Medical Care最新文献

{"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":"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":"646-655"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327499/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Better Understanding of Primary Care Physician Career Typologies.","authors":"Erin Fraher, Todd Jensen, Alberta Tran, Evan Galloway, Jasmine Weiss, Brianna Lombardi","doi":"10.1097/MLR.0000000000002167","DOIUrl":"10.1097/MLR.0000000000002167","url":null,"abstract":"<p><strong>Background: </strong>The nation faces a persistent shortage and maldistribution of primary care physicians (PCPs). A better understanding of PCP career typologies could help policy makers target interventions toward certain subgroups, rather than using a \"one-size fits all\" approach to improving PCP supply, distribution and diversity across settings and in rural areas.</p><p><strong>Methods: </strong>This study used cross-sectional data from 2009 and 2019, derived from the North Carolina (NC) Medical Board, on PCPs in active practice in family medicine, general internal medicine, general pediatrics, geriatrics, and obstetrics and gynecology in NC. We used latent class analysis (LCA) to investigate: (1) whether different career typologies exist in the primary care physician workforce; (2) if so, whether career typologies changed in the 10-year period before the COVID-19 pandemic (2009 and 2019); and (3) whether a physician's generational cohort, age, sex, race/ethnicity, career stage, and medical school location were associated with different career typologies.</p><p><strong>Results: </strong>The LCA yielded 4 distinct career typologies in both 2009 and 2019 with high levels of class separation. The 4 typologies were relatively stable over the decade. Distinguishing factors between typologies included practice in a rural area, hospital, and ambulatory care employment, and provision of obstetric and prenatal care.</p><p><strong>Conclusions: </strong>Understanding PCP career typologies could be used to tailor interventions to improve the supply and distribution of PCP workforce. Medical schools could use this information to support trainees' decision-making about future careers and policy makers to target funding for training to support careers in rural and ambulatory settings.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"637-645"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225877","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 Nurse Work Environment, Staffing, and Skill Mix With Length of Stay for Patients With Intellectual and Developmental Disabilities.","authors":"Lynne Moronski, Jesse L Chittams, Eileen T Lake, Matthew D McHugh","doi":"10.1097/MLR.0000000000002168","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002168","url":null,"abstract":"<p><strong>Introduction: </strong>Complex care for individuals with intellectual and developmental disability (IDD) may translate into longer than needed hospital lengths of stay (LOS). Nurses are poised to influence the outcomes of patients with IDD. But ample evidence suggests that nurses' capacity to provide optimal care may depend on key organizational features such as having sufficient staff, supportive work environments, and sufficient mix of registered nurses, termed nursing resources. This paper aims to determine the association of nursing resource factors with LOS in adults with IDD.</p><p><strong>Methods: </strong>Linked data from 3 datasets representing 4 states were used. Zero-truncated negative binomial regression models that clustered for patients in the same hospital were used to examine the association between nursing resources and LOS for adults with IDD.</p><p><strong>Results: </strong>Receiving care in a hospital with a better nurse work environment, skill mix, and staffing was associated with reduced LOS in this sample of 38,587 patients with IDD in 595 hospitals. In univariate models adjusted for hospital and patient characteristics, all 3 nursing resources were independently associated with reduced LOS. In an adjusted multivariate model, work environment and skill mix remained significant with identical effect sizes to the separate models, that is, for an increase of 1 SD, work environment is associated with a reduction in LOS of 2.7% (P=0.005), a 6 day to 5.84 day reduction, and skill mix of 2% (P=0.039), a 6 day to 5.88 day reduction.</p><p><strong>Conclusions: </strong>The appropriate deployment of nursing resources may lead to a reduction in LOS for patients with IDD.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 9","pages":"672-678"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821880","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":"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":"694-702"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","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":"Association Between Paid Sick Leave and Dental Services Utilization Among Working Adults in the United States.","authors":"Rashmi Lamsal, Hyo Jung Tak, Fernando A Wilson, Melissa K Tibbits, Li-Wu Chen, David Palm","doi":"10.1097/MLR.0000000000002208","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002208","url":null,"abstract":"<p><strong>Background: </strong>Timely access to regular dental visits allows the detection of preventable conditions at an earlier stage. Nonetheless, 37% of adults aged 18 and above had no dental visits in 2020. Various factors affect utilization, but little is known about the influence of job characteristics. This study examined the association between paid sick leave (PSL) and different types of dental services utilization among working adults aged 18-64 in the United States.</p><p><strong>Methods: </strong>The study sample population included employed adults aged 18-64 in the 2019 Medical Expenditure Panel Survey (N=7645). The four outcome variables were a binary variable of having any dental care, including preventive, diagnostic, and treatment dental care in the past 12 months. The primary independent variable was having PSL as a job benefit. A multivariable logistic model was used, adjusting for demographics, socioeconomic status, and general health status. All analyses were adjusted for complex survey design.</p><p><strong>Results: </strong>Seventy-three percent of working adults had paid sick leave benefits. Availability of PSL was significantly associated with higher utilization of any dental visits [Adjusted odds ratio (aOR): 1.38, 95% CI: 1.17-1.63], preventive dental care (aOR: 1.33, 95% CI: 1.12-1.57), and diagnostic dental care (aOR: 1.31, 95% CI: 1.11-1.55).</p><p><strong>Conclusions: </strong>PSL is associated with a significant increase in dental services, preventive dental, and diagnostic dental visits. The study offers insights for medical practitioners and policymakers aiming to prevent adverse oral health outcomes, reduce disparities, and manage health care costs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959839","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":"Indian Health Service, Health Status, and Financial Barriers to Care.","authors":"Sean Hubbard","doi":"10.1097/MLR.0000000000002204","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002204","url":null,"abstract":"<p><strong>Objective: </strong>To better understand financial barriers to care facing American Indian and Alaska Native households, this study builds on previous findings that these communities have a higher likelihood of having medical debt and engaging in cost avoidance. This study aims to build on those findings by controlling for health status, insurance type, and IHS eligibility.</p><p><strong>Design: </strong>This study uses data from the National Health Information Survey in binomial logistic regression models to examine the likelihood of American Indian and Alaska Native households having medical debt and engaging in cost avoidance.</p><p><strong>Results: </strong>The results of the logistic regression analysis found that while health status and IHS eligibility significantly contribute to the likelihood of having medical debt or engaging in cost avoidance, racial disparities remain for American Indian and Alaska Native communities.</p><p><strong>Conclusions: </strong>Despite access to the Indian Health Service and Tribal care, American Indian and Alaska Native households face disparities in financial barriers to care. These results suggest that, rather than the proposed cuts to the Indian Health Service, additional funding is needed to address shortcomings in the IHS/Tribal system of care in American Indian and Alaska Native communities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959869","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":"How Organizational Inclusion Shapes Patient Satisfaction in Magnet Hospitals.","authors":"Hyunmin Yu, Heather Brom, José A Bauermeister, Jessie Reich, Matthew D McHugh, Tari Hanneman, Linda H Aiken","doi":"10.1097/MLR.0000000000002201","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002201","url":null,"abstract":"<p><strong>Objective: </strong>Magnet hospitals exhibit higher patient satisfaction than non-Magnet hospitals, yet the underlying mechanisms driving these differences remain underexplored. This study examined the associations between Magnet status, hospitals' inclusion efforts for diverse populations, and patient satisfaction, and whether inclusion efforts explain Magnet hospitals' higher satisfaction.</p><p><strong>Methods: </strong>This cross-sectional study analyzed 2023 secondary data from 4 sources: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the Healthcare Equality Index (HEI), the American Hospital Association Annual Survey, and the list of Magnet-recognized organizations. The sample included 708 hospitals (216 Magnet, 492 non-Magnet) participating in both HCAHPS and HEI. HEI scores, which assess hospitals' inclusion efforts for lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) populations, were used as a proxy for overall inclusion. Patient satisfaction was measured using 8 HCAHPS indicators. Mediation analyses tested whether HEI scores explained the association between Magnet designation and patient satisfaction.</p><p><strong>Results: </strong>Magnet hospitals had higher HEI scores (M=92.0, SD=12.2) compared with non-Magnet hospitals (M=88.5, SD=13.3). They also had higher hospital ratings (M=88.4, SD=2.4 vs. M=87.6, SD=3.3) and patient recommendations (M=88.4, SD=3.2 vs. M=86.8, SD=4.1). Magnet status had direct effects on hospital ratings (b=1.75, P<0.001) and recommendations (b=2.37, P<0.001), as well as indirect effects through HEI performance on hospital ratings (b=0.07, P=0.022) and recommendations (b=0.10, P=0.026), resulting in total effects on hospital ratings (b=1.82, P<0.001) and recommendations (b=2.47, P<0.001).</p><p><strong>Conclusions: </strong>The findings underscore the importance of organizational priorities and policies that promote patient-centeredness and inclusion for the satisfaction of all patients.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959823","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":"Claims-Based Measures of Care Coordination and Long-Term Health Among Older Women With Endometrial Cancer.","authors":"Chelsea Anderson, Jennifer L Lund, Victoria Bae-Jump, Justin G Trogdon, Hazel B Nichols","doi":"10.1097/MLR.0000000000002189","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002189","url":null,"abstract":"<p><strong>Background: </strong>Coordination of care between providers may help ensure that cancer survivors receive the appropriate health care services to improve their long-term health. We examined associations between a claims-based measure of care coordination and several health outcomes among older endometrial cancer survivors.</p><p><strong>Methods: </strong>Using SEER-Medicare data, we identified women with endometrial cancer at ages 66+ during 2009-2015 (N=13,696). Medicare claims during years 1-3 postdiagnosis were used to calculate care density, a measure of care coordination, as the ratio of the number of patients shared among a woman's outpatient providers to the number of provider pairs seen by that patient. We estimated associations between care density tertile and hospitalizations, emergency room (ER) visits, and all-cause mortality from 3 years postdiagnosis on, and adherence to guideline-recommended follow-up during years 3-5 postdiagnosis.</p><p><strong>Results: </strong>No clear trends were observed for risk of all-cause mortality, hospitalizations or ER visits according to care density category. However, for hospitalizations (HR=0.93; 95% CI: 0.87-0.99) and ER visits (HR=0.93; 95% CI: 0.88-0.98), there was a slightly lower risk in the highest care density tertile compared with the lowest. Women in the middle (OR=1.67; 95% CI: 1.40-2.00) and highest care density tertiles (OR=1.63; 95% CI: 1.36-1.96) were more likely to be adherent to follow-up recommendations than those in the lowest tertile.</p><p><strong>Conclusions: </strong>Greater care coordination during the early survivorship period may be associated with a slightly lower risk of hospitalization and ER visits and better adherence to surveillance recommendations after endometrial cancer.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959855","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":"Incorporating the Present-on-Admission Indicator to Predict In-hospital Mortality Through Elixhauser Measures: A Medicare Data Analysis.","authors":"Jianfang Liu, Ani Bilazarian, Madeline M Pollifrone, Sunmoo Yoon, Rachel Siegel, Lusine Poghosyan","doi":"10.1097/MLR.0000000000002192","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002192","url":null,"abstract":"<p><strong>Background: </strong>In 2021, the Agency for Health Care Research and Quality (AHRQ) updated its guidelines for using the Present-on-Admission (POA) indicator in the Elixhauser comorbidity index. This update helps distinguish pre-existing comorbidities from complications that arise after hospital admission, improving the validity of hospital performance assessments and more accurately measuring patients' severity of illness upon admission.</p><p><strong>Objective: </strong>To evaluate differences in comorbidity prevalence and the predictive performance of the Elixhauser Comorbidity Index for in-hospital mortality at admission under 3 comorbidity coding guidelines, including one that ignores the POA indicator.</p><p><strong>Research design: </strong>A retrospective analysis of inpatient administrative data on Medicare beneficiaries.</p><p><strong>Subjects: </strong>The dataset included 1,810,106 adult Medicare inpatient admissions across 6 U.S. states between 2017 and 2019.</p><p><strong>Methods: </strong>Elastic net models were applied to predict in-hospital mortality using 3 approaches to coding comorbidities: (1) No-POA (including all conditions as admission comorbidities), (2) Full-POA (including only POA conditions as comorbidities), and (3) the 2021 AHRQ Partial-POA (applying POA to a subset of conditions to code comorbidities). Results: C-statistics were 0.800 (0.797-0.804), 0.768 (0.763-0.771), and 0.786 (0.781-0.790) for No-POA, full-POA, and 2021 AHRQ partial-POA guidelines, respectively.</p><p><strong>Conclusion: </strong>Ignoring the POA inflated model performance by misclassifying complications as admission comorbidities. The 2021 Partial-POA guidelines achieved intermediate C-statistics while ensuring internal validity by accurately measuring illness severity at admission. This supports improved hospital evaluations, care quality, resource allocation, tailored intervention, and reimbursement. The elastic net model shows promise as a standard for predicting in-hospital mortality with the Elixhauser comorbidity measure.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959881","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 Impact of Racial/Ethnic Concordance in Patient-Reported Shared Decision-Making and Communication During the COVID-19 Era.","authors":"J B Eyring, Brandon M Hemeyer, Fernando A Wilson","doi":"10.1097/MLR.0000000000002165","DOIUrl":"10.1097/MLR.0000000000002165","url":null,"abstract":"<p><strong>Background: </strong>Patient-provider racial/ethnic concordance may mitigate disparities, which is likely due in part to improved communication. The COVID-19 pandemic exacerbated disparities and raised questions on communication, warranting further exploration to inform equitable care.</p><p><strong>Objectives: </strong>This study aimed to investigate the influence of patient-provider racial/ethnic concordance on patient-reported shared decision-making and communication during the early stages of the pandemic.</p><p><strong>Research design: </strong>Stepwise logit models were constructed of short-term non-modifiable factors (race/ethnicity, education, age, marital status), modifiable factors (health insurance, poverty status), and self-reported health status predicting communication outcomes-whether the provider included the patient in decision-making and communicated treatment options.</p><p><strong>Subjects: </strong>Adults from the 2020 US Medical Expenditure Panel Survey (N=9634), weighted consistent with complex sampling.</p><p><strong>Measures: </strong>Shared decision-making and communication of treatment options by the primary care provider were assessed by patient surveys. Demographic characteristics included race/ethnicity, poverty status, age, marital status, education, and insurance status.</p><p><strong>Results: </strong>Concordance was associated with greater age and socioeconomic status, and being married, White, and in good health. Concordance was associated with patient-reported shared decision-making and communication of treatment options. The associations between demographic characteristics and communication outcomes differed significantly by concordance status, which further differed by race/ethnicity. For example, shared decision-making was predicted by education for discordant Hispanic patients and marital status for discordant White patients, but neither were predictive among concordant patients.</p><p><strong>Conclusions: </strong>The findings suggest a potential association between concordance on shared decision-making and communication dynamics, emphasizing the need for additional research to clarify how similarities and differences may influence health care interactions.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"579-587"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989648","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}