JAMA Health Forum最新文献

{"title":"Behavioral Economics to Enhance Food Is Medicine Programs.","authors":"Kevin G Volpp, Cait Lamberton","doi":"10.1001/jamahealthforum.2024.1586","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.1586","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e241586"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592058","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":"Use of Medications for Opioid Use Disorder and Child Welfare Outcomes.","authors":"Alexandra Muhar, Elizabeth McNeer, Lauren D Presley, Anna Morad, Sarah F Loch, William D Dupont, Stephen W Patrick","doi":"10.1001/jamahealthforum.2024.1768","DOIUrl":"10.1001/jamahealthforum.2024.1768","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e241768"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592061","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":"Medicare Payment for Opioid Treatment Programs.","authors":"Carter H Nakamoto, Haiden A Huskamp, Julie M Donohue, Michael L Barnett, Adam J Gordon, Ateev Mehrotra","doi":"10.1001/jamahealthforum.2024.1907","DOIUrl":"10.1001/jamahealthforum.2024.1907","url":null,"abstract":"<p><strong>Importance: </strong>Medicare began paying for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) that dispense methadone and other MOUD in January 2020. There has been little research describing the response to this payment change and whether it resulted in more patients receiving MOUD or just a shift in who pays for this care.</p><p><strong>Objective: </strong>To describe how many and which Medicare beneficiaries receive care from OTPs and how this compares to those receiving MOUD in other settings.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included all patients receiving MOUD care identified in 2019-2022 100% US Medicare Parts B and D claims. Patients receiving care in an OTP who were dually insured with Medicare and Medicaid in the 2019-2020 Transformed Medicaid Statistical Information System were also included.</p><p><strong>Exposure: </strong>Receiving MOUD care in an OTP.</p><p><strong>Main outcomes and measures: </strong>Comparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022.</p><p><strong>Results: </strong>The share of Medicare beneficiaries treated by OTPs rose steadily from 4 per 10 000 (14 160 beneficiaries) in January 2020 to 7 per 10 000 (25 596 beneficiaries) in August 2020, then plateaued through December 2022; of 38 870 patients (23% ≥66 years; 35% female) treated at an OTP in 2022, 96% received methadone. Patients in OTPs, compared to those receiving MOUD in other settings, were more likely be 65 years and younger (65% vs 62%; P < .001), less likely to be White (72% vs 82%; P < .001), and more likely to be an urban resident (86% vs 74%; P < .001). When Medicare OTP coverage began, there was no associated drop in the number of dually insured patients with Medicaid with an OTP claim. Of the 1854 OTPs, 1115 (60%) billed Medicare in 2022, with the share billing Medicare ranging from 13% to 100% across states.</p><p><strong>Conclusions and relevance: </strong>This study showed that since the initiation of Medicare OTP coverage in 2020, there has been a rapid increase in the number of Medicare beneficiaries with claims for OTP services for MOUD, and most OTPs have begun billing Medicare. Patients in OTPs were more likely to be urban residents and members of racial or ethnic minority groups than the patients receiving other forms of MOUD.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e241907"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728280","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":"Medical and Educational Indebtedness Among US Health Care Workers.","authors":"Kathryn E W Himmelstein, Alexander C Tsai","doi":"10.1001/jamahealthforum.2024.1917","DOIUrl":"10.1001/jamahealthforum.2024.1917","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e241917"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762574","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":"Naloxone Availability and Cost After Transition to an Over-the-Counter Product.","authors":"Grace T Marley, Izabela E Annis, Kathleen L Egan, Paul Delamater, Delesha M Carpenter","doi":"10.1001/jamahealthforum.2024.1920","DOIUrl":"10.1001/jamahealthforum.2024.1920","url":null,"abstract":"<p><strong>Importance: </strong>The US Food and Drug Administration approved Narcan, a nasal spray formulation of naloxone, for sale as an over-the-counter (OTC) medication in March 2023. The purpose of OTC approval was to improve naloxone accessibility to reduce opioid overdoses; however, research has not yet evaluated whether naloxone's availability and cost changed since this policy was implemented.</p><p><strong>Objective: </strong>To evaluate whether the accessibility and cost of naloxone at North Carolina community pharmacies changed after OTC naloxone became available and whether cost and availability varied by pharmacy type and urbanicity.</p><p><strong>Design, setting, and participants: </strong>This longitudinal telephone-based secret shopper survey study included a stratified sample of 202 North Carolina community pharmacies, including health department, independent, and chain pharmacies. There were 2 separate data collection efforts from March to April 2023 (before OTC naloxone could be sold at pharmacies) and November 2023 to January 2024 (after OTC naloxone was sold at pharmacies).</p><p><strong>Exposure: </strong>OTC naloxone first became available for sale at community pharmacies in September 2023.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were same-day availability of naloxone without a clinician-issued prescription and the quoted out-of-pocket cost for cash-paying patients.</p><p><strong>Results: </strong>Data were collected from 192 pharmacies. Same-day naloxone availability increased from 42.2% (81 of 192) before OTC naloxone availability to 57.8% (111 of 192) after (P < .001). The mean (SD) quoted out-of-pocket cost decreased from $90.93 ($42.6) pre-OTC availability to $62.67 ($41.0) post-OTC availability (P < .001). Independent pharmacies had higher mean (SD) costs than chain pharmacies in both the pre-OTC phase ($109.47 [$37.90] vs $86.40 [$35.70]; P < .001) and post-OTC phase ($77.59 [$38.90] vs $57.74 [$35.90]; P = .004). Out-of-pocket costs did not differ by urbanicity in the pre-OTC phase; however, mean (SD) costs were higher at suburban ($88.67 [$66.80]) and rural ($65.43 [$35.00]) pharmacies compared with urban pharmacies ($53.58 [$29.00]) in the post-OTC phase (P = .003).</p><p><strong>Conclusions and relevance: </strong>The Food and Drug Administration's approval of OTC naloxone nasal spray contributed to an increase in pharmacy-based availability of naloxone and a reduction of its cost for cash-paying patients. Cost was higher at independent pharmacies compared with chain pharmacies and lower in urban pharmacies compared with suburban and rural pharmacies.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e241920"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762575","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":"The Role of Individual Coverage Health Reimbursement Arrangements-The Liger of Health Insurance?","authors":"Benjamin D Sommers","doi":"10.1001/jamahealthforum.2024.2937","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.2937","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e242937"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762577","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":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.0532","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.0532","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e240532"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535899","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":"Data on the US Economy-A Model for Health Data?","authors":"Cristian Liu, Joshua M Sharfstein","doi":"10.1001/jamahealthforum.2024.2770","DOIUrl":"10.1001/jamahealthforum.2024.2770","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e242770"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635730","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-Covered Services Near the End of Life in Medicare Advantage vs Traditional Medicare.","authors":"Lauren Hersch Nicholas, Stacy M Fischer, Alicia I Arbaje, Marcelo Coca Perraillon, Christine D Jones, Daniel Polsky","doi":"10.1001/jamahealthforum.2024.1777","DOIUrl":"10.1001/jamahealthforum.2024.1777","url":null,"abstract":"<p><strong>Importance: </strong>Financial incentives in Medicare Advantage (MA), the managed care alternative to traditional Medicare (TM), were designed to reduce overutilization. For patients near the end of life (EOL), MA incentives may reduce potentially burdensome care and encourage hospice but could also restrict access to costly but necessary services.</p><p><strong>Objective: </strong>To compare receipt of potentially burdensome treatments and transfers and potentially necessary postacute services in the last 6 months of life in individuals with MA vs TM.</p><p><strong>Design, setting, and participants: </strong>A retrospective analysis of Medicare claims data among older Medicare beneficiaries who died between 2016 and 2018. The study included Medicare decedents aged 66 years or older covered by TM (n = 659 135) or MA (n = 360 430). All decedents and the subset of decedents with 1 or more emergent hospitalizations with a life-limiting condition (cancer, dementia, end-stage organ failure) that would likely qualify for hospice care were included.</p><p><strong>Exposure: </strong>MA enrollment.</p><p><strong>Main outcomes: </strong>Receipt of potentially burdensome hospitalizations and treatments; receipt of postdischarge home and facility care.</p><p><strong>Results: </strong>The study included 659 135 TM enrollees (mean [SD] age at death, 83.3 [9.0] years, 54% female, 15.1% non-White, 55% with 1 or more life-limiting condition) and 360 430 MA enrollees (mean [SD] age at death 82.5 [8.7] years, 53% female, 19.3% non-White, 49% with 1 or more life-limiting condition). After regression adjustment, MA enrollees were less likely to receive potentially burdensome treatments (-1.6 percentage points (pp); 95% CI, -2.1 to -1.1) and less likely to die in a hospital (-3.3 pp; 95% CI, -4.0 to -2.7) compared with TM. However, when hospitalized, MA enrollees were more likely to die in the hospital (adjusted difference, 1.3 pp; 95% CI, 1.1-1.5) and less likely to be transferred to rehabilitative or skilled nursing facilities (-5.2 pp; 95% CI, -5.7 to -4.6). Higher rates of home health and home hospice among those discharged home offset half of the decline in facility use. Results were unchanged in the life-limiting conditions sample.</p><p><strong>Conclusions: </strong>MA enrollment was associated with lower rates of potentially burdensome and facility-based care near the EOL. Greater use of home-based care may improve quality of care but may also leave patients without adequate assistance after hospitalization.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e241777"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728281","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":"US State Restrictions and Excess COVID-19 Pandemic Deaths.","authors":"Christopher J Ruhm","doi":"10.1001/jamahealthforum.2024.2006","DOIUrl":"10.1001/jamahealthforum.2024.2006","url":null,"abstract":"<p><strong>Importance: </strong>Despite considerable prior research, it remains unclear whether and by how much state COVID-19-related restrictions affected the number of pandemic deaths in the US.</p><p><strong>Objective: </strong>To determine how state restrictions were associated with excess COVID-19 deaths over a 2-year analysis period.</p><p><strong>Design, setting, and participants: </strong>This was a cross-sectional study using state-level mortality and population data from the US Centers for Disease Control and Prevention for 2020 to 2022 compared with baseline data for 2017 to 2019. Data included the total US population, with separate estimates for younger than 45 years, 45 to 64 years, 65 to 84 years, and 85 years or older used to construct age-standardized measures. Age-standardized excess mortality rates and ratios for July 2020 to June 2022 were calculated and compared with prepandemic baseline rates. Excess death rates and ratios were then regressed on single or multiple restrictions, while controlling for excess death rates or ratios, from March 2020 to June 2020. Estimated values of the dependent variables were calculated for packages of weak vs strong state restrictions. Behavioral changes were investigated as a potential mechanism for the overall effects. Data analyses were performed from October 1, 2023, to June 13, 2024.</p><p><strong>Exposures: </strong>Age and cause of death.</p><p><strong>Main outcomes: </strong>Excess deaths, age-standardized excess death rates per 100 000, and excess death ratios.</p><p><strong>Results: </strong>Mask requirements and vaccine mandates were negatively associated with excess deaths, prohibitions on vaccine or mask mandates were positively associated with death rates, and activity limitations were mostly not associated with death rates. If all states had imposed restrictions similar to those used in the 10 most restrictive states, excess deaths would have been an estimated 10% to 21% lower than the 1.18 million that actually occurred during the 2-year analysis period; conversely, the estimates suggest counterfactual increases of 13% to 17% if all states had restrictions similar to those in the 10 least-restrictive states. The estimated strong vs weak state restriction difference was 271 000 to 447 000 deaths, with behavior changes associated with 49% to 79% of the overall disparity.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study indicates that stringent COVID-19 restrictions, as a group, were associated with substantial decreases in pandemic mortality, with behavior changes plausibly serving as an important explanatory mechanism. These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 7","pages":"e242006"},"PeriodicalIF":9.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762578","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}