Medical Care最新文献

{"title":"Comparing Logistic Regression and Artificial Neural Network Models for Analyzing Medicare Utilization and Costs Among Older Adults.","authors":"Jie Chen, Seyeon Jang, Min Qi Wang","doi":"10.1097/MLR.0000000000002305","DOIUrl":"10.1097/MLR.0000000000002305","url":null,"abstract":"<p><strong>Background: </strong>Artificial neural networks (ANNs) are increasingly applied in health care outcome prediction, yet their relative benefits compared with traditional methods in health services research remain unclear.</p><p><strong>Objective: </strong>To examine health care utilization and costs among community-dwelling older adults using the Andersen Behavioral Model, and to compare the performance of logistic regression and ANN models.</p><p><strong>Research design: </strong>Cross-sectional study utilizing linked data from CMS Medicare fee-for-service (FFS) claims and Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys (2018-2022). The sample included 254,748 Medicare beneficiaries aged 65 and older. Outcomes were high Medicare costs (top 25%), 30-day readmissions, and preventable hospitalizations (PQIs). Predictors included socioeconomic factors, chronic conditions, and patient-reported measures. Model performance was assessed using the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Brier scores.</p><p><strong>Results: </strong>Chronic conditions, including heart disease and depression, significantly predicted higher Medicare costs. Poor self-rated health, functional limitations, dual eligibility, and lower educational attainment correlated strongly with readmissions and preventable hospitalizations. ANN and logistic regression models demonstrated comparable performance across outcomes, with similar AUC, sensitivity, specificity, PPV, NPV, and Brier scores.</p><p><strong>Conclusions: </strong>Both logistic regression and ANN models effectively predict health care utilization and high-risk outcomes among older adults using structured Medicare data. Logistic regression offers interpretability and robust predictive power, whereas ANN models may provide additional value as healthcare datasets grow increasingly complex and comprehensive.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"344-352"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13166062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344597","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":"Consistent Enrollment in a Health Care Coverage Program Is Associated With Fewer Type 2 Diabetes-Related Emergency Department Visits for Uninsured Immigrants.","authors":"Annie E Ro, Mariela Villalba Madrid, Alein Haro Ramos, Sarah Axeen, Anna Gorman, Luohua Jiang, Dylan Roby, Todd Schneberk","doi":"10.1097/MLR.0000000000002323","DOIUrl":"10.1097/MLR.0000000000002323","url":null,"abstract":"<p><strong>Background: </strong>Undocumented immigrants face significant barriers maintaining regular health care, which could lead to emergency department (ED) visits for chronic diseases such as type 2 diabetes (T2D). Local health coverage programs like MyHealthLA (MHLA) in Los Angeles County can improve disease management by providing regular access to care. This study examines the relationship between enrollment patterns in MHLA and ED utilization for T2D-related conditions, focusing on how the duration of enrollment impacts the likelihood of ED visits.</p><p><strong>Research design: </strong>We analyzed 115,690 ED encounters from 44,333 MHLA patients in the Los Angeles Department of Health Service (LADHS) between 2016 and 2020. There were 5 categories based on enrollment 12 months before the ED encounter: (1) continuously enrolled ≥6 months, (2) newly enrolled for <6 months, (3) consistently unenrolled for ≥6 months, (4) newly unenrolled <6 months, and (5) never enrolled, who visited the ED before ever enrolling in MHLA.</p><p><strong>Results: </strong>Patients continuously enrolled in MHLA were less likely to visit the ED for short-term T2D complications, suggesting that consistent primary care helps manage chronic conditions and reduce ED use. Conversely, patients newly enrolled or unenrolled had higher odds of T2D-related ED visits, indicating that enrollment lapses may worsen disease management.</p><p><strong>Conclusions: </strong>These findings highlight the importance of continuous access to primary care and the potential benefits of Medicaid expansion for undocumented adults in California. Health systems should prioritize continuity of care to improve chronic disease management and reduce avoidable ED visits in underserved populations.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"64 6","pages":"381-386"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874617","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":"Defining and Measuring Delays in Postacute Care: Toward a Standardized Definition of Rehabilitation Access.","authors":"Sanghun Nam, Chih-Ying Li, Md Ibrahim Tahashilder, Yong-Fang Kuo, Timothy A Reistetter","doi":"10.1097/MLR.0000000000002318","DOIUrl":"10.1097/MLR.0000000000002318","url":null,"abstract":"<p><strong>Background: </strong>Studying delays in postacute care (PAC) rehabilitation using Medicare data is challenging due to the absence of a standardized definition of PAC access timeframes across rehabilitation provider types.</p><p><strong>Methods: </strong>We used 100% Medicare claims data for beneficiaries aged 66 and older discharged to PAC with one of 8 common medical conditions. PAC initiation was examined for inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). Daily utilization curves were generated for each PAC setting. Joinpoint regression identified the time points where the rate of PAC initiation changed significantly, based on 2019 data. These joinpoints mark thresholds beyond which fewer patients accessed PAC at a slower pace and were used to define delayed access for each setting. We evaluated the stability of joinpoints using 2018 data.</p><p><strong>Results: </strong>Among over 8.9 million hospitalizations, IRFs and SNFs showed a consistent joinpoint at day 2 postdischarge. In contrast, HHA access increased more gradually, with a joinpoint at day 12.</p><p><strong>Conclusions: </strong>Patients typically access facility-based PAC (IRF and SNF) within 2 days, whereas initiation of home-based PAC (HHA) occurs around 12 days. These findings on the joinpoint provide empirical evidence to define PAC delay for each setting. However, it also indicates a systemic gap in defining timely postacute transitions, underscoring the need for standardizing the lengths of accessing postacute services with empirical evidence.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"396-402"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574662","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":"Does Anesthesia Provider Type Affect Veteran Satisfaction With Care?","authors":"Shyam Sundar Sah, Abhishek Kumbhalwar","doi":"10.1097/MLR.0000000000002310","DOIUrl":"10.1097/MLR.0000000000002310","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"411"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434216","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":"Assessing the Utility of a Population Segmentation Tool to Determine Medical Vulnerability Among Adults Experiencing Homelessness.","authors":"Connor Drake, Abigail Rader, Erica Langan, Julia Gamble, David Matchar, Rakhi Vashishtha, Daniel Hatch, Alex Cho, Donna J Biederman","doi":"10.1097/MLR.0000000000002312","DOIUrl":"10.1097/MLR.0000000000002312","url":null,"abstract":"<p><strong>Background: </strong>Patients experiencing homelessness (PEH) have intersecting medical, social, and behavioral needs. To meet their needs, promising medical respite and integrated care models have been developed. The use of validated population segmentation screening tools is paramount for equitable triage and tailored service delivery. The Simple Segmentation Tool (SST), consisting of global impression categories (GI) and complicating factors (CFs), was developed to identify health and social service needs for whole-person care planning but has not been used to assess medical vulnerability among PEH.</p><p><strong>Objective: </strong>Evaluate the association between SST scores and medical vulnerability among PEH.</p><p><strong>Design: </strong>Retrospective cohort study conducted between November 2018 and November 2020 of a medical respite program using electronic health record (EHR) data.</p><p><strong>Participants: </strong>PEH referred to a transitional care program in the southeastern United States.</p><p><strong>Main measures: </strong>We describe GI categories and CFs as the independent variables of interest and report their unadjusted and adjusted relationship using a Poisson regression modeling approach with outcomes of interest including bed days, emergency department (ED) visits, inpatient and observation admissions, and Elixhauser comorbidity index score after adjusting for demographic characteristics.</p><p><strong>Results: </strong>Among 267 adults (mean age 51.2, 72% African American, 70.8% male), in an adjusted model, the presence of CFs was associated with a higher number of hospital stays, ED visits, and inpatient admissions. GI scores were associated with higher rates of bed days, ED visits, and Elixhauser conditions but lower observation admissions.</p><p><strong>Conclusion: </strong>SST scores were associated with utilization patterns and comorbidity burden after adjusting for age, gender, and race among an adult population experiencing homelessness. These findings suggest that the SST may be a preferable assessment than existing triage tools to objectively capture medical vulnerability and support care planning.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"361-367"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530456","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":"Award Winning Manuscripts From the American Public Health Association 2024.","authors":"Linda D Green, Katherine S Virgo","doi":"10.1097/MLR.0000000000002303","DOIUrl":"10.1097/MLR.0000000000002303","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"64 5","pages":"258-259"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627080","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":"Validating ICD-10 Algorithms for Identifying Patient Safety Indicators Through 10,655 Charts Review.","authors":"Guosong Wu, Jie Pan, Danielle A Southern, Cheligeer Cheligeer, Yuan Xu, Cathy A Eastwood, Hude Quan","doi":"10.1097/MLR.0000000000002300","DOIUrl":"10.1097/MLR.0000000000002300","url":null,"abstract":"<p><strong>Background: </strong>Patient Safety Indicators (PSIs) derived from administrative data are widely used for monitoring and improving hospital care quality. However, the validity of ICD-10-based PSI algorithms remains uncertain, particularly in terms of their sensitivity and specificity.</p><p><strong>Objectives: </strong>To evaluate the diagnostic performance of ICD-10-CA-based algorithms for identifying fifteen PSIs using chart review as the reference standard.</p><p><strong>Research design: </strong>Multicenter retrospective cohort validation study.</p><p><strong>Subjects: </strong>A random sample of 10,665 adult patients admitted to 4 acute care hospitals in Calgary, Alberta, between January 1, 2017, and March 31, 2022.</p><p><strong>Measures: </strong>Fifteen PSIs were identified using ICD-10-CA codes and validated against detailed chart reviews. Diagnostic performance was measured using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Analyses were stratified by diagnosis code type and relevant patient characteristics.</p><p><strong>Results: </strong>Among 10,665 patients, 1688 had at least one PSI confirmed by chart review. ICD-10-CA coding detected any PSI with 67.0% sensitivity (95% CI, 64.7%-69.2%), 72.8% specificity (95% CI, 71.8%-73.7%), 31.6% PPV (95% CI, 30.1%-33.1%), 92.2% NPV (95% CI, 91.5%-92.8%), and 71.8% accuracy (95% CI, 71.0%-72.7%). Restricting PSIs to conditions that occurred after admission (limited diagnosis type II code) improved specificity (95.7%; 95% CI, 95.3%-96.1%) and PPV (56.5%; 95% CI, 53.2%-59.7%) but reduced sensitivity (29.6%; 95% CI, 27.4%-31.8%). Validity varied by PSI and patient characteristics, with higher sensitivity and PPV among older adults, males, and those with greater comorbidity, longer hospital and ICU stays, 30-day readmission, or in-hospital death.</p><p><strong>Conclusions: </strong>ICD-10 coded administrative data demonstrate high specificity and NPV but varied sensitivity and PPV in identifying PSIs. Restricting to type II codes improves PPV but reduces sensitivity. Tailoring coding strategies to specific surveillance or quality improvement goals is critical.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"310-317"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284367","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":"In Memory of Dr Julie M. Zito (1943-2025): Scientist, Advocate, Mentor, Colleague.","authors":"Jeroan J Allison, Catarina I Kiefe","doi":"10.1097/MLR.0000000000002304","DOIUrl":"10.1097/MLR.0000000000002304","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"64 5","pages":"257"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627036","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 Qualitative Study of the Implementation of Referral Coordination for Specialty Care Referrals in the Veterans Health Administration.","authors":"Anna Zogas, Varsha G Vimalananda, Megan B McCullough, Amy M Linsky, Leslie J Chatelain, Kristin M Mattocks","doi":"10.1097/MLR.0000000000002297","DOIUrl":"10.1097/MLR.0000000000002297","url":null,"abstract":"<p><strong>Background: </strong>Veteran enrollees of the Veterans Health Administration (VA) have increasing options for where and how to access health care, including within VA in person or virtually and through VA-purchased community care. To promote Veterans' informed choice and streamline access to appointments, VA initiated referral coordination, which entails clinical review and conversations with Veterans before scheduling all specialty care referrals.</p><p><strong>Objective: </strong>Identify how VA facilities implemented referral coordination and local contextual factors influencing the implementation.</p><p><strong>Research design: </strong>Qualitative formative evaluation, using process maps to compare implementation approaches by hospital system and thematic analysis to identify contextual influences on implementation.</p><p><strong>Subjects: </strong>Between March and August 2022, we interviewed VA referral coordinators (n=27) for acupuncture, cardiology, endocrinology, and hematology/oncology at 8 VA hospital systems in a geographic region with urban and rural settings.</p><p><strong>Results: </strong>We identified 2 implementation approaches for referral coordination. Three facilities added clinical review to employees' existing responsibilities (\"expanders\"), and 5 created new roles dedicated to referral coordination (\"creators\"). \"Expander\" facilities relied minimally on VA-purchased care and received little implementation support from local leadership. \"Creator\" facilities relied heavily on VA-purchased care and local leadership was actively involved in implementation. The effort employees dedicated to referral coordination tasks varied according to other demands on their time.</p><p><strong>Conclusions: </strong>This work provides an empirically grounded way to identify different implementation approaches (ie, expanders and creators), which we conceptualize as a framework for interpreting the outcomes of referral coordination on waiting times, utilization of different types of care, and Veterans' experiences seeking care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"326-334"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481047","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":"Long-Term Impact of Medicaid Expansion on Not-for-Profit Hospital Community Benefit Spending in the Southern United States.","authors":"Shelby Olin, Kelsey Owsley, Charles Stoecker, Tatiane Santos","doi":"10.1097/MLR.0000000000002250","DOIUrl":"10.1097/MLR.0000000000002250","url":null,"abstract":"<p><strong>Objective: </strong>To examine the long-term impact of Medicaid expansion on not-for-profit (NFP) hospital community benefit (CB) spending among hospitals located in Arkansas and Kentucky (9 y postexpansion), Louisiana (7 y postexpansion), and Alabama, Mississippi, Tennessee, and Texas (nonexpansion states).</p><p><strong>Background: </strong>To maintain tax-exemption status, NFP hospitals must provide CB, such as charity care and population health initiatives. In the short term, Medicaid expansion has led to decreased charity care and increased Medicaid shortfalls, but no change to other CB categories. Given these early findings and Medicaid expansion's impact on hospital finances, it is important to understand whether hospitals continued to adjust their CB spending.</p><p><strong>Methods: </strong>We used data on hospital CB spending (2011-2022), for NFP hospitals located in the West South Central and East South Central Census divisions. States that expanded Medicaid formed the treatment group (69 hospitals) and nonexpansion formed the control group (90 hospitals). We used staggered difference-in-differences and event study designs to examine changes in total CB, clinical, and population health spending as a share of operating expenses.</p><p><strong>Results: </strong>We found that Medicaid expansion was associated with a decrease in total CB spending by ∼$782,000 per hospital ( P =0.01). Clinical and population health spending decreased by ∼$759,000 ( P =0.01) and $92,000 per hospital ( P =0.009), respectively.</p><p><strong>Conclusion: </strong>Among southern hospitals, Medicaid expansion led to sustained long-term reductions in CB spending. Our findings suggest that states may need to implement CB laws to encourage hospitals to invest more in their communities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"260-267"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715042","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}