Medical Care最新文献

{"title":"Are Rates of Skin Procedures Higher in Veterans Health Administrations Purchased Care Than Veterans Health Administrations Delivered Care?","authors":"Matthew P Dizon, Steven M Asch, Todd H Wagner","doi":"10.1097/MLR.0000000000002151","DOIUrl":"10.1097/MLR.0000000000002151","url":null,"abstract":"<p><strong>Background: </strong>To improve access to care, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program, allowing enrollees to receive care outside VA facilities if they met eligibility requirements tied to wait times, travel, and availability of services. VA-purchased care has grown significantly to more than $32 billion in 2024, representing 24% of VA's medical care budget.</p><p><strong>Objectives: </strong>To compare the annual utilization of skin procedures for Veterans who received only VA-purchased care versus any VA-delivered care.</p><p><strong>Research design: </strong>Using medical records and claims data, we conducted a retrospective cohort study of Veterans who received outpatient evaluation and management (E/M) services and skin procedures delivered or purchased by the VA during the era of the Veterans Choice Program (VCP) from January 1, 2015, to June 5, 2019. We examined the annual utilization of outpatient procedures and E/M services and adjusted for demographic and clinical characteristics using zero-inflated Poisson regression models and propensity score matching.</p><p><strong>Results: </strong>VA-purchased care was associated with greater utilization for all skin procedures examined. For the most common procedures, destruction of premalignant lesions and biopsies, annual rates were 1.4-fold and 1.5-fold greater in the VA-purchased care group, respectively.</p><p><strong>Conclusions: </strong>The growth of purchased community care is a concern if it reflects a growth of low-value services. If the resource-intensive purchased care were unnecessary, it would pose risks for VA and Veterans, and alternative payment models should be explored to limit this risk.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"555-562"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110798","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 Equity and Hospital Markets: Differences in the Association of Market Concentration and Quality of Care by Patient Race/Ethnicity and Payer.","authors":"Alexander C Adia, Charleen Hsuan, Hector P Rodriguez","doi":"10.1097/MLR.0000000000002123","DOIUrl":"10.1097/MLR.0000000000002123","url":null,"abstract":"<p><strong>Background: </strong>As hospital markets become increasingly consolidated, whether regulators should account for consolidation's impacts on health equity has become a key policy question. We assess the association of hospital market concentration with quality of care and examine differences by patient race/ethnicity and payer.</p><p><strong>Methods: </strong>We analyzed linked 2017 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Data from 14 US states. Market concentration was measured using the Herfindahl-Hirschman Index (HHI) at the county level, and quality was assessed using the Prevention Quality Indicators (PQI). We assessed the relationship of HHI, patient race/ethnicity, and payer with having any PQI admission, controlling for patient and hospital characteristics. We used interaction terms for race-HHI and payer-HHI to assess differential associations of concentration by race/ethnicity and payer using linear probability models.</p><p><strong>Results: </strong>In adjusted analyses, minoritized racial/ethnic group status and having a noncommercial primary payer were associated with a higher probability of having a PQI admission. Differences between Hispanic adults and White adults decreased in more competitive markets but increased for Asian/Pacific Islander adults versus White adults. Differences in the probability of a PQI admission between adults covered by Medicaid and self-pay/no-pay adults versus commercially insured adults increased, while differences for adults covered by Medicare decreased.</p><p><strong>Conclusions: </strong>Hospital market concentration may have heterogeneous effects on the quality of care by patient race/ethnicity and payer. Because market concentration may impact equity, regulators should consider accounting for health equity impacts in merger reviews.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"565-572"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657629","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":"Preventive Drug Lists Reduce Income-Related Disparities in Medication Adherence Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.","authors":"Dennis Ross-Degnan, Stephanie Argetsinger, Christine Y Lu, Anita Wagner, Matt Lakoma, Fang Zhang, J Frank Wharam","doi":"10.1097/MLR.0000000000002186","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002186","url":null,"abstract":"<p><strong>Background: </strong>Employers add Preventive Drug Lists (PDLs) to commercial insurance plans to reduce out-of-pocket payments for medicines that treat important chronic illnesses.</p><p><strong>Objective: </strong>This study examined the impact of PDLs among patients with pre-existing diabetes.</p><p><strong>Research design: </strong>Interrupted time series design with difference-in-difference analysis.</p><p><strong>Subjects: </strong>We identified 5575 patients aged 12-64 with diabetes whose employers adopted PDL coverage for 2 years after a baseline year without; an equivalent number of matched and weighted controls were selected from employers that did not offer PDL plans.</p><p><strong>Measures: </strong>Utilization, out-of-pocket payments, and medication adherence overall, among lower-income patients, and for those paying full cost for medicines under high-deductible plans.</p><p><strong>Results: </strong>Compared with controls, patients with PDL coverage experienced large, statistically significant 35%-55% relative reductions in OOP payments. The PDL group experienced significant relative increases in 30-day fills in follow-up year 1 for noninsulin antidiabetics (+9.5) and a nonsignificant increase for insulin (+6.2%); these were matched by similar increases in percentage of days in which medicines were available. Increases were all substantially greater in the second follow-up year, larger among lower-income patients, and greatest by year 2 for lower-income patients in high-deductible plans with health savings accounts.</p><p><strong>Conclusions: </strong>PDL coverage was associated with substantial reductions in OOP payments for medications to manage diabetes and cardiovascular risk. Patients on antidiabetic medications, especially those with lower incomes, experienced improvements in adherence, which grew over time.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742668","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":"Hospital Selection Patterns for Emergency Surgical Care: Structural Barriers as a Contributor to Surgical Outcomes.","authors":"Jiuying Han, Neng Wan, Joshua J Horns, Simon Brewer, Marta L McCrum","doi":"10.1097/MLR.0000000000002182","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002182","url":null,"abstract":"<p><strong>Background: </strong>Structural inequities are pervasive in the US emergency care system and disproportionately affect socially vulnerable neighborhoods. Spatial patterns of hospital access for patients requiring emergency surgical care are influenced by health system structure; however, neighborhood-level variation and its association with clinical outcomes has not yet been characterized.</p><p><strong>Objective: </strong>Examine variation in spatial patterns of hospital access for adults with nontraumatic surgical emergencies and its association with clinical outcomes.</p><p><strong>Design: </strong>Retrospective analysis of California State Inpatient Discharge Data (2014-2015) of adults admitted with 1 of 8 emergency general surgery (EGS) conditions. We visualized patient home-to-hospital flows, then assessed Zip Code Tabulation Areas (ZCTA) patterns of spatial access using the Dispersion Index (DI), measured by the coefficient of variation of patient travel times where higher values indicate greater dispersion. Mixed-effect regression analysis was used to examine the association of DI with in-hospital mortality, nonhome discharge, and length of stay, adjusting for relevant patient, hospital, and neighborhood characteristics.</p><p><strong>Results: </strong>Among 337,695 EGS admissions, increasing DI was associated with greater neighborhood social deprivation index (SDI). After adjusting for relevant covariates, greater dispersion was associated with an increase in in-hospital mortality in the highest decile of dispersion (aOR: 1.14; 95% CI: 1.03-1.26). The magnitude of effect was greater for patients from high-SDI neighborhoods: mortality (aOR: 1.27; 95% CI: 1.11-1.44).</p><p><strong>Conclusions: </strong>High dispersion was associated with unfavorable clinical outcomes among EGS patients, with a greater effect for underserved groups. High variation in patterns of hospital access for emergency care likely reflects structural barriers to care and may be one mechanism contributing to the relationship between neighborhood social vulnerability and surgical outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742666","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":"Racial Disparities in Quality of Dental Care Among Publicly Insured Children.","authors":"Sung Eun Choi, Rindala Fayyad, Sharon-Lise Normand","doi":"10.1097/MLR.0000000000002184","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002184","url":null,"abstract":"<p><strong>Background: </strong>Reducing oral health disparities requires identifying subgroups experiencing gaps in quality of dental care and the sizes of those gaps. This study measured magnitudes and trends of racial/ethnic disparities in overall quality of dental care and examined factors contributing to the disparities.</p><p><strong>Methods: </strong>This retrospective cohort study used claims data from beneficiaries under age 21 enrolled in Medicaid and Children's Health Insurance Program in 6 states during 2015-2019. A standardized composite score of dental care quality was derived from 6 dental quality measures using Item Response Theory. Robust mixed-effect regression estimated the magnitudes and trends of quality disparities, adjusting for person-level covariates. A Blinder-Oaxaca decomposition quantified the relative contributions of the social and structural factors in the estimated racial/ethnic disparities.</p><p><strong>Results: </strong>Among 3.4 million beneficiaries, compared with White counterparts, Black children had lower baseline quality scores in 2 states and experienced decreases in quality in most states. Children of other race had lower baseline quality scores in 4 states with the largest gap of -0.16 (95% CI: -0.18,-0.15) and experienced decreases in quality in 3 states. Hispanic children had the higher baseline quality scores in all states with the largest gap of 0.34 (95% CI: 0.34,0.35) and experienced increases in quality in 4 states. Decomposition analysis indicated that structural factors, such as residential segregation, place of dental care, and dentist supply, explained portions of the quality gaps.</p><p><strong>Conclusion: </strong>Dental care quality was lower among Black and children of other race and higher among Hispanic and Asian children relative to their White counterparts. Tailored quality improvement efforts and refinements in Medicaid policy would be encouraged to reduce disparities in dental care and oral health.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742669","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 Telehealth Payment Parity on Recommended Care and Emergency Department Service Utilization Among Workers With Chronic Conditions.","authors":"Zhang Zhang, M Kate Bundorf, Qing Gong, Justin G Trogdon, Donna Gilleskie, Sean Y Sylvia","doi":"10.1097/MLR.0000000000002185","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002185","url":null,"abstract":"<p><strong>Background and objective: </strong>State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our study is to evaluate how improved access, driven by telehealth payment parity, affected the utilization of disease-specific recommended care management services and emergency department (ED) services among insured patients with chronic conditions.</p><p><strong>Research design: </strong>We adopted a 2-way fixed-effect difference-in-differences approach using the Merative Commercial Claims and Encounters database from 2019 to 2021.</p><p><strong>Subjects: </strong>We focused on insured workers aged 19-64 with pre-existing mental health disorders or cardiometabolic risks (CMRs).</p><p><strong>Measures: </strong>Outcomes include psychotherapy for mental health disorders, preventive care counseling for CMRs, and ED visits.</p><p><strong>Results: </strong>Telehealth payment parity was associated with a significant increase in the number of psychotherapy visits and tele-psychotherapy by 0.221 visits (95% CI: 0.050-0.391) and 0.411 visits (95% CI: 0.003-0.818) per patient per quarter, respectively. The regulation significantly reduced E.D. visits among individuals with mental health disorders by 0.003 visits (95% CI: -0.007 to 0.000) per quarter, a 25% relative decrease compared with the control at preperiod. However, payment parity was not statistically associated with increasing preventive care visits and lowering ED visits among individuals with CMRs.</p><p><strong>Conclusion: </strong>Telehealth payment parity has effectively promoted the adoption of psychotherapy and reduced ED visits among insured workers with mental health disorders. However, it has not significantly improved the uptake of preventive care counseling for individuals with CMRs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742670","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":"Economic Costs of Chronic Pain-United States, 2021.","authors":"Gery P Guy, Gabrielle F Miller, Jaswinder K Legha, S Michaela Rikard, Andrea E Strahan, Christina Mikosz, Curtis S Florence","doi":"10.1097/MLR.0000000000002181","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002181","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain affects more than 1 in 5 adults in the United States. Understanding the economic burden of chronic pain can inform interventions and strategies to improve the quality of life for individuals with chronic pain.</p><p><strong>Objective: </strong>To estimate the economic cost of chronic pain in the United States in 2021.</p><p><strong>Research design: </strong>A cross-sectional analysis estimating the economic costs of chronic pain in 2021.</p><p><strong>Subjects: </strong>In 2021, 6445 (representing 65.8 million) adults with chronic pain were identified using ICD-10-CM codes from the nationally representative Medical Expenditure Panel Survey.</p><p><strong>Measures: </strong>Direct medical costs were examined by source of payment and service type. Indirect morbidity costs were estimated from lost productivity from employment disability and missed workdays. We evaluated the economic burden of chronic pain by estimating excess costs among individuals with chronic pain compared with individuals without chronic pain using multivariable regression.</p><p><strong>Results: </strong>Individuals with chronic pain had additional total annual medical expenditures of $8068 and additional lost productivity of $2923 per person compared with individuals without chronic pain. In 2021, the economic costs of chronic pain in the United States were estimated to be $722.8 billion, including $530.6 billion in medical care costs and $192.2 billion in lost work productivity.</p><p><strong>Conclusions: </strong>The economic costs of chronic pain are substantial, resulting in excess health care expenditures and lost productivity costs. These findings highlight the importance of interventions and strategies aimed at providing high-quality, accessible, low-barrier, cost-effective pain care to improve quality of life and reduce disruptions in work among adults with chronic pain.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742664","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":"Geographic Access to Cancer Care and Breast Cancer Treatment in Low-Income Women.","authors":"Min Lian, James Struthers, Tracy Greever-Rice, Chester Schmaltz, Ying Liu","doi":"10.1097/MLR.0000000000002178","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002178","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the role of geographic access to oncologists in breast cancer treatment among low-income patients.</p><p><strong>Methods: </strong>Using Missouri Cancer Registry-Medicaid claims data, we identified Medicaid enrollees aged 18-64 with newly diagnosed breast cancer from 2007 to 2015 (n=3930). Census tract-level geographic access to radiation oncologists (ROs), medical oncologists (MOs), and primary care physicians (PCPs) was quantified using the 2-step floating catchment area approach and categorized into tertiles. Logistic regression was used to estimate odds ratios (ORs) of undergoing mastectomy (vs. breast-conserving surgery), utilizing (yes/no), timely initiating (≤90 d post-surgery), and completing radiotherapy and chemotherapy, as well as being adherent to (medication possession ratio ≥80%) and continuing (<90-consecutive day gap) endocrine therapy (ET) in the first year.</p><p><strong>Results: </strong>Compared with patients in census tracts with the greatest access to ROs, those in census tracts with the lowest access to ROs had higher odds of mastectomy (OR=1.23, 95% CI: 1.02-1.48, Ptrend=0.04), lower odds of radiotherapy completion (OR=0.68, 95% CI: 0.49-0.95, Ptrend=0.02), and similar odds of utilization and timely initiation of radiotherapy. Patients in census tracts with the lowest (vs. highest) access to MOs had comparable odds of utilization and timely initiation of chemotherapy but lower odds of chemotherapy completion (OR=0.71, 95% CI: 0.51-0.97, Ptrend=0.06). Geographic access to MOs and PCPs was unrelated to ET.</p><p><strong>Conclusions: </strong>Geographic access to oncologists was associated with choice of surgery and completion of radiotherapy/chemotherapy for breast cancer among Medicaid enrollees, highlighting the importance of addressing geographic barriers to oncologists to improve their treatment adherence.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742665","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 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}