American Journal of Managed Care最新文献_第8页

Physician preferences for an electronic lung cancer screening decision aid. 医生对电子肺癌筛查决策辅助工具的偏好。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89551

Orly Morgan, Julie B Schnur, Michael A Diefenbach, Minal S Kale

{"title":"Physician preferences for an electronic lung cancer screening decision aid.","authors":"Orly Morgan, Julie B Schnur, Michael A Diefenbach, Minal S Kale","doi":"10.37765/ajmc.2024.89551","DOIUrl":"10.37765/ajmc.2024.89551","url":null,"abstract":"Objective: To present primary care physician (PCP) suggestions for design and implementation of a decision aid (DA) tool to support patient-provider shared decision-making on lung cancer screening (LCS).Study design: Semistructured interviews were conducted with 15 PCPs at an academic medical center.Methods: The deidentified transcripts were independently coded by 2 study interviewers and jointly reviewed every 5 interviews until we determined that data saturation had been achieved. We then identified themes in the data and selected illustrative quotes.Results: Three main themes were identified: (1) make it brief and familiar (make the tool user-friendly and implement a similar format to other widely used DAs); (2) bring me to automation station (limit busywork; focus on the patient and on the decision); and (3) involve the patient (facilitate patient involvement in the DA with simple language, visual aids, and bullet-point takeaways).Conclusions: Findings contain concrete suggestions by PCPs to inform usable and acceptable LCS DA tool design and implementation. For an LCS DA to be most successful, PCPs emphasized that the tool must be easy to use and incorporate autopopulation functions to limit redundant patient charting.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of the COVID-19 pandemic on regular emergency department users. COVID-19 大流行对急诊科常客的影响。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89540

Olesya Baker, Alison Galbraith, Ann Thomas, Robert F LeCates, J Frank Wharam

{"title":"Impact of the COVID-19 pandemic on regular emergency department users.","authors":"Olesya Baker, Alison Galbraith, Ann Thomas, Robert F LeCates, J Frank Wharam","doi":"10.37765/ajmc.2024.89540","DOIUrl":"10.37765/ajmc.2024.89540","url":null,"abstract":"Objectives: Regular users of the emergency department (ED) include both patients who could be better served in lower-acuity settings and those with high-severity conditions. ED use decreased during the COVID-19 pandemic, but patterns among regular ED users are unknown. To determine the impact of the COVID-19 pandemic on this population, we examined quarterly postpandemic ED utilization among prepandemic regular ED users. Key subgroups included prepandemic ED users with regular visits for (1) low-severity conditions and (2) high-severity conditions.Study design: An event study design with COVID-19 and historic controls cohorts.Methods: We identified 4710 regular ED users at baseline and followed their ED utilization for 7 quarters. We used a generalized estimating equations model to compare the relative quarterly percent difference in ED visit rates between the COVID-19 and historic controls cohorts.Results: The first postpandemic quarter was associated with the largest decline in ED visits, at -36.0% (95% CI, -42.0% to -29.3%) per regular ED user overall, -52.2% (95% CI, -69.4% to -25.3%) among high-severity users, and -29.6% (95% CI, -39.8% to -17.8%) among low-severity users. However, use did not statistically differ from expected levels after 5 quarters among all regular ED users, 1 quarter among high-severity users, and 3 quarters among regular low-severity users.Conclusions: Initial reductions among regular high-severity ED users raise concern for harm from delayed or missed care but did not result in increased high-severity visits later. Nonsustained declines among regular low-severity ED users suggest barriers to and opportunities for redirecting nonurgent ED use to lower-acuity settings.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Traditional Medicare supplemental insurance and the rise of Medicare Advantage. 传统的医疗保险补充保险和医疗保险优势的兴起。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89539

Jeffrey Marr, Daniel Polsky

{"title":"Traditional Medicare supplemental insurance and the rise of Medicare Advantage.","authors":"Jeffrey Marr, Daniel Polsky","doi":"10.37765/ajmc.2024.89539","DOIUrl":"10.37765/ajmc.2024.89539","url":null,"abstract":"Objectives: Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare (TM). We examined changes in Medicare supplemental insurance coverage in the context of MA growth.Study design: Repeated cross-sectional analysis of the Medicare Current Beneficiary Survey from 2005 to 2019.Methods: We determined whether Medicare beneficiaries 65 years and older were enrolled in MA (without Medicaid), TM without supplemental coverage, TM with employer-sponsored supplemental coverage, TM with Medigap, or Medicaid (in TM or MA).Results: From 2005 to 2019, beneficiaries with TM and supplemental insurance provided by their former (or current) employer declined by approximately half (31.8% to 15.5%) while the share in MA (without Medicaid) more than doubled (13.4% to 35.1%). The decline in supplemental employer-sponsored insurance use was greater for White and for higher-income beneficiaries. Over the same period, beneficiaries in TM without supplemental coverage declined by more than a quarter (13.9% to 10.1%). This decline was largest for Black, Hispanic, and lower-income beneficiaries.Conclusions: The rapid rise in MA enrollment from 2005 to 2019 was accompanied by substantial changes in supplemental insurance with TM. Our results emphasize the interconnectedness of different insurance choices made by Medicare beneficiaries.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Digital musculoskeletal program is associated with decreased joint replacement rates. 数字化肌肉骨骼计划与降低关节置换率有关。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-04-01 DOI: 10.37765/ajmc.2024.89463

Louie Lu, Laura S Gold, Karl M Koenig, Jonathan H Lee, Grace Wang

{"title":"Digital musculoskeletal program is associated with decreased joint replacement rates.","authors":"Louie Lu, Laura S Gold, Karl M Koenig, Jonathan H Lee, Grace Wang","doi":"10.37765/ajmc.2024.89463","DOIUrl":"10.37765/ajmc.2024.89463","url":null,"abstract":"Objectives: To compare 12-month total knee arthroplasty (TKA) and total hip arthroplasty (THA) rates for digital musculoskeletal (MSK) program members vs patients who received traditional care for knee or hip osteoarthritis (OA).Study design: Retrospective, longitudinal study with propensity score-matched comparison group that used commercial medical claims data representing more than 100 million commercially insured lives.Methods: Study participants with hip OA (M16.x) or knee OA (M17.x) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were identified in the medical claims database. Digital MSK program members were identified using record linkage tokens. The comparison group had hip- or knee-related physical therapy identified via ICD-10-CM and Current Procedural Terminology codes. Respectively in each knee and hip OA group, digital members were matched to control group patients with similar demographics, comorbidities, and baseline MSK-related medical care use. TKA and THA at 12 months post participation were compared.Results: In the knee OA group, 739 of 56,634 control group patients were matched to 739 digital members. At 12 months, 3.79% of digital members and 14.21% of control group patients had TKA (difference, 10.42%; P < .001). In the hip OA group, 141 of 20,819 control group patients were matched to 141 digital members. At 12 months, 16.31% of digital members and 32.62% of control group patients had THA (difference, 16.31%; P = .001).Conclusions: These findings suggest that patients who participated in a digital MSK program to manage OA have lower rates of total joint arthroplasty in the 12 months after enrollment.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Safety vs price in the generic drug market: metformin. 仿制药市场的安全性与价格：二甲双胍。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-04-01 DOI: 10.37765/ajmc.2024.89450

Ben Teasdale, Amber Hudspeth, Kaury Kucera, David Light, Jill Nailor, Shannon Williams, Arnold Milstein, Kevin A Schulman

{"title":"Safety vs price in the generic drug market: metformin.","authors":"Ben Teasdale, Amber Hudspeth, Kaury Kucera, David Light, Jill Nailor, Shannon Williams, Arnold Milstein, Kevin A Schulman","doi":"10.37765/ajmc.2024.89450","DOIUrl":"10.37765/ajmc.2024.89450","url":null,"abstract":"Objectives: Generic medications represent 90% of prescriptions in the US market and provide a tremendous financial benefit for patients. Recently, multiple generic drugs have been recalled due to the presence of carcinogens, predominantly N-nitrosodimethylamine (NDMA), including an extensive recall of extended-release (ER) metformin products in 2020.Study design: Primary pharmaceutical quality testing and database analysis.Methods: We tested marketed metformin immediate-release (IR) and ER tablets from a wide sample of generic manufacturers for the presence of carcinogenic impurities NDMA and N,N-dimethylformamide (DMF). We examined the association of level of impurity with drug price and the impact of the 2020 FDA recalls on unit price and prescription fill rate.Results: Postrecall NDMA levels were significantly lower in metformin ER samples (standardized mean difference = -2.0; P = .01); however, we found continued presence of carcinogens above the FDA threshold in 2 of 30 IR samples (6.67%). Overall, the presence of contaminant levels was not significantly associated with price for either IR (NDMA: R2 = 0.142; P = .981; DMF: R2 = 0.382; P = .436) or ER (NDMA: R2 = 0.124; P = .142; DMF: R2 = 0.199; P = .073) samples. Despite recalls, metformin ER prescription fills increased by 8.9% while unit price decreased by 19.61% (P < .05).Conclusions: Recalls of metformin ER medications were effective in lowering NDMA levels below the FDA threshold; however, some samples of generic metformin still contained carcinogens even after FDA-announced recalls. The absence of any correlation with price indicates that potentially safer products are available on the market for the same price as poorer-quality products.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors associated with primary care physician turnover in the VA. 退伍军人事务部初级保健医生流失的相关因素。

IF 3.2 4区医学

American Journal of Managed Care Pub Date : 2024-03-21

Leah M Marcotte, Charles Maynard, Ashok Reddy, Seppo T Rinne, Ryan Sterling, Peter J Kaboli, Edwin S Wong

{"title":"Factors associated with primary care physician turnover in the VA.","authors":"Leah M Marcotte, Charles Maynard, Ashok Reddy, Seppo T Rinne, Ryan Sterling, Peter J Kaboli, Edwin S Wong","doi":"","DOIUrl":"","url":null,"abstract":"Objectives: To quantify the association between primary care team workload satisfaction and primary care physician (PCP) turnover and examine potential mediation of workplace climate factors using survey and administrative data. Study Design: Longitudinal observational study using data from 2008 to 2016. Methods: The outcome variable was PCP turnover. The main explanatory variable was satisfaction with amount of workload. We included 7 additional workplace climate measures (eg, satisfaction with direct supervision) as mediators. We included characteristics of PCPs (eg, PCP years of experience, gender), salary, and clinic factors (eg, urban vs rural geography, community vs hospital based) as covariates. Results: US Department of Veterans Affairs (VA) PCPs working at 787 VA primary care clinics nationally were recruited for this study. Over the 9-year study period, 8362 unique PCPs were employed in the VA. The unadjusted mean quarterly turnover rate was 1.83%, and the mean (SD) workload satisfaction score was 3.58 ( 0.24) on a 5-point Likert scale over the study period. In adjusted analysis, a 1-point increase in workload satisfaction was associated with a decrease of 0.73 (95% CI, 0.36-1.10) percentage points in the probability of turnover in a calendar quarter. In the mediation analysis, we found that workload satisfaction impacted turnover through only 1 of the 7 workplace climate measures: satisfaction with direction by senior managers. Conclusions: Our study findings highlight the key role that achieving primary care workload satisfaction can play in reducing PCP turnover. Identification of direction by senior managers as an underlying mechanism is an important finding for strategic planning to mitigate PCP turnover.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inappropriate wrist MRI: did guidelines have an impact? 不恰当的腕部磁共振成像：指南有影响吗？

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-03-01 DOI: 10.37765/ajmc.2024.89517

Trista M Benítez, Meghan N Cichocki, Weijia Jin, Anne V Seyferth, Lu Wang, Kevin C Chung, Erika D Sears

{"title":"Inappropriate wrist MRI: did guidelines have an impact?","authors":"Trista M Benítez, Meghan N Cichocki, Weijia Jin, Anne V Seyferth, Lu Wang, Kevin C Chung, Erika D Sears","doi":"10.37765/ajmc.2024.89517","DOIUrl":"10.37765/ajmc.2024.89517","url":null,"abstract":"Objectives: To assess the national prevalence and cost of inappropriate MRI in patients with wrist pain prior to and following American College of Radiology (ACR) guideline publication.Study design: We used administrative claims from the IBM MarketScan Research Databases to evaluate the appropriateness of wrist MRI in a national cohort of patients with commercial insurance or Medicare Advantage.Methods: Adult patients with a diagnosis of wrist pain between 2016 and 2019 were included and followed for 1 year. We made assessments of appropriateness based on ACR guidelines for specific wrist pain etiologies. We tabulated the total costs and out-of-pocket expenses associated with inappropriate MRI studies using weighted mean payments for facility and professional fees. We performed segmented logistic regression on interrupted time series data to identify predictors of receiving inappropriate imaging and the impact of guideline publication on MRI use.Results: The study cohort consisted of 867,119 individuals. Of these, 40,164 individuals (4.6%) had MRI, of whom 52.6% received an inappropriate study. Inappropriate studies accounted for $44,493,234 in total payments and $8,307,540 in out-of-pocket expenses. The interrupted time series found an approximately 1% monthly decrease in the odds of receiving an inappropriate study after guideline dissemination.Conclusions: MRI as a diagnostic tool for wrist pain is often inappropriate and expensive. Our findings support interventions to increase guideline adherence, such as integrated clinical decision support tools.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

At-home hemoglobin A1c testing during COVID-19 improved glycemic control. COVID-19 期间的居家血红蛋白 A1c 检测改善了血糖控制。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-03-01 DOI: 10.37765/ajmc.2024.89449

Lauren C LaMonica, Jingwei Ren, Nina Jain, Eli S Goldberg, Kyu B Rhee, Paige Wickner, Sreekanth K Chaguturu

{"title":"At-home hemoglobin A1c testing during COVID-19 improved glycemic control.","authors":"Lauren C LaMonica, Jingwei Ren, Nina Jain, Eli S Goldberg, Kyu B Rhee, Paige Wickner, Sreekanth K Chaguturu","doi":"10.37765/ajmc.2024.89449","DOIUrl":"10.37765/ajmc.2024.89449","url":null,"abstract":"Objectives: COVID-19 has exacerbated barriers to routine testing for chronic disease management. This study investigates whether a home hemoglobin A1c (HbA1c) test kit intervention increases frequency of HbA1c testing and leads to changes in HbA1c 6 months post testing and whether self-reinforcement education improves maintenance of HbA1c testing.Study design: Retrospective analysis of a randomized, controlled quality improvement intervention among members with type 2 diabetes (T2D) in a large commercial health plan.Methods: Participants were 41,214 commercial fully insured members with T2D without an HbA1c test in the past 6 months or with only 1 HbA1c test in the last 12 months. Members were randomly assigned to either a control group or an at-home HbA1c testing intervention group consisting of either an opt-in test or a direct-to-member opt-out HbA1c test kit shipment. A third cohort of members was assigned to a self-reinforcement group to encourage continued testing twice per year. Main outcomes were HbA1c testing rates and HbA1c levels (in %).Results: A total of 11.1% (508 of 4590) at-home HbA1c kits were completed. At-home HbA1c test kits increased testing rates by 4.9% compared with controls (P < .001). Members with an HbA1c level of at least 7% who requested and completed at-home HbA1c testing had a 0.38% reduction in HbA1c in the 6 months post intervention when controlling for baseline HbA1c (P < .001). Members who received self-reinforcement messaging had a 0.37% HbA1c reduction post intervention (P = .015).Conclusions: This novel, at-home approach to test HbA1c is an effective intervention to increase testing rates and facilitate HbA1c reduction over time in patients with T2D.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Out-of-pocket costs for diabetes medications in employer-sponsored health insurance plans. 雇主资助的医疗保险计划中糖尿病药物的自付费用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-03-01 DOI: 10.37765/ajmc.2024.89510

Jennie Quach, Cody Midlam, Chantell Sell, Jeff Levin-Scherz

引用次数: 0

Evaluation of a collaborative model between managed care and affordable housing on acute care costs. 管理式医疗与经济适用房合作模式对急症护理成本的评估。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-03-01 DOI: 10.37765/ajmc.2024.89514

Jack Tsai, Suja Rajan, Chau Truong, Vanessa Schick, Cecilia Ganduglia Cazaban

{"title":"Evaluation of a collaborative model between managed care and affordable housing on acute care costs.","authors":"Jack Tsai, Suja Rajan, Chau Truong, Vanessa Schick, Cecilia Ganduglia Cazaban","doi":"10.37765/ajmc.2024.89514","DOIUrl":"10.37765/ajmc.2024.89514","url":null,"abstract":"Objectives: This study evaluated a collaborative service model between the largest Medicaid managed care organization (MCO) in Texas, Superior HealthPlan, and the affordable housing provider Prospera Housing Community Services.Study design: Using a quasi-experimental 2-groups research design, we compared health care outcomes and costs between a sample of 104 participants served by the Prospera+Superior collaborative model and a group of 104 participants who had health care coverage through the Superior HealthPlan Medicaid MCO but did not live at Prospera properties (ie, Superior-only group).Methods: Data from medical claims were analyzed to examine change in outcomes 12 months before and after implementation of the Prospera+Superior collaborative model in 2019.Results: The Prospera+Superior group had a 56% lower rate of emergency department/urgent care visits and spent $2061 less in prescription costs than the Superior-only group after implementation.Conclusions: These findings provide needed evidence of the clinical and economic value of forming multisector collaborative models between MCOs and other community providers.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0