidence interval 1.47-1.96, p < 0.01) and lower HALP scores (hazard ratio 1.62, 95% confidence interval 1.12-2.33, p < 0.01) were significantly associated with in-hospital mortality. Moreover, higher FI-lab scores and low HALP scores were linked to a prolonged hospital stay and reduced likelihood of discharge. In contrast, none of these indicators was correlated with in-hospital falls.</p><p><strong>Conclusions: </strong>The FI-lab demonstrated superior predictive capability for in-hospital mortality compared to the HALP score. However, the HALP score also proved effective in forecasting adverse outcomes among older adults hospitalized in general internal medicine wards. Automatically calculable laboratory scores could offer significant value in caring for diverse older inpatients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Medicare Insurance Coverage Type in Annual Wellness Visits: A Comparison Between Traditional Medicare and Medicare Advantage Plan.","authors":"Zhang Zhang, Nancy L Schoenborn, Katherine E M Miller, Jennifer L Wolff, Daniel Polsky","doi":"10.1007/s11606-025-09825-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09825-8","url":null,"abstract":"<p><strong>Background: </strong>The Medicare Annual Wellness Visit (AWVs) was introduced in 2011 as a preventive services visit. AWV uptake has been increasing but remains disproportionately low among vulnerable populations in Traditional Medicare (TM). However, less is known about the differential uptake of the AWV by Medicare insurance coverage type-a consequence of the increasing beneficiary enrollment shifts from TM to Medicare Advantage (MA) plans.</p><p><strong>Objective: </strong>This study aims to quantify the differential effects of Medicare insurance coverage type (MA versus TM) on AWV uptake for key subpopulations.</p><p><strong>Design: </strong>We used 20% nationally representative Medicare insurance claims data from 2018 to 2019. Probit models assessed the likelihood of AWV uptake, with subgroup analyses by age, race/ethnicity, dual eligibility, chronic conditions, and ADRD status.</p><p><strong>Participants: </strong>We included 8,799,206 Medicare beneficiaries aged 65 and older, among whom 41.2% were enrolled in MA, and 58.8% were enrolled in TM.</p><p><strong>Main measures: </strong>The outcome is whether to have an AWV; the independent variable is the Medicare insurance coverage type.</p><p><strong>Key results: </strong>Over 1/3 (37.3%) of beneficiaries received an AWV in 2019. MA enrollees were 4.3 percentage points more likely to receive an AWV than TM enrollees (p < 0.001). Subgroup analysis showed higher AWV uptake in MA across all key subgroups of interest (all p < 0.001), with the largest differences among the oldest-old adults aged above 85 + (5.6 percentage points), dual eligibles (11.5 percentage points), Black beneficiaries (8.9 percentage points), and those with ADRD (6.6 percentage points).</p><p><strong>Conclusion: </strong>Enrollment in an MA plan is associated with a higher probability of AWV uptake, particularly among vulnerable populations from racial and ethnic minorities, dual eligibility, and those diagnosed with ADRD. These findings highlight MA's potential role in promoting preventive care and health equity. Future studies need to examine whether higher AWV uptake leads to improved patient outcomes in MA plans.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Restraint Use on Inpatient Medical/Surgical and Psychiatric Units at a Tertiary Care County Hospital.","authors":"Anna K Hing, Max Fraden, Brian Yablon, Martin Henkemeyer, Stamatis Zeris, Erika Kaske, Eduardo A Colon Navarro","doi":"10.1007/s11606-025-09884-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09884-x","url":null,"abstract":"<p><strong>Background: </strong>Racism contributes to worse patient care and health outcomes in the USA. Disparities in restraint application have been documented in the emergency department context, yet inpatient medical/surgical and psychiatric settings are less studied.</p><p><strong>Objective: </strong>The primary objective of this analysis is to determine factors associated with restraint use within the inpatient medical/surgical and psychiatric populations at a tertiary, academic medical center. We predict that Black, American Indian, Native American, or Alaska Native, or Hispanic/Latinx racialized identity, age, presence of medical/cognitive disorders, substance use disorders, and psychiatric illnesses will be associated with higher odds of restraint use (H1), of locked restraint use (H2), and of seclusion (H3), and with more time spent in restraints (H4).</p><p><strong>Design: </strong>Logistic regression models were used to predict odds of restraint, odds of locked restraint, and odds of seclusion, while linear regression models were used to predict time spent in restraints.</p><p><strong>Participants: </strong>We included admitted inpatients greater than 17 years, discharged between January 1, 2018, and December 31, 2022, at an urban, Level I academic trauma center who stayed at least one night in a medical/surgical or psychiatry unit.</p><p><strong>Main measures: </strong>Four outcome variables included restraint, locked restraint, seclusion, and time spent in restraints. Other key variables included race/ethnicity, age, substance use, medical/cognitive disorders, psychiatric illness, sex, interpreter use, insurance status, being recently unhoused, and having a history of violence.</p><p><strong>Key results: </strong>For medical/surgery patients, higher odds of restraint use and of locked restraints were found for American Indian, Native American, or Alaska Native patients and Latinx/Hispanic patients are restrained for nearly 30 h more than white patients. For psychiatry patients, Black patients had higher odds of seclusion, but this significant association disappeared when covariates were added.</p><p><strong>Conclusions: </strong>This is the first paper to examine differences in time spent in restraints and the type of restraint used, suggesting that variability exists in how racialized inequities appear across dimensions of restraint.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EBM BLS: Self-collected Human Papillomavirus Cervical Cancer Screening Is Non-Inferior to Clinician-Collected Samples.","authors":"Claire Ruben, Sweta Narasimhan, Eric Nolan","doi":"10.1007/s11606-025-09830-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09830-x","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Adherence to Screening for Colorectal, Cervical, and Lung Cancer in a US Consortium.","authors":"Ethan A Halm, Natalie J Del Vecchio, Katharine A Rendle, Jasmin A Tiro, Yingye Zheng, Rachel L Winer, Jennifer S Haas, Douglas A Corley, Celette Sugg Skinner, Joanne Schottinger, Nirupa R Ghai, Jessica Chubak","doi":"10.1007/s11606-025-09835-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09835-6","url":null,"abstract":"<p><strong>Background: </strong>Effective screening for colorectal, cervical, and lung cancer requires adherence over time, but little is known about repeat testing in real-world practice.</p><p><strong>Objective: </strong>Describe patterns of longitudinal screening adherence and identify patient and system factors associated with repeat testing.</p><p><strong>Design: </strong>Retrospective cohort study of colorectal, cervical, or lung cancer screening in 2010-2019.</p><p><strong>Participants: </strong>Adults eligible for repeat colorectal (stool-based), cervical, or lung cancer screening following a negative index test in ten regional health systems comprising the US PROSPR consortium.</p><p><strong>Main measures: </strong>Repeat screening based on guideline-recommended intervals. For the colorectal and lung cohorts with opportunities for multiple annual screening rounds, the main outcome was repeat screening categorized as none, inconsistent, or consistent.</p><p><strong>Results: </strong>The sample size was: 1,566,346 for colorectal, 216,344 for cervical, and 6,209 for lung cancer screening. For colorectal, cervical, and lung screeners, mean age at index was 58.2, 39.4, and 64.6 years, respectively, and 49%, 55% and 30% were Hispanic and/or non-white. Completion of the next screening round was 62% for colorectal, 56% for cervical, and 56% for lung cancer. For colorectal, over the next two rounds of testing, 53% were consistent, 33% inconsistent, and 14% no repeat screeners. The comparable percentages over 3 + rounds for colorectal were 40% consistent, 50% inconsistent, and 11% no repeat screeners. For lung, over the next two rounds, 47% were consistent, 31% inconsistent, and 22% no repeat screeners. The proportions over 3 + rounds for lung were 44% consistent, 42% inconsistent, and 14% no repeat screening. The health system was the strongest predictor of repeat and consistent testing with three- to ten-fold variation.</p><p><strong>Conclusions: </strong>Adherence to longitudinal screening for colorectal, cervical and lung cancer was suboptimal, particularly as the number of testing rounds increased. System-level strategies are needed to increase screening adherence given the strong relationship between health system and outcomes.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Sure, Let's See What You Got\": A Qualitative Analysis of Healthcare Provider Letters Used in Court Proceedings.","authors":"Ella van Deventer, Nicole C Giron, Elizabeth Tobin-Tyler, Rahul Vanjani, Justin Berk","doi":"10.1007/s11606-025-09891-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09891-y","url":null,"abstract":"<p><strong>Background: </strong>Formerly incarcerated individuals face a host of social and medical barriers to reintegrating sustainably into society. The potential role of medical provider input in these individuals' criminal-legal involvement through providing information via letters has yet to be explored.</p><p><strong>Objective: </strong>To examine the role of provider letters in court proceedings for criminal-legally involved patients.</p><p><strong>Design: </strong>Retrospective chart review for patients who received provider letters and qualitative analysis of court transcripts that correlate with the timing of said letters.</p><p><strong>Participants: </strong>Any patient enrolled in the primary care clinic with a record of a customizable provider letter documented in the electronic health record (EHR).</p><p><strong>Main measures: </strong>Themes and subthemes from court transcripts for primary care patients with criminal-legal involvement who had provider letters written on their behalf.</p><p><strong>Key results: </strong>Customizable provider letters that provide information about the medical and social circumstances of patients were acceptable documents to legal professionals in a court setting and found to hold relevant data referenced in judicial decision-making.</p><p><strong>Conclusions: </strong>Overall, this study has important implications for the role that healthcare providers can play in the judicial process for their patients. This study highlights a novel area for providing provider insight in a court setting, thus improving the comprehensiveness of healthcare for criminal-legally involved patients. Customizable provider letters are accepted methods for providing useful information in a court setting and are a tool at the intersection of health and justice that deserves further study and scaling.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commercial Prices for Primary Care Physician Office Visits.","authors":"Yang Wang, Mark Meiselbach, Xu Wang, Ge Bai, Gerard Anderson","doi":"10.1007/s11606-025-09798-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09798-8","url":null,"abstract":"<p><strong>Background: </strong>Primary care is the frontline and cornerstone of the US healthcare system. Prices paid by commercial insurance plans, which cover the majority of the US population, influence primary care physicians' (PCPs) labor supply and patients' access to care. However, little is known regarding the level and variation of commercial prices for primary care and the associated factors.</p><p><strong>Objective: </strong>To examine the level and variation in commercial prices for PCP office visits and assess physician-level, practice-level, and market-level factors that explain the price variation.</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Participants: </strong>A total of 174,561 PCPs offering office visit services for commercially insured patients from four national insurers-Blue Cross Blue Shield (BCBS), Cigna, Elevance Health, and United Healthcare, using insurer-disclosed Transparency in Coverage (TiC) pricing data as of March 2024.</p><p><strong>Main measures: </strong>Outcomes are 876,079 commercial prices for level 3 PCP office visits for both new and established patients, measured at the physician-insurer-service level.</p><p><strong>Key results: </strong>National mean commercial prices were $145.2 (95% CI $145.0-$145.4) and $101.6 (95% CI $101.5-$101.7) for level 3 new and established patient office visits, respectively. For new patient office visits, PCPs with corporate ownership obtained 17.9% (95% CI 17.7-18.2%) higher prices. PCPs practicing in organizations with more than 100 physicians negotiated 28% (95% CI 27.3-28.7%) higher prices than solo practices. Prevalence of corporate ownership and large practice affiliation was substantially higher among young PCPs aged 31-40. PCPs specializing in family medicine and practicing in counties with lower median household income negotiated lower prices. Results were consistent for established patient office visits.</p><p><strong>Conclusions: </strong>PCPs' corporate ownership, size of practice, age, specialty, and local income level are important factors that explain the commercial pricing variation and are crucial for improving the US primary care system.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}