Medical Care最新文献

{"title":"High-Intensity End-of-Life Care Among Young and Middle-Aged Hispanic Adults With Cancer in Puerto Rico.","authors":"Jessica Velazquez, Maira A Castañeda-Avila, Axel Gierbolini-Bermúdez, María R Ramos-Fernández, Karen J Ortiz-Ortiz","doi":"10.1097/MLR.0000000000002115","DOIUrl":"10.1097/MLR.0000000000002115","url":null,"abstract":"<p><strong>Background: </strong>Timely palliative and hospice care, along with advanced care planning, can reduce avoidable high-intensity care and improve quality of life at the end of life (EoL).</p><p><strong>Objective: </strong>We examined patterns of care at EoL and evaluated predictors of high-intensity care at EoL among adults aged 18-64 with cancer.</p><p><strong>Methods: </strong>Using data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we examined 1359 patients diagnosed with cancer in 2010-2019, who died of cancer between 2017 and 2019 at 64 years and younger, and who were enrolled in Medicaid or private health insurance in last 30 days before death. We used composite measures for high-intensity and recommended EoL care using claims-based indicators in the last 30 days before death. Multivariable logistic regression was used to examine predictors associated with high-intensity EoL care.</p><p><strong>Results: </strong>About 70.3% of young and middle-aged Hispanic cancer patients received high-intensity EoL care, whereas only 20.6% received recommended EoL care. Patients without recommended EoL care were more likely to receive high-intensity EoL care (aOR=4.23; 95% CI=3.18-5.61). High-intensity EoL care was more likely in female patients (aOR=1.43; 95% CI=1.11-1.85) and patients with hematologic cancers (aOR=1.91; 95% CI=1.13-3.20) and less likely in patients who survived >12 months after cancer diagnosis (aOR=0.55; 95% CI=0.43-0.71).</p><p><strong>Conclusions: </strong>A high proportion of Hispanic adults with cancer in Puerto Rico receive high-intensity EoL care and have unmet needs at EoL. Tailored interventions can reduce high-intensity EoL care and increase recommended EoL care. Recommended EoL care can ease pain, reduce distress, honor personal preferences, and cut unnecessary medical costs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"193-201"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008136","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":"Knowledge of Medical Interpretation Rights Among Individuals With Non-English Language Preference: A Cross-Sectional Study.","authors":"Miguel Linares, Stuart Lipsitz, Shimon Shaykevich, Lipika Samal, Jorge A Rodriguez","doi":"10.1097/MLR.0000000000002109","DOIUrl":"10.1097/MLR.0000000000002109","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify demographic, acculturation, and health care factors associated with self-reported knowledge of the right to medical interpretation among individuals with non-English language preference (NELP) in California.</p><p><strong>Background: </strong>NELP is a significant social determinant of health contributing to adverse health outcomes through barriers in communication, limited health literacy, and biases in care delivery. The ability of patients with NELP to self-advocate for interpreter services is crucial yet hindered by various factors, including a lack of knowledge about their rights.</p><p><strong>Methods: </strong>This cross-sectional study used pooled data from the California Health Interview Survey from 2012 to 2021. Subjects were 12,219 adults with NELP, representing 2,516,157 individuals in California. The primary outcome was self-reported knowledge of the right to medical interpretation. Covariates included demographic, acculturation, and health care factors.</p><p><strong>Results: </strong>Of the participants, 28.6% were unaware of their rights to interpretation. Married females had higher odds of knowledge, while recent immigrants (≤5 y in the United States), those with mixed language households, no doctor visits in the past year, no insurance, and self-reported poorer health had lower odds. Sociodemographic factors like age, race, ethnicity, education, and geography showed no significant association.</p><p><strong>Conclusions: </strong>Nearly one-third of individuals with NELP lack awareness of their right to medical interpretation. Factors such as recent immigration, poor health, and limited health care contact are significant barriers. In addition to system and policy level changes, interventions targeting these vulnerable groups are needed to improve health equity and empower patients to use interpreter services.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"249-255"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910011","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":"Fighting to Eliminate Burnout: A 3-Decade Journey and the Path Forward.","authors":"Mark Linzer","doi":"10.1097/MLR.0000000000002120","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002120","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 3","pages":"183-184"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414670","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":"Trends in Obesity Care Among US Adults, 2010-2021.","authors":"Meghan I Podolsky, Rafeya Raquib, Katherine Hempstead, Andrew C Stokes","doi":"10.1097/MLR.0000000000002113","DOIUrl":"10.1097/MLR.0000000000002113","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a major contributor to mortality in the United States. Clinical guidelines emphasize the need for multimodal treatment, but novel treatments may be changing care-seeking behavior.</p><p><strong>Objective: </strong>To characterize obesity treatment access patterns and factors associated with obesity care from 2010 to 2021 in the United States.</p><p><strong>Research design: </strong>This multiyear cross-sectional study was conducted using Medical Expenditure Panel Survey data, covering respondents from 2010 to 2021.</p><p><strong>Subjects: </strong>We defined individuals with a body mass index ≥30 or those with any health care event linked to a diagnosis of obesity as being clinically eligible for obesity treatment.</p><p><strong>Measures: </strong>The primary outcome was the proportion of individuals assumed eligible for obesity treatment who accessed obesity treatment or were prescribed medication to treat obesity in each calendar year from 2010 to 2021.</p><p><strong>Results: </strong>The population of individuals eligible for obesity treatment was 82,729. In total, 1311 (1.6%) reported receiving treatment for obesity. The proportion of participants receiving a prescription for obesity increased from 0.3% (0.2%, 0.6%) in 2010 to 1.8% (1.3%, 2.5%) in 2021. Multivariable logistic regression found that female individuals, older individuals, and those with higher levels of education had higher odds of accessing obesity medication or any obesity treatment.</p><p><strong>Conclusions: </strong>Utilization of pharmaceutical and nonpharmaceutical obesity treatment has increased from 2010 to 2021 but remains low. The likelihood of receiving treatment was lower for groups with lower socioeconomic status. As more effective obesity therapies become available, efforts should be made to ensure equitable access.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"234-240"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008180","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":"Using Z Codes to Document Social Risk Factors in the Electronic Health Record: A Scoping Review.","authors":"Kelley M Baker, Mary A Hill, Debora G Goldberg, Panagiota Kitsantas, Kristen E Miller, Kelly M Smith, Alicia Hong","doi":"10.1097/MLR.0000000000002101","DOIUrl":"10.1097/MLR.0000000000002101","url":null,"abstract":"<p><strong>Introduction: </strong>Individual-level social risk factors have a significant impact on health. Social risks can be documented in the electronic health record using ICD-10 diagnosis codes (the \"Z codes\"). This study aims to summarize the literature on using Z codes to document social risks.</p><p><strong>Methods: </strong>A scoping review was conducted using the PubMed, Medline, CINAHL, and Web of Science databases for papers published before June 2024. Studies were included if they were published in English in peer-reviewed journals and reported a Z code utilization rate with data from the United States.</p><p><strong>Results: </strong>Thirty-two articles were included in the review. In studies based on patient-level data, patient counts ranged from 558 patients to 204 million, and the Z code utilization rate ranged from 0.4% to 17.6%, with a median of 1.2%. In studies that examined encounter-level data, sample sizes ranged from 19,000 to 2.1 billion encounters, and the Z code utilization rate ranged from 0.1% to 3.7%, with a median of 1.4%. The most reported Z codes were Z59 (housing and economic circumstances), Z63 (primary support group), and Z62 (upbringing). Patients with Z codes were more likely to be younger, male, non-White, seeking care in an urban teaching facility, and have higher health care costs and utilizations.</p><p><strong>Discussion: </strong>The use of Z codes to document social risks is low. However, the research interest in Z codes is growing, and a better understanding of Z code use is beneficial for developing strategies to increase social risk documentation, with the goal of improving health outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"211-221"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682230","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":"Medicare Accountable Care Organization Treatment of Serious Mental Illness: Associations Between Behavioral Health Integration Activities and Outcomes.","authors":"Helen Newton, Carrie H Colla, Susan H Busch, Marisa Tomaino, Brianna Hardy, Mary F Brunette, Devang Agravat, Ellen Meara","doi":"10.1097/MLR.0000000000002102","DOIUrl":"10.1097/MLR.0000000000002102","url":null,"abstract":"<p><strong>Objective: </strong>Characterize the association between Medicare Accountable Care Organizations' (ACOs) behavioral health integration capability and quality and utilization among adults with serious mental illness (SMI).</p><p><strong>Background: </strong>Controlled research supports the efficacy of integrating physical and mental health care for adults with SMI, yet little is known about the organizations integrating care and associations between integration capability and quality.</p><p><strong>Methods: </strong>We surveyed Medicare ACOs (2017-2018 National Survey of ACOs, response rate 69%) and linked responses to 2016-2017 fee-for-service Medicare claims for beneficiaries with SMI. We examined the cross-sectional association between ACO-reported integration capability (tertiles of a 14-item index) and 7 patient-level quality and utilization outcomes. We fit generalized linear models for each outcome as a function of ACO integration capability, adjusting for ACO and beneficiary characteristics.</p><p><strong>Results: </strong>Study sample included 274,928 beneficiary years (199,910 unique beneficiaries) attributed to 265 Medicare ACOs. ACOs with high behavioral health integration capability (top-tertile) served more dual-eligible beneficiaries (67.8%) than bottom-tertile (63.7%) and middle-tertile ACOs (63.3%). Most beneficiaries received follow-up 30 days after mental health hospitalization and chronic disease monitoring-exceeding national quality benchmarks-but beneficiaries receiving care from top-tertile (vs bottom-tertile) ACOs were modestly less likely to receive follow-up [-2.17 percentage points (pp), P < 0.05], diabetes monitoring (-2.19 pp, P < 0.05), and cardiovascular disease monitoring (-6.07 pp, P < 0.05). Integration capability was not correlated with utilization.</p><p><strong>Conclusions: </strong>ACOs serving adults with substantial physical and mental health needs were more likely to report comprehensive integration capability but were not yet meeting the primary care needs of many adults with SMI.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"123-132"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770425","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":"Rural-Urban Disparities in Mobile Health Application Ownership and Utilization Among Cancer Survivors.","authors":"Asos Mahmood, Aram Mahmood, Satish Kedia, Cyril F Chang","doi":"10.1097/MLR.0000000000002092","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002092","url":null,"abstract":"<p><strong>Objective: </strong>Mobile health applications (mHealth apps) can provide health care and health-promoting information while contributing to improving cancer survivors' quality of life and health outcomes. However, little is known about the rural-urban distribution of mHealth app ownership and utilization. In this study, we explore the characteristics of cancer survivors who own and use mHealth apps and examine rural-urban disparities in mHealth app ownership and utilization among cancer survivors.</p><p><strong>Methods: </strong>We utilized data from the \"Health Information National Trends Survey-Surveillance, Epidemiology, and End Results\" pilot study, fielded among cancer survivors from 3 U.S. cancer registries (Iowa, New Mexico, and California) in 2021. Our sample included 942 cancer survivors who reported owning a smart device (a smartphone and/or a tablet computer). The analyses included computing weighted proportions and fitting a multivariable regression model.</p><p><strong>Results: </strong>Overall, 60.3% of cancer survivors reported using mHealth apps, and 16.9% resided in rural areas. Approximately 45.0% of rural cancer survivors reported utilizing mHealth apps (vs 63.5% of urban survivors). Regression analysis revealed that rural cancer survivors had 46.0% lower odds of owning and using mHealth apps compared with their urban counterparts (adjusted odds ratio = 0.54; 95% CI: 0.36, 0.80).</p><p><strong>Conclusions: </strong>Rural cancer survivors were less likely to own and use mHealth apps compared with urban survivors. Rural cancer survivors usually face structural and health care system-related barriers to health care access and affordability. Leveraging mHealth technology as a tool could potentially contribute to improving health care delivery for rural cancer survivors, and help address existing structural and informational barriers to access.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 2","pages":"111-116"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951290","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 Policy and Hepatitis C Treatment Among Rural People Who Use Drugs.","authors":"Thomas J Stopka, Bridget M Whitney, David de Gijsel, Daniel L Brook, Peter D Friedmann, Lynn E Taylor, Judith Feinberg, April M Young, Donna M Evon, Megan Herink, Ryan Westergaard, Ruth Koepke, Jennifer R Havens, William A Zule, Joseph A Delaney, Mai T Pho","doi":"10.1097/MLR.0000000000002095","DOIUrl":"10.1097/MLR.0000000000002095","url":null,"abstract":"<p><strong>Background: </strong>Restrictive Medicaid policies regarding hepatitis C virus (HCV) treatment may exacerbate rural health care disparities for people who use drugs (PWUD). We assessed associations between Medicaid restrictions and HCV treatment among rural PWUD.</p><p><strong>Methods: </strong>We compiled state-specific Medicaid treatment policies across 8 US rural sites in 10 states and merged these with participant survey data. We hypothesized that local restrictions regarding prescriber type, sobriety, and fibrosis estimates were associated with HCV treatment outcomes. We conducted a cross-sectional, ecological analysis of treatment restrictions and HCV treatment outcomes using bivariate analyses to characterize differences between PWUD who initiated HCV treatment and unadjusted logistic regressions to assess associations between restrictions and treatment.</p><p><strong>Results: </strong>Among 944 participants, 111 (12%) reported receiving HCV treatment. Participants receiving treatment were older [median age (interquartile range): 42 (34-53) vs. 35 (29-42), P<0.001], more likely to receive disability support (32% vs. 20%, P=0.002), and less likely to be Medicaid-insured (57% vs. 71%, P < 0.001). More PWUD in states without any restrictions reported receiving treatment (17% vs. 11%, P=0.08) and achieving HCV cure/clearance (42% vs. 30%, P=0.01) than in states with restrictions. Restrictions were associated with lower odds of receiving HCV treatment (odds ratio=0.61, 95% CI: 0.35-1.06, P=0.08). Sensitivity analyses showed a similar association with HCV cure/clearance (odds ratio=0.60, 95% CI: 0.40-0.91, P=0.02).</p><p><strong>Conclusions: </strong>We identified significant unadjusted associations between Medicaid restrictions and receipt of HCV treatment and cure, which has substantial implications for health outcomes among rural PWUD. Lifting remaining Medicaid restrictions will be critical to achieving HCV elimination.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 2","pages":"77-88"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951288","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":"Audio-Based Care for Managing Chronic Conditions in Adults: A Systematic Review.","authors":"Jordan A Albritton, Graham Booth, Shannon Kugley, Shivani Reddy, Manny Coker-Schwimmer, Miku Fujita, Karen Crotty","doi":"10.1097/MLR.0000000000002097","DOIUrl":"10.1097/MLR.0000000000002097","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of consensus on the effectiveness of audio-based care to manage chronic conditions. This knowledge gap has implications for health policy decisions and for health equity, as underserved populations are more likely to access care by telephone.</p><p><strong>Objectives: </strong>We compared the effectiveness of audio-based care to usual care for managing chronic conditions (except diabetes).</p><p><strong>Design: </strong>We used systematic review methods to synthesize available evidence.</p><p><strong>Studies: </strong>We searched for English-language articles reporting on randomized controlled trials (RCTs) of adults diagnosed with a chronic condition published since 2012.</p><p><strong>Outcomes: </strong>We abstracted data on clinical outcomes, patient-reported health and quality of life, health care access and utilization, care quality and experience, and patient safety.</p><p><strong>Results: </strong>We included 40 RCTs evaluating audio-based care for a variety of chronic conditions, including cancer, heart failure, neurological disease, respiratory disease, musculoskeletal conditions, kidney disease, and others. There was significant heterogeneity across conditions and interventions. We generally found low to very low certainty of evidence of comparable effectiveness in the use of audio-based care to replace other care. Audio care as a supplement exhibited greater effectiveness in some outcomes, with generally low to very low certainty of evidence for most outcomes but moderate certainty for 2 groups of study outcomes.</p><p><strong>Conclusions: </strong>More research is needed to identify the conditions, populations, and intervention design combinations that improve outcomes and to determine when audio-based care can effectively replace other synchronous care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 2","pages":"164-182"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951247","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":"Outcomes of Community-Acquired Acute Kidney Injury: A Cohort Study of US Veterans.","authors":"Virginia Wang, Lindsay Zepel, Valerie A Smith, Maurice A Brookhart, Christopher B Bowling, Matthew L Maciejewski, Clarissa J Diamantidis","doi":"10.1097/MLR.0000000000002093","DOIUrl":"10.1097/MLR.0000000000002093","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired acute kidney injury (CA-AKI) occurs outside of the hospital and is the most common form of AKI. CA-AKI is not well understood, which hinders efforts to prevent, identify, and manage CA-AKI.</p><p><strong>Objective: </strong>Examine 30-day outcomes following CA-AKI using national administrative and lab data from the Veterans Health Administration (VA).</p><p><strong>Research design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>VA primary care patients with recorded outpatient serum creatinine (SCr) with observed CA-AKI (cases) and a standardized mortality ratio propensity-weighted 5% comparator sample without observed CA-AKI in 2013-2017.</p><p><strong>Measures: </strong>CA-AKI was defined as a ≥1.5-fold relative increase in outpatient SCr or inpatient SCr (≤24 h from admission) from a reference outpatient SCr ≤12 months prior. Outcomes were 30-day mortality and hospitalization and were assessed in separate weighted Cox regression models.</p><p><strong>Results: </strong>Among 220,777 CA-AKI events and 492,539 comparators without observed CA-AKI, CA-AKI was associated with a higher risk of 30-day all-cause mortality [hazard ratio (HR)=4.17, 95% CI: 3.74, 4.63] and hospitalization (HR=1.82, 95% CI: 1.74, 1.90) versus comparator. Risks increased with severity (mortality HR=3.02, 7.67, and 12.22 for AKI stages 1-3, respectively). Outpatient CA-AKI was associated with a high risk of mortality (HR=2.04, 95% CI: 1.83, 2.28) and even higher for inpatient CA-AKI, present [≤24 h from admission (HR=11.32, 95% CI: 10.16, 12.61)].</p><p><strong>Conclusions: </strong>In a national cohort of Veterans, CA-AKI was associated with a 2-fold increased risk of hospitalization and a 3-11-fold risk of mortality. Improving identification and management is critical to mitigate adverse outcomes of CA-AKI.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"98-105"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623620","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}