JAMA Health Forum最新文献

{"title":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.4961","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4961","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e244961"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Treatment of Maternal Substance Use Disorder in Child Welfare.","authors":"Ezra G Goldstein, Sarah A Font","doi":"10.1001/jamahealthforum.2025.0054","DOIUrl":"10.1001/jamahealthforum.2025.0054","url":null,"abstract":"<p><strong>Importance: </strong>Parental substance use is a primary driver of child welfare system involvement, and child welfare services primarily seek to address caregiver challenges, including connecting parents to treatment. Although research highlights that formal child welfare services connect children to health care professionals, less is known about how the system affects caregivers' substance use treatment.</p><p><strong>Objective: </strong>To examine the prevalence of maternal substance use disorder (SUD) in the Pennsylvania child welfare system and the association between formal child welfare system response and mothers' take-up of SUD treatment.</p><p><strong>Design, setting, and participants: </strong>This cohort study used linked Medicaid claims and child welfare system records for mothers enrolled in Medicaid and involved in the Pennsylvania child welfare system between 2015 and 2018, followed by 12 months postsystem contact. The study applied a difference-in-differences framework to estimate associations between child welfare system intervention and maternal SUD treatment utilization. Data were analyzed from January to September 2024.</p><p><strong>Exposure: </strong>Child welfare system intervention was defined in 3 categories: no formal services, in-home services, and foster care services.</p><p><strong>Main outcomes and measures: </strong>Maternal SUD was defined by International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis codes. Dependent variables were mothers' monthly and cumulative use of inpatient and outpatient SUD treatment, defined by procedure and service location codes.</p><p><strong>Results: </strong>Among 46 484 mothers, the prevalence of maternal SUD was estimated at 62% within the child welfare system population, predominantly involving opioid and polysubstance use. Compared with mothers who did not receive a formal child welfare system response, those who received a formal intervention had a statistically significant higher probability of monthly outpatient (in-home services: 24%; 95% CI, 18%-28%; foster care: 63%; 95% CI, 55%-75%) and inpatient (in-home services: 36%; 95% CI, 23%-48%; foster care: 130%; 95% CI, 103%-156%) SUD treatment in the 12 months after referral.</p><p><strong>Conclusions and relevance: </strong>This cohort study demonstrates that formal child welfare services can facilitate substance use treatment for caregivers. As states seek to reduce the role of formal child welfare system responses in responding to parental substance use, alternative strategies to engage and retain parents in treatment are needed.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250054"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calibrating AI Reliance-A Physician's Superhuman Dilemma.","authors":"Shefali V Patil, Christopher G Myers, Yemeng Lu-Myers","doi":"10.1001/jamahealthforum.2025.0106","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0106","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250106"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Characteristics of Adults Unable to Complete Medicaid Renewal During the Unwinding Period.","authors":"Aparna Soni, Justin Blackburn","doi":"10.1001/jamahealthforum.2025.0092","DOIUrl":"10.1001/jamahealthforum.2025.0092","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Medicaid redetermination affects millions of people annually in the US, but little is known about beneficiaries who lose coverage during the process. In early 2023, after the COVID-19 pandemic mandate to provide continuous coverage was lifted, states resumed redetermination of eligibility and disenrollment of individuals who were no longer eligible. Medicaid disenrollment rose rapidly during this unwinding period, yet little is known about the health and financial characteristics of individuals who were unable to complete the Medicaid renewal process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess levels of self-reported mental health, functional health, and financial security among current and former Medicaid enrollees during the Medicaid unwinding period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This repeated cross-sectional study used nationally representative survey data from multiple waves of the US Census Bureau Household Pulse Survey to assess the health and financial characteristics of 131 384 current and former working-age (19-64 years) Medicaid enrollees interviewed between January 2023 and September 2024. Estimated linear regression models were used to compare measures among current Medicaid enrollees, former enrollees who could not complete renewal (procedural disenrollees), and former enrollees who dropped Medicaid for other reasons (nonprocedural disenrollees). Analysis was performed in December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Medicaid enrollment status and likely reason for disenrolling (procedural vs nonprocedural).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The total sample comprised 131 384 current and former working-age Medicaid enrollees (mean [SD] age, 41.9 [12.5] years; 82 378 females [62.7%]; 22 467 Black [17.1%], 32 715 Hispanic/Latino [24.9%], 62 276 White [47.4%], and 13 927 individuals of other races or multiracial [10.6%]), more than half of whom were parents and of lower socioeconomic status. Compared with current Medicaid enrollees, procedural disenrollees were 3.3 percentage points (pp) more likely to report anxiety (95% CI, 1.6 to 4.9 pp); frequent worrying, 3.3 (95% CI, 1.8 to 4.8) pp; little interest in things, 2.4 (95% CI, 1.0 to 3.8) pp; depression, 2.5 (95% CI, 1.1 to 3.9) pp; food insecurity, 3.6 (95% CI, 2.6 to 4.7) pp; difficulty seeing, 2.0 (95% CI, 1.0 to 3.0) pp; difficulty hearing, 1.1 (95% CI, 0.4 to 1.8) pp; and difficulty remembering things, 1.4 (95% CI, 0.1 to 2.7) pp; however, they were 1.3 pp less likely to report difficulty with mobility (95% CI, -2.5 to -0.2 pp). There was no statistically significant difference between groups in difficulty with bathing and dressing or difficulty understanding things.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cross-sectional study found that adults who could not complete the Medicaid renewal process and were procedurally disenrolled during the unwinding period had higher mental health needs, worse functional","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250092"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safer Opioid Supply, Subsequent Drug Decriminalization, and Opioid Overdoses.","authors":"Hai V Nguyen, Shweta Mital, Shawn Bugden, Emma E McGinty","doi":"10.1001/jamahealthforum.2025.0101","DOIUrl":"10.1001/jamahealthforum.2025.0101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;British Columbia, Canada, was the first and only jurisdiction globally to implement a province-wide safer supply policy, which offered pharmaceutical grade opioids to individuals at risk of opioid overdose, followed by the decriminalization of drug possession. Supporters of the safer supply policy argue that this policy could save lives by offering pharmaceutical-grade opioids to people who use toxic street drugs. Similarly, proponents of decriminalization suggest that decriminalizing drug possession could reduce drug overdoses by reducing stigma associated with drug use and enabling persons who use drugs to seek addictions treatment. However, critics of both policies believe that providing safer opioids and removing penalties for drug possession may worsen the crisis. Currently, there is limited evidence on the health impacts of these policies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the association of British Columbia's adoption of the safer supply policy and subsequent decriminalization of drug possession with opioid overdose hospitalizations and deaths.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This observational cohort study used synthetic difference-in-differences analysis with quarterly province-level data to compare prepolicy and postpolicy changes in British Columbia with those in other Canadian provinces that did not implement these policies. The study period spanned from quarter 1 of 2016 to quarter 4 of 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Safer opioid supply policy implemented in March 2020 and decriminalization of drug possession implemented in January 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Opioid-poisoning hospitalizations and apparent opioid-related toxicity deaths, measured as number per 100 000 population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The safer supply policy alone was associated with an increase of 1.66 opioid hospitalizations per 100 000 population (95% CI, 0.41-2.92; P = .009) or 33%. The addition of drug possession decriminalization was associated with a further increase of 1.27 opioid hospitalizations per 100 000 population (95% CI, 0.05-2.50; P = .046) for an overall 58% increase compared with the period before the safer supply policy was in effect. There was insufficient evidence to conclusively attribute an increase in opioid overdose deaths to these policy changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cohort study found that neither the safer supply policy nor the subsequent decriminalization of drug possession appeared to alleviate the opioid crisis. Instead, both were associated with an increase in opioid overdose hospitalizations. The observed increase in opioid hospitalizations, without a corresponding increase in opioid deaths, may reflect greater willingness to seek medical assistance because decriminalization could reduce the stigma associated with drug use. However, it is also possible that reduced stigma and removal of c","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250101"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Transparency of Legal Measurement in Health Policy Evaluation-A Guide for Researchers, Reviewers, and Editors.","authors":"Benjamin A Barsky, Alina Schnake-Mahl, Cason D Schmit, Scott Burris","doi":"10.1001/jamahealthforum.2025.0067","DOIUrl":"10.1001/jamahealthforum.2025.0067","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250067"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whither Medicaid and Medicare at 60?","authors":"Stuart M Butler","doi":"10.1001/jamahealthforum.2025.1086","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1086","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e251086"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Newborn Screening for Sickle Cell Disease and Thalassemia.","authors":"Maa-Ohui Quarmyne, Fiona Bock, Sangeetha Lakshmanan, Brandon K Attell, Angela Snyder, Jeanne Boudreaux, Sujit Sheth, M A Bender, Ashutosh Lal","doi":"10.1001/jamahealthforum.2025.0064","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0064","url":null,"abstract":"<p><strong>Importance: </strong>Hemoglobin disorders are a considerable public health issue with more than 500 000 affected infants born annually worldwide. First introduced in the 1970s, newborn screening (NBS) for sickle cell disease (SCD) was included in the Recommended Uniform Screening Panel (RUSP) in 2006, a successful public health promotion and prevention practice that has led to improved childhood survival. Although SCD is the primary target, the screening process also detects many other hemoglobinopathies.</p><p><strong>Observations: </strong>NBS programs, administered by individual states, vary in their practices for hemoglobinopathy screening, creating health inequities and compromising public health efforts. There is a lack of uniformity in the choice of primary screening test, reporting, and follow-up of abnormal results, exacerbated by inconsistent access to genetic confirmation. Consequently, newborns diagnosed through protein-based screening alone may have diverse genotypes that alter the clinical expression of hemoglobinopathies. This Special Communication considers how the universal adoption of molecular testing for hemoglobinopathy newborn screening can overcome these current shortcomings. Simultaneously, the considerable challenges of primary screening with molecular methods and how these can be overcome are evaluated. Screening with targeted genetic testing of the hemoglobin genes (HbA1, HBA2, HBB) is especially well suited to hemoglobinopathies because there exists an extensive database of variants for the prediction of pathogenicity, averting the need for secondary or multiple testing. Importantly, it would eliminate the health disparities created by location and health insurance on the access to confirmatory testing and facilitate timely referral for definitive care. Standardization of the screening platform with diagnostic specificity has vast implications for public health surveillance and resource allocation. The adoption of molecular testing requires bringing new technology online, training and changes to workflow, potentially increased cost, and concerns for genetic data protection. Some of these barriers can be overcome using high-throughput methods with the potential to multiplex with other disease conditions that use genetic testing for primary screening through the consolidation of platforms.</p><p><strong>Conclusions and relevance: </strong>The time has come for a paradigm shift in newborn screening for hemoglobinopathies through the adoption of universal molecular genetic testing.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250064"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifetime Health Effects and Cost-Effectiveness of Tirzepatide and Semaglutide in US Adults.","authors":"Jennifer H Hwang, Neda Laiteerapong, Elbert S Huang, David D Kim","doi":"10.1001/jamahealthforum.2024.5586","DOIUrl":"10.1001/jamahealthforum.2024.5586","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Newer antiobesity medications lead to greater weight loss and lower cardiometabolic risks. However, the high costs of these medications have raised policy questions about their value and coverage decisions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the cost-effectiveness of 4 antiobesity medications with lifestyle modification vs lifestyle modification alone in the US.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;A lifetime cost-effectiveness analysis was conducted in 2024 using the validated Diabetes, Obesity, Cardiovascular Disease Microsimulation model for US adults. Data were included from the 2017-2020 National Health and Nutrition Examination Survey of 4823 individuals (representing 126 million eligible US adults) aged 20 to 79 years who would meet clinical trial inclusion criteria for antiobesity medications. Individual-level simulations projected long-term cardiometabolic outcomes, quality-adjusted life-years (QALYs), and health care expenditures. Probabilistic sensitivity analyses, subgroup analyses (across body mass index [BMI] categories [≥30 or ≥27 and at least 1 weight-related comorbidity], presence of comorbidities), and multiple scenario analyses (varying treatment discontinuation rates, value-based pricing benchmarks) were conducted. Future costs and QALYs were discounted at 3% annually.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Lifestyle modification with naltrexone-bupropion, phentermine-topiramate, semaglutide, or tirzepatide vs lifestyle modification alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Obesity, diabetes, and cardiovascular disease cases averted, life-years and QALYs gained, costs incurred (2023 US dollars), and incremental cost-effectiveness ratios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 126 million eligible US adults, the mean age was 48 (SE, 0.5) years; 51% were female; and the initial mean BMI was 34.7 (SE, 0.2); and 85% had at least 1 weight-related comorbidity. Over a lifetime, tirzepatide would avert 45 609 obesity cases (95% uncertainty interval [UI], 45 092-46 126) per 100 000 individuals and semaglutide would avert 32 087 cases (95% UI, 31 292-32 882) per 100 000 individuals. Tirzepatide would reduce 20 854 incident cases of diabetes (95% UI, 19 432-22 276) per 100 000 individuals and semaglutide would reduce 19 211 cases (95% UI, 17 878-20 544) per 100 000 individuals. Tirzepatide would reduce 10 655 cardiovascular disease cases (95% UI, 10 124-11 186) per 100 000 individuals and semaglutide would reduce 8263 cases (95% UI, 7738-8788) per 100 000 individuals. Despite the largest incremental QALY gains of 0.35 for tirzepatide and 0.25 for semaglutide among all antiobesity medications, the incremental cost-effectiveness ratios were $197 023/QALY and 467 676/QALY, respectively. To reach the $100 000/QALY threshold, their prices would require additional discounts by 30.5% for tirzepatide and 81.9% for semaglutide from their current net prices. Naltrexon","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e245586"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a New Commission Make America Healthy Again?","authors":"Lawrence O Gostin, Sarah A Wetter, Peter Lurie","doi":"10.1001/jamahealthforum.2025.1304","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1304","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e251304"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}