Medical Care最新文献

{"title":"The Effects of Three Forms of Provider Discrimination on Access to Health Care and Mental Health.","authors":"Kathleen Thiede Call, Natalie Schwehr Mac Arthur, Cynthia Pando, Jinhee Cha, Rhonda Jones-Webb","doi":"10.1097/MLR.0000000000002154","DOIUrl":"10.1097/MLR.0000000000002154","url":null,"abstract":"<p><strong>Background: </strong>Provider discrimination can diminish access to care and lead to poor health outcomes, especially in marginalized populations. We extend past research by exploring the combined or intersecting effects of 3 forms of provider discrimination and by looking beyond access to care to include the impact of provider discrimination on mental health.</p><p><strong>Objectives: </strong>To examine reports of multiple forms of provider discrimination, including the prevalence, associated characteristics, and effects on health care access and mental health.</p><p><strong>Research design: </strong>Secondary analysis of pooled 2021 and 2023 Minnesota Health Access survey data.</p><p><strong>Subjects: </strong>Adults aged 18-64 who responded to the survey (unweighted sample size 11,908).</p><p><strong>Measures: </strong>Reports of 3 forms of provider discrimination based on: (1) race, ethnicity, or nationality; (2) gender or sexual orientation; or (3) insurance type or lack of insurance.</p><p><strong>Results: </strong>Nearly 1 in 5 adult Minnesotans reported at least one form of provider discrimination (19.6%), with some populations of adults reporting disproportionately higher rates. Experiencing insurance-based discrimination or gender or sexual orientation-based discrimination alone, together, and in combination with race-based discrimination was associated with foregone mental or behavioral health care, diminished confidence in getting needed care, and mental distress.</p><p><strong>Conclusions: </strong>Provider discrimination comes in different forms, which intersect to impair access and mental health. Experiences of provider discrimination were concentrated among the most marginalized members of our communities based on their gender identity, sexual orientation, race, ethnicity, nationality, age, income, public insurance, and lack of insurance. We recommend several structural solutions.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"529-538"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110902","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":"Approaches to Identify Nursing Home Specialists Using Medicare Claims Data.","authors":"Melissa R Riester, Kira L Ryskina, Elizabeth M White, Kaleen N Hayes, Daniel A Harris, Andrew R Zullo","doi":"10.1097/MLR.0000000000002161","DOIUrl":"10.1097/MLR.0000000000002161","url":null,"abstract":"<p><strong>Background: </strong>Physicians and advanced practice clinicians who practice in nursing homes (NHs) are becoming increasingly specialized. Studies have identified clinicians as NH specialists using multiple data sources; yet, researchers' access to several sources may be limited due to required data purchases.</p><p><strong>Objective: </strong>Examine the concordance of 2 approaches to measure NH specialization versus a standard approach using clinician-level Medicare Data on Provider Practice and Specialty (MD-PPAS). These alternative approaches leveraged: (1) publicly available clinician-level Medicare Part B data; and (2) patient-level Medicare Part D Event claims linked to publicly available clinician-level Medicare Part D prescribers data.</p><p><strong>Research design: </strong>Yearly cross-sections from 2016 to 2020.</p><p><strong>Subjects: </strong>Physicians and advanced practice clinicians with at least one Medicare-paid service to NH residents and at least 100 total services in a given year.</p><p><strong>Measures: </strong>Nursing home specialists were classified as clinicians with ≥90% of annual services provided to NH residents.</p><p><strong>Results: </strong>Between 2016 and 2020, NH specialists comprised 49,542 of 321,267 eligible clinician-years (15.4%) in MD-PPAS data; 35,983 of 189,992 eligible clinician-years (18.9%) in Part B data; and 31,148 of 1,101,484 eligible clinician-years (2.8%) in Part D data. Compared with the MD-PPAS approach, the concordance was greater for the Part B approach (sensitivity 71.8%, specificity 99.7%) than the Part D approach (39.4%, 97.6%).</p><p><strong>Conclusions: </strong>There were large differences in the numbers of eligible clinicians and NH specialists identified by 3 approaches. The Part B approach was reasonably concordant with the MD-PPAS approach and could be considered by researchers without the financial resources required to purchase MD-PPAS data.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"520-528"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Primary Care Spending in the United States: Toward a Common Method.","authors":"Chunliu Zhan, Lingrui Liu, Matthew Simpson","doi":"10.1097/MLR.0000000000002155","DOIUrl":"10.1097/MLR.0000000000002155","url":null,"abstract":"<p><strong>Background: </strong>The lack of common definition and methods, coupled with the scarcity of suitable data sources, have impeded efforts to track primary care spending in the United States.</p><p><strong>Objectives: </strong>Explore consistent approaches to estimating primary care spending.</p><p><strong>Research design: </strong>A recently developed framework for primary care services was applied to 2 datasets: the Medical Expenditure Panel Survey (MEPS), a survey of noninstitutionalized individuals and their families in the United States, and MarketScan, a database containing health insurance claims of employees and their dependents for a selection of major US companies, to estimate primary care spending per-person-per-year (PPPY) and as percentage of total health care spending (PTHS) covering 2010-2021. Cross-sectional and trend analyses were conducted, and key methodological issues were explored.</p><p><strong>Results: </strong>In 2019, average primary care spending was $504 PPPY (95% CI: $469-$539), accounting for 8.07% PTHS (95% CI: 7.56%-8.58%), based on MEPS, and $378 PPPY (95% CI: $377-$379), accounting for 6.30% PTHS (95% CI: 6.28%-6.32%), based on MarketScan. There were steady increases between 2010 and 2021 in PPPY primary care spending (from $309 to $639 based on MEPS and from $343 to $433 based on MarketScan), but small fluctuations in PHTS primary care spending (between 6% and 9%). Misalignments between the definitions and the data were identified, and standard errors for the estimates were calculated.</p><p><strong>Conclusions: </strong>With explicit definitions, transparent methodologies and appropriate quantification of estimation uncertainty, comparable and reproducible estimates can be obtained to assess and track primary care spending in the United States.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"514-519"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110814","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":"Differences in Initiation and Receipt of Home Health Care: Traditional Medicare Versus Medicare Advantage.","authors":"Amanda C Chen, Daniel Spertus, Christina X Fu, Madeline R Sterling, David C Grabowski","doi":"10.1097/MLR.0000000000002150","DOIUrl":"10.1097/MLR.0000000000002150","url":null,"abstract":"<p><strong>Background: </strong>Because Traditional Medicare (TM) and Medicare Advantage (MA) have different reimbursement structures and incentives, it is important to understand differences in home health agency (HHA) use by payer type.</p><p><strong>Objective: </strong>To quantify differences in care patterns and outcomes between TM and MA HHA users.</p><p><strong>Research design and subjects: </strong>Medicare HHA claims were used to identify postacute HHA episodes among US adults aged 65 and older enrolled in MA or TM (2015-2019). Adjusted regression models with and without HHA fixed effects assessed whether TM and MA beneficiaries are treated differently within an HHA.</p><p><strong>Measures: </strong>We examined process (timely initiation of care, receipt of a skilled nursing visit, and length of stay) and quality measures (hospital readmission and healthy days at home).</p><p><strong>Results: </strong>The study included 4,029,527 beneficiaries (3,034,452 TM and 995,075 MA). We identified large differences in the share of beneficiaries experiencing timely initiation of care (81.4% TM vs. 77.4% MA) and receipt of skilled nursing visits (86.8% TM vs. 81.9% MA). After including HHA fixed effects in the regression model, MA beneficiaries were 2.1 percentage points (pp) less likely to experience timely initiation of care and were 3.1 pp less likely to receive a skilled nursing visit (and 8.9 pp less likely to receive any type of skilled visit) within 2 days of starting HHA care compared with TM beneficiaries ( P <0.001).</p><p><strong>Conclusions: </strong>Our findings suggest differential treatment between MA and TM beneficiaries within the same HHA. Further research is needed to understand the mechanisms driving these within-agency differences.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"487-494"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threads of Care: Unraveling the Impact of Agency Nursing Staff on Nursing Home Quality.","authors":"Rohit Pradhan, Akbar Ghiasi, Ganisher Davlyatov, Shivani Gupta, Robert Weech-Maldonado","doi":"10.1097/MLR.0000000000002114","DOIUrl":"10.1097/MLR.0000000000002114","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of agency nursing staff utilization with nursing home (NH) quality.</p><p><strong>Background: </strong>Nursing staff are the primary caregivers in NHs, where high-quality care is contingent upon their adequacy and expertise. Long-standing staffing challenges, exacerbated by the COVID-19 pandemic, have led NHs to rely on agency/contract labor to alleviate staffing shortages.</p><p><strong>Methods: </strong>This study used the following secondary datasets: Payroll-Based Journal, Care Compare: 5-Star Quality Rating System, LTCFocus.org, Area Health Resource Files, and Rural-Urban Commuting Area codes for 2017-2022. Multivariable ordinal logistic regression with 2-way (facility and year-level) fixed effects was employed. The study included all Centers for Medicare and Medicaid Services certified U.S. NHs. Analytic data comprised 80,244 facilities, averaging 13,374 unique NHs per year. The study focused on the quality star rating (1-5 scale) from the 5-Star Quality Rating System as the dependent variable. Independent variables included the proportion of agency nursing staff hours per resident day for registered nurses, licensed practical nurses, and certified nursing assistants while controlling for facility and community characteristics that may affect NH quality.</p><p><strong>Results: </strong>A 10% increase in agency registered nurses, licensed practical nurses, and certified nursing assistants (logged) was associated with a decrease in the odds of achieving a higher star rating by 4%, 5%, and 4%, respectively ( P < 0.001).</p><p><strong>Conclusions: </strong>The use of agency nursing staff can negatively impact NH quality. Efforts to better integrate agency nursing staff into NHs, combined with strategies to recruit and retain permanent nursing staff, could lead to improved outcomes for residents.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"479-486"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910014","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":"\"Sleep Is Not Getting the Attention It Deserves\": A Qualitative Study of Patient and Provider Views on Sleep Management in the Veterans Health Administration.","authors":"Allison E Gaffey, Kristin M Mattocks, Henry K Yaggi, Valerie Marteeny, Lorrie Walker, Cynthia A Brandt, Sally G Haskell, Lori A Bastian, Matthew M Burg","doi":"10.1097/MLR.0000000000002152","DOIUrl":"10.1097/MLR.0000000000002152","url":null,"abstract":"<p><strong>Background: </strong>Unique characteristics and service exposures of the post-9/11 cohort of U.S. Veterans can influence their sleep health and associated comorbidities. The objectives of this study were to learn about men and women post-9/11 Veterans' and \"front line\" VA providers' knowledge about sleep and experiences with Veterans Health Administration (VA) sleep management.</p><p><strong>Research design: </strong>One sample included post-9/11 Veterans who received VA care (n=23; 60% women; Mage: 45 y). To complement those views, primary care and mental health providers were recruited from VA medical centers (n=27). Semistructured qualitative interviews were conducted using Microsoft Teams. Questions pertained to sleep knowledge, care practices, and perceived barriers to sleep-related VA care. Interview data were synthesized with content analysis and inductive coding to characterize major themes.</p><p><strong>Results: </strong>Four main themes emerged: (1) Sleep is viewed as foundational but Veterans and providers often have limited related knowledge and more routine education is needed. (2) Men and women have distinct sleep management needs. Relative to men, women are more likely to advocate for sleep assessment and for behavioral versus pharmacological treatment. (3) Sleep management practices vary considerably between clinics and providers. (4) Veterans and their providers each experience unique barriers to sleep management.</p><p><strong>Conclusions: </strong>Post-9/11 Veterans and providers view sleep as critical. Yet, VA sleep management needs to be more uniform. Providers are motivated to assess sleep but require standardized education and low-burden opportunities to incorporate sleep into their practice, perhaps with mental health screening. Ultimately, more specialized care is required to meet the responsibility of Veterans' sleep health.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"472-478"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032020","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":"Postoperative Complications and Readmission Rates in Robotic-Assisted and Manual Total Hip Arthroplasty: A Large, Multi-Hospital Study.","authors":"Cole Howell, Sietske Witvoet, Laura Scholl, Andrea Coppolecchia, Manoshi Bhowmik-Stoker, Antonia F Chen","doi":"10.1097/MLR.0000000000002082","DOIUrl":"10.1097/MLR.0000000000002082","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare 90-day postoperative complications, readmissions, and emergency department (ED) visits between robotic-assisted (RA-THA) and manual (M-THA) total hip arthroplasty.</p><p><strong>Methods: </strong>A retrospective review of a multi-hospital database identified primary total hip arthroplasty patients between January 2016 and December 2021. The cohorts were 1-to-1 matched based on patient sex, age, and body mass index resulting in 8033 patients in each cohort (N = 16,066). Odds of 90-day revisits, readmission with >23 hours of observation, and ED visits were compared between cohorts. Complications reported during revisits and readmission were classified according to the Clinical Classification Software schema, using the International Classification of Diseases, 10th Revision codes, and compared using mixed-effect models.</p><p><strong>Results: </strong>This study found an overall 90-day revisit rate of 8.3%. RA-THA was associated with significantly reduced odds of revisit within 90 days [odds ratio (OR): 0.71, 95% CI: 0.58-0.89, P = 0.002] and readmissions with >23 hours of observation (OR: 0.61, 95% CI: 0.48-0.77, P < 0.001). RA-THA patients had fewer readmissions with >23 hours of observation due to dislocations (RA-THA: 0.09%; M-THA: 0.39%, P < 0.001), surgical site infections (RA-THA: 0.04%; M-THA: 0.20%, P = 0.004), and wound infections/cellulitis (RA-THA: 0.01%; M-THA: 0.11%, P = 0.021). No difference in ED visits was observed between cohorts (OR: 0.92, 95% CI: 0.77-1.09, P = 0.3). RA-THA patients had more ED visits for dyspnea without pulmonary embolism (RA-THA: 0.20%; M-THA: 0.06%, P = 0.03).</p><p><strong>Conclusion: </strong>RA-THA showed significantly lower odds of overall 90-day revisit rates and readmissions with >23 hours of observation, most notably for readmissions due to dislocation and surgical site infection/wound infections. There was no significant difference in the odds of ED visits between cohorts.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 7","pages":"465-471"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266549","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":"Effects of Cognitive Behavioral Therapy on Chronic Uncontrolled Diabetes: A Randomized Clinical Trial in a Shared Primary Care Setting.","authors":"Ryan Bellacov, Yvonne Novasio","doi":"10.1097/MLR.0000000000002170","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002170","url":null,"abstract":"<p><strong>Background: </strong>In the context of escalating diabetes prevalence worldwide, this study investigates the efficacy of integrating cognitive behavioral therapy (CBT) within primary care visits for managing uncontrolled diabetes.</p><p><strong>Design: </strong>The randomized clinical trial in an integrated health care clinic in Oregon involved 72 adults aged 20-89 with uncontrolled diabetes. Participants were enrolled and randomly assigned to 2 groups: one receiving both cognitive behavioral health (n=36) and the other receiving traditional primary care (n=36).</p><p><strong>Results: </strong>The study primarily measured clinical improvements in hemoglobin A1C levels for a year. Results indicated significant improvements in the cognitive behavioral health group compared with the traditional care group at various intervals up to 51 weeks, with notable enhancements in hemoglobin A1C and secondary outcomes of patient satisfaction scores. During the 36th and 51st weeks, the shared visit group demonstrated significantly lower hemoglobin A1c levels (36 wk: 9.22±0.2 vs. 10.02±0.2, P<0.001; 51 wk: 9.22±0.1 vs. 10.91±0.2, P<0.001), indicating improved long-term glycemic control.</p><p><strong>Conclusions: </strong>Combining cognitive behavioral health with primary care visits significantly outperformed traditional care in improving clinical outcomes and patient satisfaction among adults with uncontrolled diabetes. The percentage of participants with clinically meaningful improvement in 36 weeks was 22.2% in the CBT versus 0.0% in the traditional primary care visit group. The positive outcomes suggest that integrated cognitive behavioral therapy can effectively contribute to diabetes management strategies, highlighting the importance of innovative approaches in addressing the diabetes epidemic.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225874","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":"Impact of Maryland's 2015 Nurse Practitioner Full Scope of Practice Law on Statewide Rates of Outpatient Potentially Harmful Medication Prescribing to Older Adults.","authors":"Jessica Lipori, Joshua Thorpe","doi":"10.1097/MLR.0000000000002163","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002163","url":null,"abstract":"<p><strong>Background: </strong>Since 2010, there has been an increase in Full Scope of Practice (FSP) laws allowing Nurse Practitioners (NPs) to practice independently. We aimed to utilize synthetic control models to examine the impact of a 2015 NP FSP laws on outpatient potentially harmful medication (PHM) prescribing to older adults (65 years and above) in Maryland.</p><p><strong>Methods: </strong>We utilized Medicare Public Use Files to measure statewide rates of outpatient PHM prescribing to older adults with Part D from fiscal year 2013-2019. An interrupted time series analysis was performed, and geographic and health access covariates were used to create synthetic control models. Placebo tests were used to test differences in PHM prescribing after the policy change.</p><p><strong>Results: </strong>The interrupted time series analysis was not significant. Maryland's synthetic control model chose a weighted average of New Jersey, Delaware, and Massachusetts. There was no significant difference in PHM prescribing after the passage of Maryland's FSP law compared with synthetic control.</p><p><strong>Discussion: </strong>We found that Maryland's FSP law did not impact statewide rates of PHM prescribing. State-wide prescribing trends should be considered in states debating changes in nurse practitioner scope of practice.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225875","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":"Patterns of Medical Care Cost by Service Type Associated With Lung Cancer Screening.","authors":"Kris Wain, Mahesh Maiyani, Nikki M Carroll, Rafael Meza, Robert T Greenlee, Christine Neslund-Dudas, Michelle R Odelberg, Caryn Oshiro, Debra P Ritzwoller","doi":"10.1097/MLR.0000000000002169","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002169","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer screening (LCS) enhances early stage cancer detection; however, its impact on health care costs in real-world clinical settings is not well understood. The objective of this study was to assess changes in health care costs during the 12 months before LCS compared with the 12 months after.</p><p><strong>Methods: </strong>This retrospective study analyzed health care costs based upon Medicare's fee-for-service reimbursement system using data from the Population-based Research to Optimize the Screening Process Lung Consortium. We included individuals who met age and smoking LCS eligibility criteria and were engaged within 4 health care systems between February 5, 2015, and December 31, 2021. Generalized linear models estimated health care costs from the payer perspective during 12 months prior and 12 months post baseline LCS. We compared these costs to eligible individuals who did not receive LCS. Secondary analyses examined costs among the sample who completed LCS by positive versus negative scan results. We reported mean predicted costs with average values for all other explanatory variables.</p><p><strong>Results: </strong>We identified 10,049 eligible individuals who received baseline LCS and 15,233 who did not receive LCS. Receipt of LCS was associated with additional costs of $3698 compared with individuals not receiving LCS. Secondary analyses found costs increased by $11,664 among individuals with positive scans; however, no increases occurred among individuals with negative scans.</p><p><strong>Conclusion: </strong>These findings suggest LCS was only associated with increased health care costs among patients with a positive scan. LCS is a potentially cost-effective approach to identify early stage lung cancer. Healthcare systems should prioritize strategies to improve LCS participation.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225876","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}