Medical Care最新文献

{"title":"Evaluating Dynamic Trends in Veteran Enrollment and Health Care Utilization in the Veterans Health Administration From 2018 to 2021.","authors":"Jacqueline M Ferguson, Ray Van Cleve, Abby Mulcahy, Thomas F Osborne","doi":"10.1097/MLR.0000000000002143","DOIUrl":"10.1097/MLR.0000000000002143","url":null,"abstract":"<p><strong>Background: </strong>The impact of the COVID-19 pandemic on Veteran enrollment and health care utilization within the United States Veterans Health Administration (VHA) remains uncertain.</p><p><strong>Objective: </strong>To evaluate drivers of enrollment and utilization of health care services at VHA with an emphasis on differences before and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We included 14,107,785 Veterans from the US Veterans Eligibility Trends and Statistics (USVETS) FY2017-2021 annual datasets in a repeat cross-sectional design. We assessed the adjusted incidence of VHA enrollment, and the probability of utilizing VHA health care by fiscal year among social determinants of health, including number of children, attained education, income, marital status, household size, and rurality of residence.</p><p><strong>Results: </strong>Contrary to prepandemic years, Veterans with adverse or negative social determinants of health that can lead to poor health (eg, lower income and lower attained education) were less likely than other groups to enroll in FY2021. However, among those enrolled, the probability of using VHA health care service increased by (1%-2%) in FY2021 across all social determinants of health. The largest increases in the probability of VHA health care use were among Veterans with higher income, higher education, and those living in urban areas.</p><p><strong>Conclusions: </strong>Veterans with adverse social determinants of health, that could lead to poor health, showed decreased VHA enrollment during FY2021. During the same time period, the largest utilization increases occurred among Veterans facing fewer adverse social determinants of health, highlighting nuanced socioeconomic dynamics and need for dedicated programs to ensure equitable care and access during significant societal disruptions.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 6","pages":"436-442"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068996","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":"Effects of the COVID-19 Pandemic on New Physician Job Market Outcomes.","authors":"Tarun Ramesh, David Armstrong, Gaetano J Forte, Marcela Horvitz-Lennon, Fang Zhang, Hao Yu","doi":"10.1097/MLR.0000000000002137","DOIUrl":"10.1097/MLR.0000000000002137","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the pandemic's impacts on new physician job market outcomes.</p><p><strong>Design: </strong>We conducted a retrospective, repeated cross-sectional analysis using an interrupted time series approach on graduating residents and fellows from New York. We estimated linear probability models to examine binary outcomes and a generalized estimating equations model to analyze the base salary (measured in 2022 dollars). Each model included the following covariates: sex, age, race/ethnicity, educational debt, primary care specialty, international medical graduate status, and citizenship. We also conducted stratification analyses.</p><p><strong>Setting: </strong>Annual data from the 2010 to 2022 Survey of Residents Completing Training in New York.</p><p><strong>Participants: </strong>In all, 31,925 graduating residents and fellows, with 16,612 accepting a job offer to enter the workforce as new physicians, participated in the study.</p><p><strong>Interventions: </strong>COVID-19.</p><p><strong>Results: </strong>Graduating residents and fellows had a 1.58% (95% confidence interval (CI), 0.000, 0.031) increase (86.60% vs. 88.18%) in their likelihood of receiving any job offers, but a 11.64% (95% CI, -0.139, -0.095) decrease (55.77% vs. 44.13%) in reporting a good job market outlook without a significant change in accepting a job offer from pre-pandemic to during the pandemic. New physicians experienced reductions in likelihood of entering rural practice(3.4% vs. 0.62% with a change of -3.38%, 95% CI, -0.046, -0.022), base salary ($288,257 vs. $264,687 with a change of -$23,569, 95% CI, -$28,703, -$18,435), likelihood of receiving additional job-related incentives (69.18% vs. 66.26% with a change of -2.92%, 95% CI,-0.054, -0.0043), and salary satisfaction (86.46% vs. 84.05% with a change of -2.4%, 95% CI, -0.005, -0.043) compared with the pre-pandemic trend.</p><p><strong>Conclusions: </strong>The pandemic significantly reduced new physicians' likelihood of entering rural practice and compensation, disproportionately affecting new primary care physicians. Such reductions may have adverse impacts on health care access, especially in rural areas.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"413-421"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605493","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":"A Spatial Epidemiologic Analysis of Opioid Use Disorder Treatment in New York State.","authors":"Ashly E Jordan, Weihui Zhang, Sarah Gorry, Andrew Heck, Constance Burke, Chinazo O Cunningham","doi":"10.1097/MLR.0000000000002142","DOIUrl":"10.1097/MLR.0000000000002142","url":null,"abstract":"<p><strong>Background: </strong>Opioid agonist treatments (OAT; methadone and buprenorphine) for opioid use disorder (OUD) reduce overdose death by more than 50%. Low population-level rates of OAT are missed opportunities to reduce OUD-related mortality.</p><p><strong>Objective: </strong>We examined county-level OAT utilization patterns to guide state-level and county-level initiatives to improve equitable access and utilization in New York State (NYS).</p><p><strong>Research design: </strong>We calculated NYS county-level methadone and buprenorphine population utilization rates per 100,000 residents by county of patient residence using NYS Office of Addiction Services and Supports and public access datasets.</p><p><strong>Measures: </strong>We mapped rates onto counties and conducted analyses to assess if utilization varied by county, and to identify areas of high utilization (hot spots) and low utilization (cold spots). We used t tests and Fisher exact tests to compare county-level factors.</p><p><strong>Results: </strong>County-level buprenorphine and methadone utilization rates were 673.76 and 132.19 per 100,000 residents, respectively. Buprenorphine hot spot counties had significantly lower proportions of unemployed (-1.4, P- value<0.01), and higher proportions of non-Hispanic white residents (+50.1, P value<0.01) than counties identified as buprenorphine cold spots. Methadone hot spot counties had significantly higher proportions of unemployed (+1.0, P- value<0.01) and lower proportions of non-Hispanic white residents (-48.1, P- value<0.01) than counties identified as methadonecold spots. All buprenorphine cold spot counties were methadone hot spot counties.</p><p><strong>Conclusions: </strong>We found that OAT utilization rates differed by race/ethnicity and socioeconomic factors at the county level consistent with national and other state-level findings. Ensuring equitable OAT access must be part of a coordinated response to address the overdose crisis.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"386-392"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605489","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":"Updated Adjustment of the HCAHPS Survey for New Modes of Survey Administration and Patient Mix.","authors":"Marc N Elliott, Megan K Beckett, Katrin Hambarsoomian, Julie Brown, Paul Cleary, William G Lehrman, Elizabeth Goldstein, Laura A Giordano, Layla Parast","doi":"10.1097/MLR.0000000000002127","DOIUrl":"10.1097/MLR.0000000000002127","url":null,"abstract":"<p><strong>Background: </strong>Web-first multimode survey protocols increase Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response rates and representativeness but may result in different HCAHPS scores because of survey mode effects and selective email address availability. A variable absent from many patient-mix adjustment models that may result in more positive patient experiences is whether the hospital admission was planned; adjustment for planned stays may better measure hospital performance.</p><p><strong>Objectives: </strong>Develop adjustments for new Web-first survey protocols and planned admissions to facilitate comparisons across hospitals.</p><p><strong>Research design: </strong>Using 2021 survey mode experiment data, we estimate survey protocol effects in linear models predicting HCAHPS top-box outcomes from protocol indicators (which incorporate email availability for Web-first protocols), patient-mix adjustors, and hospital intercepts. We evaluate the unique effect on scores of whether a stay was planned.</p><p><strong>Results: </strong>Phone-only and Web-Phone without email produce more positive responses than Mail-only, requiring negative adjustments. All other survey protocol effects and adjustments are mixed in direction and generally small. Planned stays are associated with more positive experiences for otherwise similar patients and make a unique contribution beyond other current patient-mix adjustment variables.</p><p><strong>Conclusions: </strong>It is important to adjust HCAHPS scores for survey protocol effects to ensure fair comparisons across hospitals and to enable hospitals to choose the survey protocol that best represents their patients. Incomplete email address availability necessitates that HCAHPS survey protocol adjustment control for email address availability when a Web-first protocol is used. Accounting for differences associated with planned stays may improve patient-mix adjustment.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"358-365"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Disease and Future Perceptions of Financial Control: Results From the Midlife in the United States Cohort Study.","authors":"Victoria H Davis, Guanghao Zhang, Minal R Patel","doi":"10.1097/MLR.0000000000002126","DOIUrl":"10.1097/MLR.0000000000002126","url":null,"abstract":"<p><strong>Objective: </strong>Rising health care costs and chronic disease prevalence have increased concerns about health-related financial burden. This study examined how baseline chronic disease burden was associated with subsequent perceptions of financial control ∼9 years later.</p><p><strong>Methods: </strong>Data came from the Midlife in the United States (MIDUS) cohort, with MIDUS 1 and 2 used as baseline predictors for future perceived financial control outcomes at MIDUS 3. Adjusted mixed effect models examined the relationship between baseline chronic disease burden on 4 variables representing future perceptions of financial control.</p><p><strong>Results: </strong>A total of 3297 participants [mean (SD) age: 54 (11.36) y] were included. Greater chronic disease burden and medication use at baseline were associated with a higher likelihood of inadequate resources [adjusted odds ratio (AOR) = 1.22; 95% CI: 1.07-1.38; P = 0.001 and AOR = 1.29; 95% CI: 1.13-1.46; P = 0.001, respectively]. Having more chronic conditions predicted reduced feelings of financial control (AOR=0.85; 95% CI, 0.78-0.93; P <0.001) and a more pessimistic financial outlook (AOR = 0.87; 95% CI: 0.79-0.97; P < 0.01). Higher baseline cholesterol levels showed mixed associations: better perception of current finances (AOR = 1.36; 95% CI: 1.22-1.51; P =0.001) but reduced sense of financial control (AOR = 0.86; 95% CI: 0.78-0.95; P < 0.001) and more negative financial outlook (AOR = 0.69; 95% CI: 0.62-0.77; P < 0.001). No baseline factors predicted bill payment capability.</p><p><strong>Conclusion: </strong>The findings suggest a need for additional strategies to reduce the financial burden of chronic diseases.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"353-357"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080541","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 Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States.","authors":"Sarah Bessen, Wuyang Zhang, Frank R Lin, Emmanuel E Garcia Morales, Nicholas S Reed","doi":"10.1097/MLR.0000000000002133","DOIUrl":"10.1097/MLR.0000000000002133","url":null,"abstract":"<p><strong>Background: </strong>Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes.</p><p><strong>Objectives: </strong>To investigate the associations between self-recognition of hearing loss and hospitalization outcomes.</p><p><strong>Research design and subjects: </strong>This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study.</p><p><strong>Exposures and outcomes: </strong>The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss.</p><p><strong>Results: </strong>Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss.</p><p><strong>Conclusions: </strong>In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"379-385"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024022","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 Social Support in Bridging the Digital Divide for Older Veterans.","authors":"Josephine C Jacobs, Liberty Greene, Sonya SooHoo, Cindie Slightam, Kritee Gujral, Donna M Zulman","doi":"10.1097/MLR.0000000000002131","DOIUrl":"10.1097/MLR.0000000000002131","url":null,"abstract":"<p><strong>Background: </strong>For nearly a decade, the US Veterans Health Administration (VA) has distributed tablets to Veterans with access barriers who may benefit from video telehealth visits. Older Veterans' lower likelihood of tablet use relative to younger Veterans has prompted interest in factors influencing tablet utilization.</p><p><strong>Objectives: </strong>We examined whether social support facilitates video telehealth utilization among older Veterans who received VA tablets.</p><p><strong>Research design: </strong>We performed a cross-sectional analysis of electronic health record-linked survey data. We used multivariable logistic regression to examine the relationship between social support and telehealth use, controlling for predisposing, enabling, and health factors.</p><p><strong>Subjects: </strong>Veterans aged ≥65 who received a VA-issued tablet and responded to a national survey (September 2021 to January 2022) (n=859).</p><p><strong>Measures: </strong>The outcome measure was any VA video telehealth use in the 6 months post-tablet receipt. Social support measures included tangible support, living with others, and marital status.</p><p><strong>Results: </strong>Fewer than two-thirds of respondents (62.4%) had a video visit in the 6 months post-tablet receipt. In all, 32.2% of respondents noted that the absence of family or friends to help with video visits hindered their use of video telehealth. In multivariable analyses, greater tangible social support was associated with 54.1% (95% CI: 10.1%-116.2%) higher odds of having a video visit.</p><p><strong>Conclusions: </strong>Older adults who receive technological devices to engage in video telehealth benefit from tangible social support from family and friends. Assessing and addressing patients' social and environmental circumstances may help optimize digital divide interventions and ensure that older adults are not excluded from telehealth-related access gains.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"374-378"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066483","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":"Managed Care in Mental Health Care: How Do We Know When Cost Savings Is Cost-Effective?","authors":"Jennifer L Humensky, Michael C Freed, Agnes Rupp, Rachel Smith, Patricia A Areán","doi":"10.1097/MLR.0000000000002146","DOIUrl":"10.1097/MLR.0000000000002146","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"334-337"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657630","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":"Leveraging Electronic Health Record Data to Identify Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Veteran Participants in the Pride in All Who Served Program.","authors":"Guneet K Jasuja, Joel I Reisman, Christina Jefferson, Robert B Hall, Raymond G Van Cleve, Teddy Bishop, Heather A Sperry, Michelle C Wilcox, A M Racila, Michelle M Hilgeman","doi":"10.1097/MLR.0000000000002132","DOIUrl":"10.1097/MLR.0000000000002132","url":null,"abstract":"<p><strong>Background: </strong>Pride in All Who Served (PRIDE) is an intervention in the Veterans Health Administration (VHA) focused on enhancing Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) veterans' access to affirmative care services, social support, and engagement with VHA. Evaluation of PRIDE to date has focused on self-report data, missing critical opportunities to examine the impact of this program on health outcomes and utilization indicators detectable in the electronic health record (EHR).</p><p><strong>Objective: </strong>This study is the first to: (1) comprehensively identify a sample of LGBTQ+ veterans who attended PRIDE; and (2) describe the sample demographics, health conditions, and health care utilization.</p><p><strong>Research design: </strong>A retrospective cross-sectional study was conducted using EHR data and staff-reported PRIDE information (eg, site name, facilitator names, dates of delivery). PRIDE-related keywords and chart reviews were used to validate participation and determine the final sample.</p><p><strong>Subjects: </strong>We identified 588 PRIDE participants at 34 VHA sites from 2016 to 2022.</p><p><strong>Measures: </strong>Demographics (eg, age), health conditions (eg, depression), and health care utilization (eg, mental/behavioral health care visits).</p><p><strong>Results: </strong>Nearly half of the PRIDE participants (47%) were women, 75% were transgender and gender diverse, and 37% identified as lesbian or gay. A high proportion of the sample had stress-related health conditions, including depression (63%), hypertension (22%), and posttraumatic stress disorder (48%).</p><p><strong>Conclusions: </strong>PRIDE serves a disproportionate number of women and transgender and gender diverse veterans compared with general VHA users. In the absence of standardized EHR fields, time-intensive methods are required to leverage EHRs to evaluate programs addressing health equity for LGBTQ+ people.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"366-373"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605503","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":"Learning Health Systems Research: Continued Progress and Ongoing Challenges.","authors":"Rebecca L Tisdale, Urmimala Sarkar","doi":"10.1097/MLR.0000000000002121","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002121","url":null,"abstract":"<p><strong>Background: </strong>Learning health systems research (LHSR) builds on concepts of systems-based participatory research to form a new paradigm for partnered research.</p><p><strong>Objective: </strong>Defines LHSR and its ongoing challenges and future directions.</p><p><strong>Research design: </strong>Qualitative description of relevant dimensions of LHSR.</p><p><strong>Results: </strong>In LHSR, researchers and health system stakeholders co-create research with dual aims of producing internal quality improvement and generalizable, disseminable knowledge. This approach aligns research priorities with community and health system needs, resulting in interventions that are both feasible and acceptable in real-world settings and effective. LHSR methods and outcomes reflect elements of implementation science, particularly participatory implementation science and the use of mixed methods, but the field is distinct in its emphasis on co-creation with health system leaders and the use of theory to inform rather than drive the work. Practitioners of LHSR face challenges related to the complex and multi-stakeholder nature of the field, including the time-intensive nature of building partnerships, conflicting project time horizons, imprecision inherent in real-world data, and barriers to publication of the smaller studies that typically result from LHSR.</p><p><strong>Conclusions: </strong>Continued advancement of the field requires confronting these challenges with a variety of interventions, including explicit institutional support and incentives for this type of work, training and career development opportunities, a diversity of funding sources, investment in data resources and expertise, and inclusive research governance structures.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 5","pages":"331-333"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803680","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}