Medical Care最新文献

{"title":"Developing and Validating Models to Predict Suboptimal Early Glycemic Control Among Individuals With Younger Onset Type 2 Diabetes.","authors":"Anjali Gopalan, Christine A Board, Stacey E Alexeeff, Joshua R Nugent, Pranita Mishra, Andrew J Karter, Richard W Grant","doi":"10.1097/MLR.0000000000002164","DOIUrl":"10.1097/MLR.0000000000002164","url":null,"abstract":"<p><strong>Objective: </strong>Younger age at the time of type 2 diabetes onset increases individuals' future complication risk. Proactively identifying younger-onset individuals at increased risk of not achieving early glycemic goals can support targeted initial care.</p><p><strong>Design and methods: </strong>Individuals (ages 21-44) newly diagnosed with type 2 diabetes were identified and randomly assigned to training (70%) and validation (30%) datasets. Least absolute shrinkage and selection operator regression models were specified to identify key predictors (assessed at diagnosis) of suboptimal glycemic control (HbA1c≥8%) within 1 year after diagnosis using the training dataset. The full model included 48 candidate predictors. We also developed additional more streamlined models using more widely available predictors (transferable model), a smaller number of available predictors (simplified transferable model), and a bivariate model with HbA1c as the sole predictor (HbA1c-only model). Model-based predicted risk scores were used to stratify individuals in the validation dataset.</p><p><strong>Results: </strong>The cohort included 10,879 individuals. All of the models, including the HbA1c-only model, performed comparably. All had good discrimination (C-statistics ranging from 0.71 to 0.73) in the validation dataset.</p><p><strong>Conclusions: </strong>When predicting the risk of not achieving glycemic goals, the HbA1c-only model had comparable performance to the more complex prediction models. This simple risk stratification requires no computation and could be implemented simply by looking at the diagnosis HbA1c value. This practical approach can be used to identify newly diagnosed younger adults who may need extra attention during the critical early period after diagnosis.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"614-623"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110781","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":"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":"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":2.8,"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":2.8,"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}

{"title":"Estimating Primary Care Spending in the United States: Toward a Common Method.","authors":"Chunliu Zhan, Lingrui Liu, Matthew Simpson","doi":"10.1097/MLR.0000000000002155","DOIUrl":"10.1097/MLR.0000000000002155","url":null,"abstract":"<p><strong>Background: </strong>The lack of common definition and methods, coupled with the scarcity of suitable data sources, have impeded efforts to track primary care spending in the United States.</p><p><strong>Objectives: </strong>Explore consistent approaches to estimating primary care spending.</p><p><strong>Research design: </strong>A recently developed framework for primary care services was applied to 2 datasets: the Medical Expenditure Panel Survey (MEPS), a survey of noninstitutionalized individuals and their families in the United States, and MarketScan, a database containing health insurance claims of employees and their dependents for a selection of major US companies, to estimate primary care spending per-person-per-year (PPPY) and as percentage of total health care spending (PTHS) covering 2010-2021. Cross-sectional and trend analyses were conducted, and key methodological issues were explored.</p><p><strong>Results: </strong>In 2019, average primary care spending was $504 PPPY (95% CI: $469-$539), accounting for 8.07% PTHS (95% CI: 7.56%-8.58%), based on MEPS, and $378 PPPY (95% CI: $377-$379), accounting for 6.30% PTHS (95% CI: 6.28%-6.32%), based on MarketScan. There were steady increases between 2010 and 2021 in PPPY primary care spending (from $309 to $639 based on MEPS and from $343 to $433 based on MarketScan), but small fluctuations in PHTS primary care spending (between 6% and 9%). Misalignments between the definitions and the data were identified, and standard errors for the estimates were calculated.</p><p><strong>Conclusions: </strong>With explicit definitions, transparent methodologies and appropriate quantification of estimation uncertainty, comparable and reproducible estimates can be obtained to assess and track primary care spending in the United States.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"514-519"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110814","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":"Changes in Reimbursed Acupuncture Therapy Amidst the COVID-19 Pandemic: A Cross-Sectional Analysis.","authors":"Molly Candon, Jeffery A Dusek, Arya Nielsen","doi":"10.1097/MLR.0000000000002153","DOIUrl":"10.1097/MLR.0000000000002153","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic induced a shift to telemedicine, which may have disproportionately affected in-person treatments such as acupuncture therapy.</p><p><strong>Objectives: </strong>We measured trends in reimbursed acupuncture between 2018 and 2021. We also measured trends in other types of pain care among patients with low back pain (LBP), which was the most common diagnosis for acupuncture.</p><p><strong>Research design: </strong>A descriptive, retrospective, and claims-based analysis.</p><p><strong>Subjects: </strong>The sample included any patient who used their insurance to pay for acupuncture, which was defined using Current Procedural Technology (CPT) codes 97810, 97811, 97813, and 97814. In secondary analysis, the sample included only patients with LBP, which were identified using the International Classification of Diseases, 10th Edition code of M54.5.</p><p><strong>Measures: </strong>We tracked reimbursed acupuncture and patient and provider characteristics associated with reimbursed acupuncture. Among patients with LBP, trends in acupuncture were compared with trends in chiropractic care, physical therapy, psychotherapy, as well as prescription fills for gabapentinoids, muscle relaxants, and opioids.</p><p><strong>Results: </strong>After increasing between 2018 and 2019, there was a 28% decline in the number of patients receiving reimbursed acupuncture between 2019 and 2020. Although acupuncture use increased between 2020 and 2021, it did not reach pre-COVID-19 levels. Acupuncturists comprised a smaller share of providers who billed insurance for acupuncture while the share of providers who identified as rehabilitation specialists increased. Among patients with LBP, use of acupuncture fell more during COVID-19 compared with other types of pain care.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic had a disproportionate impact on acupuncture therapy, which may be driven by a reduction in acupuncturists who billed insurance. Future research should assess the long-term impact of COVID-19 on acupuncture use in the United States.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 7","pages":"500-506"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12333544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789532","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":"Potentially Inappropriate Medication Use Among Patients With Dementia in Traditional Medicare and Medicare Advantage.","authors":"Eli Raver, Jeah Jung, Caroline Carlin, Roger Feldman, Sheldon M Retchin, Wendy Xu","doi":"10.1097/MLR.0000000000002160","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002160","url":null,"abstract":"<p><strong>Background: </strong>Older adults with dementia are susceptible to receiving potentially inappropriate medications (PIMs), where the risks likely outweigh the benefits. Medicare advantage prescription drug plans (MA-PDs) cover both medical and prescription drug benefits, creating a financial incentive to reduce PIM use and unnecessary health care costs from adverse drug events, whereas standalone Medicare prescription drug plans (PDPs) used by traditional Medicare beneficiaries are only responsible for outpatient prescription drug costs.</p><p><strong>Objective: </strong>The objective is to compare the use of PIMs between PDP and MA-PD enrollees with dementia.</p><p><strong>Methods: </strong>Using 2016-2019 Medicare claims and encounter data, we estimated the associations between Medicare enrollment type and PIM use: (1) potentially harmful drug-disease interactions in older adults with dementia; (2) potentially harmful drug-disease interactions in older adults with dementia and a history of falls; and (3) high-risk medication use in older adults.</p><p><strong>Results: </strong>MA-PD enrollees had significantly lower utilization of PIMs than standalone PDP enrollees: a 0.7 percentage-point [95% CI: 0.5, 0.8] lower prevalence of potentially harmful drug-disease interactions in older adults with dementia; a 3.1 percentage-point [2.6, 3.5] lower prevalence of potentially harmful drug-disease interactions in older adults with dementia and a history of falls; and a 0.5 percentage-point [0.4, 0.6] lower prevalence of high-risk medications in older adults.</p><p><strong>Conclusions: </strong>MA-PD enrollees with dementia experienced consistently lower prevalence of PIM use than those in PDP. As Medicare advantage enrollment continues to grow, it will be increasingly important to identify and leverage the features of MA-PD plans that promote safe medication prescribing for Medicare beneficiaries with dementia.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 7","pages":"495-499"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789534","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":"Differences in Initiation and Receipt of Home Health Care: Traditional Medicare Versus Medicare Advantage.","authors":"Amanda C Chen, Daniel Spertus, Christina X Fu, Madeline R Sterling, David C Grabowski","doi":"10.1097/MLR.0000000000002150","DOIUrl":"10.1097/MLR.0000000000002150","url":null,"abstract":"<p><strong>Background: </strong>Because Traditional Medicare (TM) and Medicare Advantage (MA) have different reimbursement structures and incentives, it is important to understand differences in home health agency (HHA) use by payer type.</p><p><strong>Objective: </strong>To quantify differences in care patterns and outcomes between TM and MA HHA users.</p><p><strong>Research design and subjects: </strong>Medicare HHA claims were used to identify postacute HHA episodes among US adults aged 65 and older enrolled in MA or TM (2015-2019). Adjusted regression models with and without HHA fixed effects assessed whether TM and MA beneficiaries are treated differently within an HHA.</p><p><strong>Measures: </strong>We examined process (timely initiation of care, receipt of a skilled nursing visit, and length of stay) and quality measures (hospital readmission and healthy days at home).</p><p><strong>Results: </strong>The study included 4,029,527 beneficiaries (3,034,452 TM and 995,075 MA). We identified large differences in the share of beneficiaries experiencing timely initiation of care (81.4% TM vs. 77.4% MA) and receipt of skilled nursing visits (86.8% TM vs. 81.9% MA). After including HHA fixed effects in the regression model, MA beneficiaries were 2.1 percentage points (pp) less likely to experience timely initiation of care and were 3.1 pp less likely to receive a skilled nursing visit (and 8.9 pp less likely to receive any type of skilled visit) within 2 days of starting HHA care compared with TM beneficiaries ( P <0.001).</p><p><strong>Conclusions: </strong>Our findings suggest differential treatment between MA and TM beneficiaries within the same HHA. Further research is needed to understand the mechanisms driving these within-agency differences.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"487-494"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016374","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":"Threads of Care: Unraveling the Impact of Agency Nursing Staff on Nursing Home Quality.","authors":"Rohit Pradhan, Akbar Ghiasi, Ganisher Davlyatov, Shivani Gupta, Robert Weech-Maldonado","doi":"10.1097/MLR.0000000000002114","DOIUrl":"10.1097/MLR.0000000000002114","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of agency nursing staff utilization with nursing home (NH) quality.</p><p><strong>Background: </strong>Nursing staff are the primary caregivers in NHs, where high-quality care is contingent upon their adequacy and expertise. Long-standing staffing challenges, exacerbated by the COVID-19 pandemic, have led NHs to rely on agency/contract labor to alleviate staffing shortages.</p><p><strong>Methods: </strong>This study used the following secondary datasets: Payroll-Based Journal, Care Compare: 5-Star Quality Rating System, LTCFocus.org, Area Health Resource Files, and Rural-Urban Commuting Area codes for 2017-2022. Multivariable ordinal logistic regression with 2-way (facility and year-level) fixed effects was employed. The study included all Centers for Medicare and Medicaid Services certified U.S. NHs. Analytic data comprised 80,244 facilities, averaging 13,374 unique NHs per year. The study focused on the quality star rating (1-5 scale) from the 5-Star Quality Rating System as the dependent variable. Independent variables included the proportion of agency nursing staff hours per resident day for registered nurses, licensed practical nurses, and certified nursing assistants while controlling for facility and community characteristics that may affect NH quality.</p><p><strong>Results: </strong>A 10% increase in agency registered nurses, licensed practical nurses, and certified nursing assistants (logged) was associated with a decrease in the odds of achieving a higher star rating by 4%, 5%, and 4%, respectively ( P < 0.001).</p><p><strong>Conclusions: </strong>The use of agency nursing staff can negatively impact NH quality. Efforts to better integrate agency nursing staff into NHs, combined with strategies to recruit and retain permanent nursing staff, could lead to improved outcomes for residents.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"479-486"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910014","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":"\"Sleep Is Not Getting the Attention It Deserves\": A Qualitative Study of Patient and Provider Views on Sleep Management in the Veterans Health Administration.","authors":"Allison E Gaffey, Kristin M Mattocks, Henry K Yaggi, Valerie Marteeny, Lorrie Walker, Cynthia A Brandt, Sally G Haskell, Lori A Bastian, Matthew M Burg","doi":"10.1097/MLR.0000000000002152","DOIUrl":"10.1097/MLR.0000000000002152","url":null,"abstract":"<p><strong>Background: </strong>Unique characteristics and service exposures of the post-9/11 cohort of U.S. Veterans can influence their sleep health and associated comorbidities. The objectives of this study were to learn about men and women post-9/11 Veterans' and \"front line\" VA providers' knowledge about sleep and experiences with Veterans Health Administration (VA) sleep management.</p><p><strong>Research design: </strong>One sample included post-9/11 Veterans who received VA care (n=23; 60% women; Mage: 45 y). To complement those views, primary care and mental health providers were recruited from VA medical centers (n=27). Semistructured qualitative interviews were conducted using Microsoft Teams. Questions pertained to sleep knowledge, care practices, and perceived barriers to sleep-related VA care. Interview data were synthesized with content analysis and inductive coding to characterize major themes.</p><p><strong>Results: </strong>Four main themes emerged: (1) Sleep is viewed as foundational but Veterans and providers often have limited related knowledge and more routine education is needed. (2) Men and women have distinct sleep management needs. Relative to men, women are more likely to advocate for sleep assessment and for behavioral versus pharmacological treatment. (3) Sleep management practices vary considerably between clinics and providers. (4) Veterans and their providers each experience unique barriers to sleep management.</p><p><strong>Conclusions: </strong>Post-9/11 Veterans and providers view sleep as critical. Yet, VA sleep management needs to be more uniform. Providers are motivated to assess sleep but require standardized education and low-burden opportunities to incorporate sleep into their practice, perhaps with mental health screening. Ultimately, more specialized care is required to meet the responsibility of Veterans' sleep health.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"472-478"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032020","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}