Medical Care最新文献

{"title":"Updated Adjustment of the HCAHPS Survey for New Modes of Survey Administration and Patient Mix.","authors":"Marc N Elliott, Megan K Beckett, Katrin Hambarsoomian, Julie Brown, Paul Cleary, William G Lehrman, Elizabeth Goldstein, Laura A Giordano, Layla Parast","doi":"10.1097/MLR.0000000000002127","DOIUrl":"10.1097/MLR.0000000000002127","url":null,"abstract":"<p><strong>Background: </strong>Web-first multimode survey protocols increase Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response rates and representativeness but may result in different HCAHPS scores because of survey mode effects and selective email address availability. A variable absent from many patient-mix adjustment models that may result in more positive patient experiences is whether the hospital admission was planned; adjustment for planned stays may better measure hospital performance.</p><p><strong>Objectives: </strong>Develop adjustments for new Web-first survey protocols and planned admissions to facilitate comparisons across hospitals.</p><p><strong>Research design: </strong>Using 2021 survey mode experiment data, we estimate survey protocol effects in linear models predicting HCAHPS top-box outcomes from protocol indicators (which incorporate email availability for Web-first protocols), patient-mix adjustors, and hospital intercepts. We evaluate the unique effect on scores of whether a stay was planned.</p><p><strong>Results: </strong>Phone-only and Web-Phone without email produce more positive responses than Mail-only, requiring negative adjustments. All other survey protocol effects and adjustments are mixed in direction and generally small. Planned stays are associated with more positive experiences for otherwise similar patients and make a unique contribution beyond other current patient-mix adjustment variables.</p><p><strong>Conclusions: </strong>It is important to adjust HCAHPS scores for survey protocol effects to ensure fair comparisons across hospitals and to enable hospitals to choose the survey protocol that best represents their patients. Incomplete email address availability necessitates that HCAHPS survey protocol adjustment control for email address availability when a Web-first protocol is used. Accounting for differences associated with planned stays may improve patient-mix adjustment.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"358-365"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059730","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":"A Spatial Epidemiologic Analysis of Opioid Use Disorder Treatment in New York State.","authors":"Ashly E Jordan, Weihui Zhang, Sarah Gorry, Andrew Heck, Constance Burke, Chinazo O Cunningham","doi":"10.1097/MLR.0000000000002142","DOIUrl":"10.1097/MLR.0000000000002142","url":null,"abstract":"<p><strong>Background: </strong>Opioid agonist treatments (OAT; methadone and buprenorphine) for opioid use disorder (OUD) reduce overdose death by more than 50%. Low population-level rates of OAT are missed opportunities to reduce OUD-related mortality.</p><p><strong>Objective: </strong>We examined county-level OAT utilization patterns to guide state-level and county-level initiatives to improve equitable access and utilization in New York State (NYS).</p><p><strong>Research design: </strong>We calculated NYS county-level methadone and buprenorphine population utilization rates per 100,000 residents by county of patient residence using NYS Office of Addiction Services and Supports and public access datasets.</p><p><strong>Measures: </strong>We mapped rates onto counties and conducted analyses to assess if utilization varied by county, and to identify areas of high utilization (hot spots) and low utilization (cold spots). We used t tests and Fisher exact tests to compare county-level factors.</p><p><strong>Results: </strong>County-level buprenorphine and methadone utilization rates were 673.76 and 132.19 per 100,000 residents, respectively. Buprenorphine hot spot counties had significantly lower proportions of unemployed (-1.4, P- value<0.01), and higher proportions of non-Hispanic white residents (+50.1, P value<0.01) than counties identified as buprenorphine cold spots. Methadone hot spot counties had significantly higher proportions of unemployed (+1.0, P- value<0.01) and lower proportions of non-Hispanic white residents (-48.1, P- value<0.01) than counties identified as methadonecold spots. All buprenorphine cold spot counties were methadone hot spot counties.</p><p><strong>Conclusions: </strong>We found that OAT utilization rates differed by race/ethnicity and socioeconomic factors at the county level consistent with national and other state-level findings. Ensuring equitable OAT access must be part of a coordinated response to address the overdose crisis.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"386-392"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605489","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":"Chronic Disease and Future Perceptions of Financial Control: Results From the Midlife in the United States Cohort Study.","authors":"Victoria H Davis, Guanghao Zhang, Minal R Patel","doi":"10.1097/MLR.0000000000002126","DOIUrl":"10.1097/MLR.0000000000002126","url":null,"abstract":"<p><strong>Objective: </strong>Rising health care costs and chronic disease prevalence have increased concerns about health-related financial burden. This study examined how baseline chronic disease burden was associated with subsequent perceptions of financial control ∼9 years later.</p><p><strong>Methods: </strong>Data came from the Midlife in the United States (MIDUS) cohort, with MIDUS 1 and 2 used as baseline predictors for future perceived financial control outcomes at MIDUS 3. Adjusted mixed effect models examined the relationship between baseline chronic disease burden on 4 variables representing future perceptions of financial control.</p><p><strong>Results: </strong>A total of 3297 participants [mean (SD) age: 54 (11.36) y] were included. Greater chronic disease burden and medication use at baseline were associated with a higher likelihood of inadequate resources [adjusted odds ratio (AOR) = 1.22; 95% CI: 1.07-1.38; P = 0.001 and AOR = 1.29; 95% CI: 1.13-1.46; P = 0.001, respectively]. Having more chronic conditions predicted reduced feelings of financial control (AOR=0.85; 95% CI, 0.78-0.93; P <0.001) and a more pessimistic financial outlook (AOR = 0.87; 95% CI: 0.79-0.97; P < 0.01). Higher baseline cholesterol levels showed mixed associations: better perception of current finances (AOR = 1.36; 95% CI: 1.22-1.51; P =0.001) but reduced sense of financial control (AOR = 0.86; 95% CI: 0.78-0.95; P < 0.001) and more negative financial outlook (AOR = 0.69; 95% CI: 0.62-0.77; P < 0.001). No baseline factors predicted bill payment capability.</p><p><strong>Conclusion: </strong>The findings suggest a need for additional strategies to reduce the financial burden of chronic diseases.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"353-357"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080541","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":"Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States.","authors":"Sarah Bessen, Wuyang Zhang, Frank R Lin, Emmanuel E Garcia Morales, Nicholas S Reed","doi":"10.1097/MLR.0000000000002133","DOIUrl":"10.1097/MLR.0000000000002133","url":null,"abstract":"<p><strong>Background: </strong>Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes.</p><p><strong>Objectives: </strong>To investigate the associations between self-recognition of hearing loss and hospitalization outcomes.</p><p><strong>Research design and subjects: </strong>This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study.</p><p><strong>Exposures and outcomes: </strong>The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss.</p><p><strong>Results: </strong>Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss.</p><p><strong>Conclusions: </strong>In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"379-385"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024022","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 Social Support in Bridging the Digital Divide for Older Veterans.","authors":"Josephine C Jacobs, Liberty Greene, Sonya SooHoo, Cindie Slightam, Kritee Gujral, Donna M Zulman","doi":"10.1097/MLR.0000000000002131","DOIUrl":"10.1097/MLR.0000000000002131","url":null,"abstract":"<p><strong>Background: </strong>For nearly a decade, the US Veterans Health Administration (VA) has distributed tablets to Veterans with access barriers who may benefit from video telehealth visits. Older Veterans' lower likelihood of tablet use relative to younger Veterans has prompted interest in factors influencing tablet utilization.</p><p><strong>Objectives: </strong>We examined whether social support facilitates video telehealth utilization among older Veterans who received VA tablets.</p><p><strong>Research design: </strong>We performed a cross-sectional analysis of electronic health record-linked survey data. We used multivariable logistic regression to examine the relationship between social support and telehealth use, controlling for predisposing, enabling, and health factors.</p><p><strong>Subjects: </strong>Veterans aged ≥65 who received a VA-issued tablet and responded to a national survey (September 2021 to January 2022) (n=859).</p><p><strong>Measures: </strong>The outcome measure was any VA video telehealth use in the 6 months post-tablet receipt. Social support measures included tangible support, living with others, and marital status.</p><p><strong>Results: </strong>Fewer than two-thirds of respondents (62.4%) had a video visit in the 6 months post-tablet receipt. In all, 32.2% of respondents noted that the absence of family or friends to help with video visits hindered their use of video telehealth. In multivariable analyses, greater tangible social support was associated with 54.1% (95% CI: 10.1%-116.2%) higher odds of having a video visit.</p><p><strong>Conclusions: </strong>Older adults who receive technological devices to engage in video telehealth benefit from tangible social support from family and friends. Assessing and addressing patients' social and environmental circumstances may help optimize digital divide interventions and ensure that older adults are not excluded from telehealth-related access gains.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"374-378"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066483","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":"Managed Care in Mental Health Care: How Do We Know When Cost Savings Is Cost-Effective?","authors":"Jennifer L Humensky, Michael C Freed, Agnes Rupp, Rachel Smith, Patricia A Areán","doi":"10.1097/MLR.0000000000002146","DOIUrl":"10.1097/MLR.0000000000002146","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"334-337"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657630","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":"Leveraging Electronic Health Record Data to Identify Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Veteran Participants in the Pride in All Who Served Program.","authors":"Guneet K Jasuja, Joel I Reisman, Christina Jefferson, Robert B Hall, Raymond G Van Cleve, Teddy Bishop, Heather A Sperry, Michelle C Wilcox, A M Racila, Michelle M Hilgeman","doi":"10.1097/MLR.0000000000002132","DOIUrl":"10.1097/MLR.0000000000002132","url":null,"abstract":"<p><strong>Background: </strong>Pride in All Who Served (PRIDE) is an intervention in the Veterans Health Administration (VHA) focused on enhancing Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) veterans' access to affirmative care services, social support, and engagement with VHA. Evaluation of PRIDE to date has focused on self-report data, missing critical opportunities to examine the impact of this program on health outcomes and utilization indicators detectable in the electronic health record (EHR).</p><p><strong>Objective: </strong>This study is the first to: (1) comprehensively identify a sample of LGBTQ+ veterans who attended PRIDE; and (2) describe the sample demographics, health conditions, and health care utilization.</p><p><strong>Research design: </strong>A retrospective cross-sectional study was conducted using EHR data and staff-reported PRIDE information (eg, site name, facilitator names, dates of delivery). PRIDE-related keywords and chart reviews were used to validate participation and determine the final sample.</p><p><strong>Subjects: </strong>We identified 588 PRIDE participants at 34 VHA sites from 2016 to 2022.</p><p><strong>Measures: </strong>Demographics (eg, age), health conditions (eg, depression), and health care utilization (eg, mental/behavioral health care visits).</p><p><strong>Results: </strong>Nearly half of the PRIDE participants (47%) were women, 75% were transgender and gender diverse, and 37% identified as lesbian or gay. A high proportion of the sample had stress-related health conditions, including depression (63%), hypertension (22%), and posttraumatic stress disorder (48%).</p><p><strong>Conclusions: </strong>PRIDE serves a disproportionate number of women and transgender and gender diverse veterans compared with general VHA users. In the absence of standardized EHR fields, time-intensive methods are required to leverage EHRs to evaluate programs addressing health equity for LGBTQ+ people.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"366-373"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605503","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":"Health Care Utilization and Expenditure Associated With Musculoskeletal Disorders Among Adults With Type 2 Diabetes: A Cross-Sectional Study.","authors":"Taiwo P Adesoba, Clare C Brown, Holly C Felix, Jure Baloh, Riley Lipschitz, Anthony Goudie","doi":"10.1097/MLR.0000000000002129","DOIUrl":"10.1097/MLR.0000000000002129","url":null,"abstract":"<p><strong>Introduction: </strong>Adults with type 2 diabetes (T2D) often experience musculoskeletal disorders (MSDs), which complicate health care provision and negatively impact their health and health care utilization and expenditure. The objective of this study was to estimate the incremental health care utilization and expenditure associated with MSD among adult T2D patients in the United States overall and by race/ethnicity.</p><p><strong>Methods: </strong>A sample (unweighted n=6205) of noninstitutionalized US adults with a T2D diagnosis was obtained from the Medical Expenditure Panel Survey (MEPS), panels 2015-2016 to 2019-2020. Propensity score matching (PSM) was used to reduce selection bias between participants with and without MSD. Differences in health care utilization were estimated using negative binomials, while expenditures were estimated using generalized linear models and 2-part models. Outcomes were estimated overall and by race and ethnicity.</p><p><strong>Results: </strong>Among the sample of patients with T2D before PSM, 52% had MSD. In the matched sample, increased utilization associated with MSD occurred across all health care service types, with prescription medications (13.31; 95% CI: 11.12, 15.50) having the largest increase. The increased total expenditure associated with MSD among T2D patients was $5712 (95% CI: $4278, $7147), and the major drivers were office and inpatient expenditures. Increased total expenditure associated with MSD was highest among Hispanic patients ($8490; 95% CI: $4744, $12,237).</p><p><strong>Conclusions: </strong>MSD is associated with increased utilization and expenditure among T2D patients, particularly Hispanics. Efforts targeting earlier recognition and management of MSD may reduce excess utilization and expenditure, and also racial/ethnic disparities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"346-352"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066480","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":"Learning Health Systems Research: Continued Progress and Ongoing Challenges.","authors":"Rebecca L Tisdale, Urmimala Sarkar","doi":"10.1097/MLR.0000000000002121","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002121","url":null,"abstract":"<p><strong>Background: </strong>Learning health systems research (LHSR) builds on concepts of systems-based participatory research to form a new paradigm for partnered research.</p><p><strong>Objective: </strong>Defines LHSR and its ongoing challenges and future directions.</p><p><strong>Research design: </strong>Qualitative description of relevant dimensions of LHSR.</p><p><strong>Results: </strong>In LHSR, researchers and health system stakeholders co-create research with dual aims of producing internal quality improvement and generalizable, disseminable knowledge. This approach aligns research priorities with community and health system needs, resulting in interventions that are both feasible and acceptable in real-world settings and effective. LHSR methods and outcomes reflect elements of implementation science, particularly participatory implementation science and the use of mixed methods, but the field is distinct in its emphasis on co-creation with health system leaders and the use of theory to inform rather than drive the work. Practitioners of LHSR face challenges related to the complex and multi-stakeholder nature of the field, including the time-intensive nature of building partnerships, conflicting project time horizons, imprecision inherent in real-world data, and barriers to publication of the smaller studies that typically result from LHSR.</p><p><strong>Conclusions: </strong>Continued advancement of the field requires confronting these challenges with a variety of interventions, including explicit institutional support and incentives for this type of work, training and career development opportunities, a diversity of funding sources, investment in data resources and expertise, and inclusive research governance structures.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 5","pages":"331-333"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803680","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":"Medicaid Managed Care Penetration and Mental Health Service Use Among Adults.","authors":"Ju-Chen Hu, Janet R Cummings, Xu Ji, Adam S Wilk","doi":"10.1097/MLR.0000000000002105","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002105","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between Medicaid managed care (MMC) penetration and mental health (MH) service use among Medicaid-enrolled non-elderly adults, with a special focus on those with MH conditions.</p><p><strong>Background: </strong>Medicaid covers over 9 million adults living with MH conditions, with many enrolled in MMC. Despite increases in MMC enrollment over the past decade, nationwide evidence of MMC's association with MH service use during this period is lacking.</p><p><strong>Methods: </strong>Using 2015-2019 National Survey on Drug Use and Health data, we applied logistic and negative binomial regression models to examine the association between MMC penetration and MH service use among 35,500 non-elderly enrollees in 40 MMC states, and separately among 11,800 enrollees with MH conditions. Four dichotomous outcomes separately measured any MH service use in inpatient, outpatient, prescription medication, and any settings. Two additional count outcomes measured the number of inpatient MH stays and outpatient MH visits.</p><p><strong>Results: </strong>A 2-percentage point higher level of MMC penetration was associated with a 9% reduction (adjusted incidence rate ratio = 0.91, 95% CI = 0.87, 0.94) in days of inpatient MH stays among all enrollees and a 7% reduction (adjusted incidence rate ratio= 0.93, 95% CI = 0.87, 0.99) among enrollees with MH conditions. MMC penetration was not associated with significant changes in other outcomes.</p><p><strong>Conclusions: </strong>Among non-elderly adults and those with MH conditions, increased MMC enrollment was associated with reduced inpatient MH services with no significant changes in the use in other settings. Ongoing monitoring is crucial to assess the potential impact of shortened inpatient stays on MH outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 5","pages":"338-345"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811753","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}