JAMA Health Forum最新文献

{"title":"Scaling the CMS Cardiovascular Risk Reduction Model.","authors":"Dawn Alley, Nina Ashford, Will Shrank","doi":"10.1001/jamahealthforum.2024.1774","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.1774","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535902","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 Eligibility and Changes in Coverage, Access to Care, and Health by Sexual Orientation and Gender Identity.","authors":"Kyle A Gavulic, Jacob Wallace","doi":"10.1001/jamahealthforum.2024.1756","DOIUrl":"10.1001/jamahealthforum.2024.1756","url":null,"abstract":"<p><strong>Importance: </strong>Medicare provides nearly universal insurance coverage at age 65 years. However, how Medicare eligibility affects disparities in health insurance coverage, access to care, and health status among individuals by sexual orientation and gender identity is poorly understood.</p><p><strong>Objective: </strong>To assess the association of Medicare eligibility with disparities in health insurance coverage, access to care, and self-reported health status among individuals by sexual orientation and by gender identity.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used the age discontinuity for Medicare eligibility at age 65 years to isolate the association of Medicare with health insurance coverage, access to care, and self-reported health status, by their sexual orientation and by their gender identity. Data were collected from the Behavioral Risk Factor Surveillance System for respondents from 51 to 79 years old from 2014 to 2021. Data analysis was performed from September 2022 to April 2023.</p><p><strong>Exposures: </strong>Medicare eligibility at age 65 years.</p><p><strong>Main outcomes and measures: </strong>Proportions of respondents with health insurance coverage, usual source of care, cost barriers to care, influenza vaccination, and self-reported health status.</p><p><strong>Results: </strong>The study population included 927 952 individuals (mean [SD] age, 64.4 [7.7] years; 524 972 [56.6%] females and 402 670 [43.4%] males), of whom 28 077 (3.03%) identified as a sexual minority-lesbian, gay, bisexual, or another sexual minority identity (LGB+) and 3286 (0.35%) as transgender or gender diverse. Respondents who identified as heterosexual had greater improvements at age 65 years in insurance coverage (4.2 percentage points [pp]; 95% CI, 4.0-4.4 pp) than those who identified as LGB+ (3.6 pp; 95% CI, 2.3-4.8 pp), except when the analysis was limited to a subsample of married respondents. For access to care, improvements in usual source of care, cost barriers to care, and influenza vaccination were larger at age 65 years for heterosexual respondents compared with LGB+ respondents, although confidence intervals were overlapping and less precise for LGB+ individuals. For self-reported health status, the analyses found larger improvements at age 65 years for LGB+ respondents compared with heterosexual respondents. There was considerable heterogeneity by state in disparities by sexual orientation among individuals who were nearly eligible for Medicare (close to 65 years old), with the US South and Central states demonstrating the highest disparities. Among the top-10 highest-disparities states, Medicare eligibility was associated with greater increases in coverage (6.7 pp vs 5.0 pp) and access to a usual source of care (1.4 pp vs 0.6 pp) for LGB+ respondents compared with heterosexual respondents.</p><p><strong>Conclusions and relevance: </strong>The findings of this cross-sectional ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535900","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":"Use of Track One Prioritized Examination for Pharmaceutical Patents.","authors":"S Sean Tu, William B Feldman","doi":"10.1001/jamahealthforum.2024.1886","DOIUrl":"10.1001/jamahealthforum.2024.1886","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728284","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":"Mortality Disparities Among Arrestees by Race, Sentencing Disposition, and Place.","authors":"George Zuo, Beau Kilmer, Nancy Nicosia","doi":"10.1001/jamahealthforum.2024.1794","DOIUrl":"10.1001/jamahealthforum.2024.1794","url":null,"abstract":"<p><strong>Importance: </strong>Understanding mortality disparities among justice system-involved populations is crucial for public health and policy, especially for marginalized racial groups such as American Indian/Alaska Native persons.</p><p><strong>Objective: </strong>To examine racial disparities in mortality within the broader justice system-involved population in South Dakota, focusing on different sentencing dispositions and the role of place.</p><p><strong>Design, setting, and participants: </strong>This observational study used administrative criminal records linked to mortality data from January 2000 to December 2016. The statewide data linked data from South Dakota Attorney General's Office and South Dakota Department of Health. Individuals aged 18 years and older with arrests were analyzed in this population-based sample. Data were analyzed from August 1, 2022, to July 30, 2023.</p><p><strong>Exposure: </strong>Sentencing dispositions were categorized as arrest only, fine, probation, jail, and prison.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were mortality rates (both all-cause and cause-specific) calculated using Poisson regression models, adjusted for demographic and county variables.</p><p><strong>Results: </strong>Of 182 472 individuals with 422 987 arrests, the study sample included 29 690 American Indian/Alaska Native arrestees (17 900 [60%] male; mean [SD] age, 29.4 [11.0] years) and 142 248 White arrestees (103 471 [73%] male; mean [SD] age, 32.6 [12.9] years). American Indian/Alaska Native persons accounted for 16% of arrestees and 26% of arrests, but only 9% of the population in South Dakota. Across dispositions, mortality risk was greater for White individuals sentenced to probation, jail, and prison relative to White individuals who were arrested only. In terms of racial disparities, all-cause mortality risk was 2.37 (95% CI, 1.95-2.88) times higher for American Indian/Alaska Native than White arrestees in the arrest-only disposition. Disparities persisted across all dispositions but narrowed substantially for probation and prison. Results were similar for cause-specific mortality risk, except for cancer risk. In urban areas, mortality risk was 2.70 (95% CI, 1.29-2.44) times greater for American Indian/Alaska Native individuals relative to White individuals among those with arrest-only dispositions.</p><p><strong>Conclusions and relevance: </strong>In this population-based observational study, mortality risk and associated racial disparities among justice system-involved individuals differed substantially across dispositions and places, underscoring the need for public health interventions tailored to these factors. Further research is needed to understand the mechanisms through which sentencing and place shape these disparities.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592060","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":"Insurance Instability for Patients With Opioid Use Disorder in the Year After Diagnosis.","authors":"Paul J Christine, Anna L Goldman, Jake R Morgan, Shapei Yan, Avik Chatterjee, Amy L Bettano, Ingrid A Binswanger, Marc R LaRochelle","doi":"10.1001/jamahealthforum.2024.2014","DOIUrl":"10.1001/jamahealthforum.2024.2014","url":null,"abstract":"<p><strong>Importance: </strong>Transitions in insurance coverage may be associated with worse health care outcomes. Little is known about insurance stability for individuals with opioid use disorder (OUD).</p><p><strong>Objective: </strong>To examine insurance transitions among adults with newly diagnosed OUD in the 12 months after diagnosis.</p><p><strong>Design, setting, and participants: </strong>Longitudinal cohort study using data from the Massachusetts Public Health Data Warehouse. The cohort includes adults aged 18 to 63 years diagnosed with incident OUD between July 1, 2014, and December 31, 2014, who were enrolled in commercial insurance or Medicaid at diagnosis; individuals diagnosed after 2014 were excluded from the main analyses due to changes in the reporting of insurance claims. Data were analyzed from November 10, 2022, to May 6, 2024.</p><p><strong>Exposure: </strong>Insurance type at time of diagnosis (commercial and Medicaid).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the cumulative incidence of insurance transitions in the 12 months after diagnosis. Logistic regression models were used to generate estimated probabilities of insurance transitions by insurance type and diagnosis for several characteristics including age, race and ethnicity, and whether an individual started medication for OUD (MOUD) within 30 days after diagnosis.</p><p><strong>Results: </strong>There were 20 768 individuals with newly diagnosed OUD between July 1, 2014, and December 31, 2014. Most individuals with newly diagnosed OUD were covered by Medicaid (75.4%). Those with newly diagnosed OUD were primarily male (67% in commercial insurance, 61.8% in Medicaid). In the 12 months following OUD diagnosis, 30.4% of individuals experienced an insurance transition, with adjusted models demonstrating higher transition rates among those starting with Medicaid (31.3%; 95% CI, 30.5%-32.0%) compared with commercial insurance (27.9%; 95% CI, 26.6%-29.1%). The probability of insurance transitions was generally higher for younger individuals than older individuals irrespective of insurance type, although there were notable differences by race and ethnicity.</p><p><strong>Conclusions and relevance: </strong>This study found that nearly 1 in 3 individuals experience insurance transitions in the 12 months after OUD diagnosis. Insurance transitions may represent an important yet underrecognized factor in OUD treatment outcomes.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762572","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 Highlights From the AcademyHealth Annual Research Meeting.","authors":"John Z Ayanian, Melinda B Buntin","doi":"10.1001/jamahealthforum.2024.2493","DOIUrl":"10.1001/jamahealthforum.2024.2493","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762573","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":"Congress Must Update FDA Regulations for Medical AI.","authors":"Scott Gottlieb","doi":"10.1001/jamahealthforum.2024.2691","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.2691","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581496","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":"Outcomes and Hospital Service Use Among Patients With COPD in a Nurse- and Allied Health-Led Clinic.","authors":"Kailu Wang, Shi Zhao, Susan Zi-May Yau, Yuchen Wei, Yim-Chu Li, Ryan Wai-Ching Orr, Ivan Hin-Lai Lam, Yushan Wu, Eliza Lai-Yi Wong, Chi-Tim Hung, Eng-Kiong Yeoh","doi":"10.1001/jamahealthforum.2024.1575","DOIUrl":"10.1001/jamahealthforum.2024.1575","url":null,"abstract":"<p><strong>Importance: </strong>Multidisciplinary disease management efforts enable the improvement in lung function among patients with chronic obstructive pulmonary disease (COPD), but there is little evidence of its association with risks of adverse health outcomes and health care service use.</p><p><strong>Objective: </strong>To examine the association between the use of a nurse- and allied health-led primary care clinic for respiratory patients, namely the Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory), and their risks of mortality and morbidity and health care service use.</p><p><strong>Design, setting, and participants: </strong>This territory-wide, population-based, propensity-matched, retrospective cohort study used data from the electronic health records of all patients who used public health care services in Hong Kong, China, from January 1, 2010, to December 31, 2019. All patients with COPD treated in public outpatient clinics between January 1, 2010, and December 31, 2014, were included. Patients who attended NAHC-Respiratory and usual care only were propensity score-matched at a 1:2 ratio. Data analyses were conducted between August 2023 and April 2024.</p><p><strong>Exposure: </strong>Attendance at NAHC-Respiratory.</p><p><strong>Main outcomes and measures: </strong>All-cause and cause-specific mortality, incidence of COPD complications, and use of emergency department and inpatient services until the end of 2019 were compared between the NAHC-Respiratory and usual care participants using Cox proportional hazard regression, Poisson regression, and log-link gamma regression models after matching.</p><p><strong>Results: </strong>This study included 9048 eligible patients after matching, including 3093 in the exposure group (2814 [91.0%] men; mean [SD] age, 69.8 [9.5] years) and 5955 in the reference group (5431 [91.2%] men; mean [SD] age, 69.5 [11.7] years). Compared with patients in the usual care-only group (reference), patients in the exposure group had lower risks of all-cause mortality (hazard ratio [HR], 0.84; 95% CI, 0.78-0.90) as well as pneumonia-caused (HR, 0.85; 95% CI, 0.74-0.97), respiratory-caused (HR, 0.86; 95% CI, 0.77-0.96), and cardiovascular-caused (HR, 0.74; 95% CI, 0.59-0.93) mortality. Exposure was associated with reduced rates of emergency department visits (incidence rate ratio [IRR], 0.92; 95% CI, 0.86-0.98) and hospitalization through emergency department (IRR, 0.89; 95% CI, 0.83-0.95).</p><p><strong>Conclusions: </strong>In this cohort study, the use of a nurse- and allied health-led clinic in primary care settings was associated with reduced risks of mortality and use of hospital services among patients with COPD. These findings emphasize the important role of health care workers other than physicians in disease management in the primary care setting. The NAHC-Respiratory model and service components can be used to help improve primary care programs to benefit more patients with COPD.</","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535901","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":"Errors in a Table and Figure.","authors":"","doi":"10.1001/jamahealthforum.2024.2301","DOIUrl":"10.1001/jamahealthforum.2024.2301","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592059","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":"Growth of Statewide Emergency Medical Services Bypass Policies for Acute Stroke.","authors":"Rachel Dunkley, Nina Omeaku, Amber W Trickey, Megha D Tandel, Ariadna Garcia, Prasanthi Govindarajan","doi":"10.1001/jamahealthforum.2024.1752","DOIUrl":"10.1001/jamahealthforum.2024.1752","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535898","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}