JAMA Health Forum最新文献

{"title":"Drug Overdose Deaths Among Medicaid Beneficiaries.","authors":"Tami L Mark, Benjamin D Huber","doi":"10.1001/jamahealthforum.2024.4365","DOIUrl":"10.1001/jamahealthforum.2024.4365","url":null,"abstract":"<p><strong>Importance: </strong>Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.</p><p><strong>Objective: </strong>To determine the rate of drug overdose among Medicaid beneficiaries.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.</p><p><strong>Exposure: </strong>Participation in the Medicaid program.</p><p><strong>Main outcome: </strong>Death of a drug overdose.</p><p><strong>Results: </strong>In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.</p><p><strong>Conclusions and relevance: </strong>The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244365"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787721","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":"High-Risk Opioid Prescribing and Nurse Practitioner Independence.","authors":"Lucas D Cusimano, Nicole Maestas","doi":"10.1001/jamahealthforum.2024.4544","DOIUrl":"10.1001/jamahealthforum.2024.4544","url":null,"abstract":"<p><strong>Importance: </strong>Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs), but the association of NP practice independence with high-risk opioid prescribing is not well understood.</p><p><strong>Objective: </strong>To assess whether the rates of high-risk opioid prescribing changed in association with NP independence legislation.</p><p><strong>Design, setting, and participants: </strong>This difference-in-differences analysis compared rates of high-risk opioid prescribing in 6 states over 2 years following the adoption of NP independence compared with 10 neighboring nonadopting states from January 2012 to December 2021. Prescription insurance claims for 2 874 213 continuously enrolled individuals (members) aged 18 to 64 years from Blue Cross Blue Shield Axis were analyzed. Data analysis was carried out from 2021 to 2024.</p><p><strong>Exposure: </strong>Timing of the legislative effective date of NP independence in a state.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the rate of opioid prescriptions that overlapped with a prescription for a central nervous system (CNS) depressant. Secondary outcomes included the number of days of opioid-CNS depressant overlap, as well as the dosage and days supplied of opioids among all members and among opioid-naive members.</p><p><strong>Results: </strong>Six states that adopted NP independence legislation and 10 nonadopting neighboring states were similar in terms of demographic characteristics and had comparable pretrends in prescribing. The estimated change in the rate of opioid prescriptions that overlapped with a CNS depressant was -0.03 per 100 members per month (95% CI, -0.11 to 0.05). Changes in the number of days of opioid-CNS depressant overlap and in the dosage and days supplied of opioids among all members and among opioid-naive members were also small and statistically insignificant.</p><p><strong>Conclusions and relevance: </strong>The results of this difference-in-differences analysis suggest that there was no relative increase in rates of high-risk opioid prescribing during the 2 years following the adoption of independence for NPs.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244544"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866444","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":"Developing Evidence-Based Health Policy for Dementia Care.","authors":"Katherine Baicker, Kosali Simon","doi":"10.1001/jamahealthforum.2024.5252","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.5252","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e245252"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814646","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":"Declining Medicare Enrollment Among Patients Initiating Dialysis-Advantage Whom?","authors":"Jillian S Caldwell, Glenn M Chertow","doi":"10.1001/jamahealthforum.2024.4300","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4300","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244300"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787772","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":"With or Without ACA Repeal, ACA and Medicaid Cuts Are Looming.","authors":"Larry Levitt","doi":"10.1001/jamahealthforum.2024.5140","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.5140","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e245140"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787783","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":"The 2024 Presidential Election-An Inflection Point for Science.","authors":"Lawrence O Gostin","doi":"10.1001/jamahealthforum.2024.5370","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.5370","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e245370"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856756","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":"Medicare Enrollment and Spending Among Patients Initiating Dialysis After the Affordable Care Act.","authors":"Virginia Wang, Lauren E Wilson, Neil P Rowen, Caroline E Sloan, Matthew L Maciejewski, Bradley G Hammill","doi":"10.1001/jamahealthforum.2024.4304","DOIUrl":"10.1001/jamahealthforum.2024.4304","url":null,"abstract":"<p><strong>Importance: </strong>Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 passage of the Affordable Care Act (ACA) and introduction of the ACA Marketplace.</p><p><strong>Objective: </strong>To describe trends in public and private insurance coverage and dialysis spending among patients with incident ESKD from 2012 to 2017.</p><p><strong>Design, setting, and participants: </strong>This serial cross-sectional study included patients 18 to 64 years old in Colorado who were not enrolled in Medicare at dialysis initiation. Data analysis was conducted from May to August 2023.</p><p><strong>Exposure: </strong>Introduction of the ACA Marketplace in 2014.</p><p><strong>Main outcomes and measures: </strong>Medicare, Medicaid, or private insurance enrollment in the first year after dialysis initiation, and dialysis spending by insurance type.</p><p><strong>Results: </strong>Of 2005 patients included in the sample, 1416 (70.6%) were 45 to 64 years old, and 1259 (62.8%) were male. A lower proportion of patients with incident ESKD starting dialysis were newly enrolled in Medicare in the years following the ACA (361 of 713 [50.6%]) compared to 2 years prior (420 of 595 [70.6%]). Unadjusted rates of switching from Medicaid to Medicare 1 year after dialysis initiation decreased 14.3 percentage points over time (68.9% in 2012-2013 vs 58.3% and 54.6% in 2014-2015 and 2016-2017, respectively). Unadjusted rates of switching from private insurance to Medicare 1 year after dialysis initiation decreased by 22.3 percentage points (68.1% in 2012-2013 vs 52.2% and 45.8% in 2014-2015 and 2016-2017, respectively). Over the entire 2012 to 2017 period, quarterly dialysis spending in the first year of dialysis among patients with private insurance was higher than among those with Medicare coverage ($26 351-$29 781 vs $10 039-$12 741).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study demonstrates that lower Medicare enrollment rates over time among those initiating dialysis may be inducing higher social spending. This finding raises concerns about the effectiveness of Medicare policies and federal leverage to improve access, outcomes, and value of dialysis care.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244304"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787773","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":"Participant Support for Changes to the Supplemental Nutrition Assistance Program.","authors":"C Ross Hatton, Julia A Wolfson, Alessandra Uriarte, Cindy W Leung","doi":"10.1001/jamahealthforum.2024.4090","DOIUrl":"10.1001/jamahealthforum.2024.4090","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244090"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787775","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":"Financial Performance Gaps Between Critical Access Hospitals and Other Acute Care Hospitals.","authors":"Christopher Whaley, Marilyn Bartlett, Ge Bai","doi":"10.1001/jamahealthforum.2024.3959","DOIUrl":"10.1001/jamahealthforum.2024.3959","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e243959"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866443","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":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.0537","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.0537","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e240537"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787729","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}