Medical Care最新文献

{"title":"Geographic Access, Transportation Resources, and Early-Stage Lung Cancer Treatment Among Socioeconomically Disadvantaged Patients.","authors":"Min Lian, James Struthers, Ying Liu","doi":"10.1097/MLR.0000000000002370","DOIUrl":"10.1097/MLR.0000000000002370","url":null,"abstract":"<p><strong>Background: </strong>A recent study reported that geographic access to cancer care was associated with guideline-recommended treatment for early-stage non-small cell lung cancer (NSCLC), particularly among uninsured and Medicaid patients.</p><p><strong>Objective: </strong>To examine whether transportation resources modify the association between geographic access and treatment for early-stage NSCLC.</p><p><strong>Methods: </strong>We used Surveillance, Epidemiology, and End Results data linked with Medicaid Analytic eXtracts Personal Summary files to identify patients aged 18 years or above with stage I/II NSCLC diagnosed during 2007-2019 who were uninsured or had Medicaid as primary/secondary payers at diagnosis. Geographic access to thoracic surgeons (TS) and radiation oncologists (RO) was calculated using the 2-step floating catchment area method and categorized into quartiles. Transportation resources were evaluated as county-level vehicle ownership and public transit availability, both dichotomized at the median level. Poisson regression with county-level clustering estimated rate ratios (RRs) for surgery and radiotherapy.</p><p><strong>Results: </strong>Geographic access to TS was associated with surgery in both low (RR=0.92, 95% CI: 0.87-0.97 for lowest vs. highest access; P =0.66 for interaction) and high (RR=0.91, 95% CI 0.87-0.96) vehicle ownership counties. In contrast, geographic access to RO was associated with radiotherapy only among patients in counties with low vehicle ownership (RR=0.81, 95% CI: 0.74-0.89; P =0.01 for interaction), but not those in counties with high vehicle ownership (RR=0.96, 95% CI: 0.88-1.04). Similar patterns were observed in metropolitan counties with low vehicle ownership and limited public transit availability.</p><p><strong>Conclusions: </strong>Local transportation resources modified the association between geographic access and radiotherapy, but not surgery. Improving transportation access may enhance radiotherapy use for NSCLC.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"771-776"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713211","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":"Examination of Geospatial Characteristics Surrounding Retail Health Clinics: National Estimates From the Linked Retail Health Clinic (LiRHC) Database.","authors":"Jennifer Bernard, Brian W Ward, Thomas B Foster, Mark A Klee, Donald K Cherry, Xianghua Yin, Alice Zawacki","doi":"10.1097/MLR.0000000000002363","DOIUrl":"10.1097/MLR.0000000000002363","url":null,"abstract":"<p><strong>Background: </strong>Retail health clinics (RHCs) have the potential to improve population health and expand access to health care for populations typically disconnected from traditional health care providers. However, previous studies have often found that RHCs are located near populations having characteristics associated with better health and access to traditional health care providers.</p><p><strong>Objectives: </strong>This study uses data from the new Linked Retail Health Clinic (LiRHC) database, along with a variety of other data sources such as the Agency for Healthcare Research and Quality's database on Social Determinants of Health, to examine the characteristics of populations residing near RHCs through a fine-grained analysis of the spatial distribution of RHCs and the geographical and contextual characteristics of the census tracts in which they are located.</p><p><strong>Research design: </strong>This study compares the characteristics of census tracts most exposed to RHCs with those of surrounding, less-exposed tracts across 5 broad dimensions: economic stability, education, health care access, neighborhood environment, and demographics.</p><p><strong>Results: </strong>Residents of predominantly urban census tracts, who are most exposed to RHCs, are more economically stable and have greater access to education and health care. They are older, more likely to be non-Hispanic White or Asian, and less likely to be Hispanic or non-Hispanic Black. Only 2 statistically significant differences between more- and less-exposed tracts are observed in rural areas.</p><p><strong>Conclusions: </strong>In most instances, this study finds smaller differences between more- and less-exposed census tracts than those documented in previous work. This result plausibly is driven by a finer definition of treatment and comparison geographies enabled by the LiRHC database.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"777-786"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620693","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":"Impact of Alternative Payment Models on Quality of Care in Federally Qualified Health Centers From 2014 to 2024: A 2-stage Difference-in-Differences Analysis.","authors":"Tianjiao Gao, Wu Zeng","doi":"10.1097/MLR.0000000000002367","DOIUrl":"10.1097/MLR.0000000000002367","url":null,"abstract":"<p><strong>Background: </strong>Federally Qualified Health Centers (FQHCs) are essential safety-net providers, but traditional payment mechanisms may focus on volume over quality-of-care. Alternative payment models (APMs) have been introduced to enhance value-based purchasing. It is hypothesized that APMs would improve flexibility and incentivize quality of care, but evidence remains limited, especially for maternal and child health and cardiovascular conditions.</p><p><strong>Objectives: </strong>We aim to evaluate the impact of APMs on quality-of-care in FQHCs in the United States.</p><p><strong>Methods: </strong>We used a 2-stage difference-in-differences design to compare FQHCs in states adopting APMs with those that did not, using data from 2014 to 2024 in 695 FQHCs. Quality-of-care was measured using 6 indicators, including 2 associated with maternal and child services (early prenatal care and dental sealants), 2 with preventive care (depression screening and tobacco use screening), and 2 with cardiovascular disease management (cardiovascular and ischemic vascular disease treatment). To examine heterogeneity of the effects, the analysis stratified FQHCs into 3 groups based on patient volume.</p><p><strong>Results: </strong>APM adoption was significantly associated with improvements in 4 quality measures: a 3.82-percentage-point increase in early prenatal care, a 9.12 percentage point increase in dental sealants, a 5.08 percentage point increase in depression screening, and a 3.50 percentage point increase in ischemic vascular disease treatment. Stratified analyses showed that large FQHCs in APM-adopting states experienced statistically significant improvements in 3 indicators.</p><p><strong>Conclusions: </strong>Overall, APMs were associated with positive but modest improvements in quality-of-care at FQHCs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"811-817"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725284","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":"Quantifying and Addressing Racial and Ethnic Disparities in Lower-Limb Prosthesis Prescriptions Among US Veterans.","authors":"Anthony I Roberts, Andrew R Zullo, Amal N Trivedi, M Jason Highsmith, Linda J Resnik","doi":"10.1097/MLR.0000000000002385","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002385","url":null,"abstract":"<p><strong>Background: </strong>Black and Hispanic Veterans undergo lower-limb amputations at higher rates than White Veterans, yet it remains unclear whether they receive equitable access to prosthetic devices within the Veterans Health Administration (VHA).</p><p><strong>Objective: </strong>To quantify racial and ethnic disparities in lower-limb prosthesis (LLP) prescriptions among Veterans and identify factors contributing to these disparities.</p><p><strong>Research design: </strong>Retrospective cohort study using generalized Kitagawa-Oaxaca-Blinder decomposition and prescriptive disparity analysis with double/debiased machine learning.</p><p><strong>Subjects: </strong>Veterans who underwent major lower-limb amputation within the VHA from 2010 to 2022 (n=16,157; 66.2% White, 27.4% Black, 6.4% Hispanic).</p><p><strong>Measures: </strong>Prescription of any LLP and advanced LLP within 12 months postamputation.</p><p><strong>Results: </strong>Black and Hispanic Veterans were 5.7 percentage points (pp) [95% confidence limits (CLs): 4.0, 7.5] and 5.6 pp (95% CLs: 2.4, 8.8) less likely than White Veterans to receive any LLP prescription, respectively. For advanced LLPs, disparities were 1.7 pp (95% CLs: 0.8, 2.6) for Black Veterans and 3.0 pp (95% CLs: 1.5, 4.5) for Hispanic Veterans. Facility-level factors explained 58.2% of the White-Black disparity in any LLP prescriptions. Measured factors fully explained the White-Black disparity in advanced LLP prescription, with preamputation clinical factors contributing most. Prescriptive analysis revealed that targeted quality improvement at facilities serving high proportions of Black Veterans could reduce disparities by 32.5%, while interventions addressing end-stage renal disease could reduce advanced LLP disparities by 33.6%.</p><p><strong>Conclusions: </strong>Targeted resource allocation to facilities serving high proportions of racial and ethnic minority Veterans and integrated care pathways for Veterans with complex comorbidities represent actionable interventions for reducing prosthetic care inequities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182869","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":"Determinants of Delivery Hospital Choice in Georgia, 2016-2021: Maternal Characteristics, Hospital Attributes, and Time Price.","authors":"E Kathleen Adams, Ian M McCarthy, Peter J Joski, Anne L Dunlop","doi":"10.1097/MLR.0000000000002383","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002383","url":null,"abstract":"<p><strong>Background: </strong>US maternal mortality and severe maternal morbidity (SMM) are marked by substantial disparities by race, payer, and geography. To the extent that such disparities are driven by differences across hospitals rather than within hospitals, understanding what shapes delivery hospital choice can inform policy responses.</p><p><strong>Objectives: </strong>To examine how distance, hospital attributes, and maternal characteristics jointly shape delivery hospital choice, and whether patterns differ between urban Atlanta and smaller Georgia markets.</p><p><strong>Research design: </strong>Retrospective observational study using a conditional logit model to estimate delivery hospital choice. Hospital markets were defined through community detection on patient-flow data. We report marginal effects on selection probability.</p><p><strong>Subjects: </strong>Seven hundred ten thousand eight hundred seventy deliveries across 84 Georgia hospitals, 2016-2021.</p><p><strong>Measures: </strong>Deterministically linked hospital discharge, birth, and fetal death records, supplemented with American Hospital Association, CMS, and Area Resource Files data.</p><p><strong>Results: </strong>Distance (in miles) strongly deterred hospital selection in both markets, with greater sensitivity in Atlanta (-2.7 percentage points [pp] per additional mile) than outside Atlanta (-1.9 pp/mile). Individuals preferred hospitals with higher perinatal levels of care and teaching status. A hospital's elective C-section rate was negatively associated with its selection outside Atlanta (-1.3 pp) but positively in Atlanta (+2.5 pp). Higher comorbidity was associated with higher-quality hospital selection, though the highest-risk Atlanta individuals showed lower preference for high-elective-C-section hospitals.</p><p><strong>Conclusions: </strong>Delivery hospital choice in Georgia reflects distance, practice environment, insurance, and clinical complexity, with urban/nonurban differences. Medicaid-insured individuals show delivery patterns consistent with provider supply-side constraints, which may raise concerns to the extent that they face an elevated risk of adverse maternal outcomes. Findings inform payment and referral policies improving access to risk-appropriate delivery settings and reducing maternal health disparities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128078","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":"Home-Based Primary Care and Emergency Department Use Among Veterans With Dementia: An Instrumental Variable Analysis.","authors":"Katherine E M Miller, Megan Price, Melissa M Garrido","doi":"10.1097/MLR.0000000000002384","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002384","url":null,"abstract":"<p><strong>Background: </strong>As the veteran population ages, the Veterans Health Administration (VHA) faces challenges in how to meet the care needs of patients with dementia. Providing high-quality, integrated care models in the home, such as home-based primary care (HBPC), can offer care aligned with veteran goals and present potential cost-savings to the VHA.</p><p><strong>Objective: </strong>Examine the effect of VHA HBPC on the probability of emergency department/urgent care (ED) use.</p><p><strong>Research design: </strong>Cohort analysis using an instrumental variable approach.</p><p><strong>Subjects: </strong>Veterans aged 65+ with dementia (2021-2023).</p><p><strong>Measures: </strong>We define HBPC as beginning the first month veterans have 2+ HBPC claims within 91 days. ED use is the key outcome.</p><p><strong>Results: </strong>Among 133,846 veterans with dementia, 17.36% (n=23,240) received HPBC during the evaluation period. Compared with non-HBPC veterans, veterans in HBPC were older and more likely to be female, reside in a metropolitan area, be Hispanic, be Black/African American, have post-traumatic stress disorder, a traumatic brain injury, have more Elixhauser conditions, and have higher ED use (7.1% vs. 5.9%). When using the instrumental variable of lagged HBPC penetration to address selection into HBPC (F-stat>100), we find that HBPC enrollees were 3.60 percentage points less likely to have ED use than non-HBPC enrollees (P<0.001).</p><p><strong>Conclusions: </strong>Reducing ED visits among people with dementia may signal improved care and offer potential cost-savings to health care systems. Our findings can help inform VHA efforts to invest in the optimal allocation of resources to best support veterans with dementia while containing costs by avoiding potentially avoidable, high-cost care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137328","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 Hepatitis B Prevalence and Care Among Medicaid Beneficiaries.","authors":"Hang Pham, Wenzhan Jing, Tien Minh Nguyen, Rosemary Huang, Diep Vu, Albert Liu, Samuel So","doi":"10.1097/MLR.0000000000002387","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002387","url":null,"abstract":"<p><strong>Background: </strong>Monitoring and antiviral treatment are essential to reduce chronic hepatitis B (CHB)-related morbidity and mortality.</p><p><strong>Methods: </strong>We analyzed Medicaid claims data from January 1, 2016, through December 31, 2019, to estimate claims-recorded CHB prevalence and to evaluate CHB-directed monitoring, antiviral use, and qualifying liver imaging.</p><p><strong>Results: </strong>Among 72.4 million adult Medicaid beneficiaries, 292,267 had claims-recorded CHB diagnosis (0.40%). After excluding beneficiaries with HIV or hepatitis C, HCC, or liver transplantation, 208,933 remained in the care-analysis cohort. Non-Hispanic Asians represented 6.2% of Medicaid beneficiaries but 42.8% of the care-analysis cohort. CHB-directed monitoring was received by 53.4% overall and 66.9% of patients with cirrhosis; antiviral use by 12.8% overall and 35.9% of those with cirrhosis. More than 90% of patients with cirrhosis had ≥1 qualifying liver imaging; among patients without cirrhosis, 73.5% of men aged 40 years or older and 74.9% of women aged 50 years or older had liver imaging. Non-Hispanic Asian and Native Hawaiian/Pacific Islander beneficiaries were significantly more likely to receive CHB-directed monitoring and antiviral therapy than non-Hispanic White beneficiaries, whereas Hispanic beneficiaries were significantly less likely. Substantial state-level variation was observed; among patients with cirrhosis, CHB-directed monitoring ranged from 51.4% to 89.8% and antiviral use from 21.1% to 51.5%.</p><p><strong>Conclusion: </strong>Substantial gaps and disparities in CHB monitoring and antiviral use persist among Medicaid beneficiaries highlighting the urgent need for targeted interventions and integration of CHB care into Medicaid quality measures. Standardizing CHB care and reducing demographic and geographic disparities are critical steps toward minimizing CHB-related complications and mortality.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137271","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's GLP-1 Coverage Gap: A Familiar and Correctable Policy Failure.","authors":"Pranav Ayyappan, Rajesh Balkrishnan","doi":"10.1097/MLR.0000000000002382","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002382","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111774","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 Effects of Inpatient Specialty Consultations on Health and Utilization Outcomes.","authors":"Zachary S Templeton","doi":"10.1097/MLR.0000000000002388","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002388","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the effects of specialty consultations on health and utilization outcomes among general medicine admissions.</p><p><strong>Background: </strong>Specialist physicians are frequently consulted in the inpatient setting to obtain additional expertise or get access to specific treatments. However, the effects of these consults have not been rigorously studied.</p><p><strong>Methods: </strong>In this quasi-experimental study, I analyzed the effects of an infectious disease, cardiology, or nephrology consult that occurred within 24 hours of admission. To address patient-level confounding, consultant team workload, defined as consult orders per provider, served as an instrumental variable for consult receipt. I identified general medicine admissions from 3 teaching hospitals in Pennsylvania using electronic health record data spanning March 2017 to August 2024. Primary outcomes were length of stay and readmission, mortality, and specialty outpatient visit within 30 days of discharge.</p><p><strong>Results: </strong>Among admissions whose consult probability varied by consultant workload, a specialty consult decreased 30-day readmission by 29.8 percentage points (pp) (95% CI: -52.0 to -7.7 pp) and increased 30-day outpatient visit by 18.6 pp (95% CI: 7.3-29.9 pp). The decrease in the probability of readmission was primarily driven by infectious disease consults and patients who had not received a specialty consult in the past year. Consults had no significant effects on mortality or length of stay.</p><p><strong>Conclusions: </strong>Specialty consults may reduce readmissions and improve continuity of care without increasing inpatient utilization on average.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111735","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":"Implementing Social Risk Screening Across a Pediatric Liver Transplant Learning Health Network: Lessons From the Starzl Network for Excellence in Pediatric Transplantation.","authors":"Gabrielle Jutras, Andrea Huerta, Chetana Bisarya, Noelle Ebel, Joshua Gossett, George Mazariegos, Vicky L Ng, Emily R Perito, James E Squires, Sharad I Wadhwani","doi":"10.1097/MLR.0000000000002299","DOIUrl":"10.1097/MLR.0000000000002299","url":null,"abstract":"<p><strong>Background: </strong>Social adversity contributes to poor health outcomes for children after liver transplantation (LT), including greater morbidity and mortality. Although social risk screening is standard practice in pediatric primary care, its adoption in pediatric LT (pLT) remains limited, despite the significant prevalence of social risks among these families.</p><p><strong>Objectives: </strong>To evaluate barriers and facilitators to social risk screening implementation in pLT settings across a multicenter learning health network.</p><p><strong>Research design: </strong>A mixed-methods study utilizing surveys and semistructured interviews.</p><p><strong>Subjects: </strong>Health care practitioners involved in pLT care across North American centers in the Starzl Network for Excellence in Pediatric Transplantation (SNEPT) Network. Participants included multidisciplinary team members, notably transplant physicians, social workers, and research coordinators.</p><p><strong>Measures: </strong>We surveyed center leads to identify center-level implementation challenges. We conducted 1-on-1 interviews with transplant team members to identify barriers and facilitators. We analyzed qualitative data using the Capability, Opportunity, Motivation-Behavior model, an implementation science model for developing targeted interventions.</p><p><strong>Results: </strong>We surveyed 10 centers, of which 40% of liver transplant clinics reported actively screening patients for Social Determinants of Health (SDoH). Most practitioners indicated reliance on social workers and cited limited resources as barriers to implementation. We also conducted interviews with 18 practitioners across 11 centers. Reported barriers included uncertainty about the tool's added value, time and space constraints during patient encounters, and challenges with data entry and sharing across a multicenter network. Facilitators included institutional support, interdisciplinary collaboration, and integration into electronic health records.</p><p><strong>Conclusion: </strong>Efforts to increase adoption should focus on improving practitioners' experiences with the tool as well as further assessing and disseminating its potential value in improving outcomes. Strategies for addressing logistical challenges to adapting workflows and simplifying network data management should be considered. This study establishes a foundation for improving screening rates and data capacity.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"64 10","pages":"705-714"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912006","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}