JAMA Health Forum最新文献

{"title":"End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations.","authors":"Jessica J Zhang, David B Reuben, Anne M Walling, David S Zingmond, Cheryl L Damberg, Neil S Wenger, Haiyong Xu, Ryo Ikesu, Gillian S Kaneshiro, Alexandra Klomhaus, Hiroshi Gotanda, Yusuke Tsugawa","doi":"10.1001/jamahealthforum.2025.0731","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0731","url":null,"abstract":"<p><strong>Importance: </strong>Individuals with dementia may receive high-intensity care at the end of life (EOL) that does not align with their preferences and is costly. Medicare Accountable Care Organizations (ACOs) are an alternative payment model that aims to incentivize high-quality care and lower spending.</p><p><strong>Objective: </strong>To compare EOL care processes, outcomes, and health care spending between Medicare beneficiaries with dementia in a Medicare Shared Savings Program (MSSP) ACO and non-ACO.</p><p><strong>Design, setting, and participants: </strong>This quasi-experimental study of EOL care used a nationally representative 20% random sample of Medicare fee-for-service beneficiaries with dementia (age ≥66 years) who died from 2017 to 2020. Difference-in-differences and event study design approaches were used to compare outcomes between beneficiaries attributed to MSSP ACO vs those who were not. Data were analyzed from June 2023 to December 2024.</p><p><strong>Exposure: </strong>MSSP ACO entry from 2017 to 2019 vs non-ACO.</p><p><strong>Main outcomes and measures: </strong>Differential changes in 5 areas: (1) billing for advance care planning; (2) palliative care counseling in last 6 months of life; (3) hospice in last 6 months of life; (4) high-intensity care in last 30 days of life (ie, emergency department visit, hospitalization, intensive care unit admission, in-hospital death, cardiopulmonary resuscitation or mechanical ventilation, feeding tube placement); and (5) health care spending in last 6 months of life.</p><p><strong>Results: </strong>Of 162 034 eligible Medicare beneficiaries (mean [SD] age, 85.0 [7.9] years; 94 304 female [58.2%]), 51 191 (31.6%) were attributed to MSSP ACO. Adjusted trends in outcomes were similar between ACO and non-ACO groups before ACO entry. The difference-in-differences analyses found no evidence that EOL care processes or outcomes (eg, hospice in last 6 months of life, -0.4 percentage points [pp]; 95% CI, -1.4 pp to 0.5 pp; P > .99) or spending (eg, total health care spending in last 6 months of life, -$632; 95% CI, -$1377 to $113; P = .96) differed between beneficiaries treated in ACOs vs non-ACOs. The event study design also showed no evidence of differential changes in outcomes between the 2 groups. Sensitivity analyses using inverse probability weighting yielded similar results.</p><p><strong>Conclusions and relevance: </strong>Using nationally representative data on beneficiaries with dementia at EOL, this quasi-experimental study found no evidence that EOL care processes, outcomes, or spending changed with ACO entry for Medicare fee-for-service beneficiaries vs non-ACO beneficiaries. Alternative payment models to ACOs may be needed to coordinate high-quality care with lower spending for beneficiaries with dementia at the EOL.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250731"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059853","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":"Gender Differences in Primary Care Physician Earnings and Outcomes Under Medicare Advantage Value-Based Payment.","authors":"Ishani Ganguli, Nicholas E Daley, Lauren Polt, Victoria DiGennaro, Benjamin Kornitzer","doi":"10.1001/jamahealthforum.2025.2001","DOIUrl":"10.1001/jamahealthforum.2025.2001","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252001"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082006","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":"Health Care Access and Use Among Adults Experiencing Homelessness.","authors":"Jessica D Fields, Ryan D Assaf, Kim Hanh Nguyen, Corbin C Platamone, J Margo Pottebaum, Jesica Giannola, Margot B Kushel","doi":"10.1001/jamahealthforum.2025.0820","DOIUrl":"10.1001/jamahealthforum.2025.0820","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Demographic and policy changes have occurred since the last large, representative study of homeless adults in the 1990s, which may affect health care access and use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe the prevalence of poor health care access and short-term health care and use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to assess the association between changes in homelessness with health care access and short-term care use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This representative survey of adults experiencing homelessness in California from October 2021 to November 2022 used multistage, venue-based, and respondent-driven sampling. Data were analyzed from May 2023 to December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Shelter status (predisposing vulnerable), insurance (enabling), impairment with activities of daily living (ADL; need), and illicit substance use during the previous 6 months (need).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The study assessed self-reported no prior-year ambulatory care use and prior 6-month unmet health care need, unmet medication need, emergency department (ED) use, and hospitalization. Population prevalence estimates with Wald 95% CIs and multivariable Poisson regressions were calculated to compute prevalence ratios (PRs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-two hundred adults completed the survey (mean age, 46.1 [95% CI, 45.3-46.9] years; 1965 cisgender men [67.2%], 1148 cisgender women [31.2%], and 57 transgender and gender queer individuals [1.6%]), of whom 2016 (77.6%) were unsheltered, 2609 (82.6%) were insured, 1056 (34.4%) had an ADL impairment, and 911 (37.1%) reported illicit substance use 3 or more times a week. A total of 1121 (39.1%) reported no ambulatory care use; 765 (24.3%) reported an unmet health care need and 714 (23.3%) an unmet medication need; 1252 (38.9%) used the ED; and 668 (22.0%) were hospitalized. Lack of ambulatory care use (PR, 1.71; 95% CI, 1.51-1.94) and unmet health care needs (PR, 1.19; 95% CI, 1.02-1.40) were more prevalent for those who were unsheltered. Lack of ambulatory care use (PR, 0.63; 95% CI, 0.57-0.70) and unmet health care needs (PR, 0.80; 95% CI, 0.67-0.95) were less prevalent for those with insurance. Unmet health care needs (PR, 2.13; 95% CI, 1.79-2.55), ED use (PR, 1.15; 95% CI, 1.02-1.30), and hospitalization (PR, 1.74; 95% CI, 1.40-2.17) were more prevalent for those with an ADL impairment. Lack of ambulatory care use (PR, 1.46; 95% CI, 1.19-1.79) and unmet health care needs (PR, 1.30; 95% CI, 1.08-1.55) were more prevalent for those who used illicit substances 3 or more times a week.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cross-sectional study found that adults experiencing homelessness reported poor access to ambulatory care and a high prevalence of short-term care use, despite high rates of insurance. Changes in homelessness during the past 30 years w","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250820"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129058","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":"Assessing US Food and Drug Administration Guidance Practices in Drug Development.","authors":"Joseph T Kannarkat, Peter Lurie, G Caleb Alexander","doi":"10.1001/jamahealthforum.2025.1124","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1124","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251124"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129089","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 Public Health Damage-and Personal Toll-of Federal Worker Layoffs.","authors":"Benjamin D Sommers","doi":"10.1001/jamahealthforum.2025.2652","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2652","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252652"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121177","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":"Cutting the NIH-The $8 Trillion Health Care Catastrophe.","authors":"David M Cutler, Edward Glaeser","doi":"10.1001/jamahealthforum.2025.2791","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2791","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252791"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174557","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":"Why a Planned Reorganization of the FDA Creates Major Challenges.","authors":"Scott Gottlieb, Mark B McClellan","doi":"10.1001/jamahealthforum.2025.2326","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2326","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252326"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058053","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":"How Anti-DEI Policies Adversely Affect Mental Health.","authors":"Ruth S Shim","doi":"10.1001/jamahealthforum.2025.2163","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2163","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252163"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055523","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":"Estimates of Illicit Opioid Use in the US.","authors":"David Powell, Mireille Jacobson","doi":"10.1001/jamahealthforum.2025.0809","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0809","url":null,"abstract":"<p><strong>Importance: </strong>Illicit opioids, particularly illicitly manufactured fentanyl (IMF), are major contributors to overdose deaths in the US. Understanding the prevalence and characteristics of illicit opioid use is crucial for addressing the opioid crisis.</p><p><strong>Objective: </strong>To estimate the prevalence of illicit opioid use, including IMF, and initial opioid exposure among those reporting illicit opioid use.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study was conducted using an online survey with targeted demographic quotas from June 10, 2024, to June 17, 2024. A total of 1515 participants aged 18 years and older from the US completed the survey. The analysis was conducted between June 30, 2024, and February 13, 2025.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was self-reported illicit opioid use within the past 12 months. Secondary outcomes included initial exposure to opioids and perceived likelihood of overdose. Logistic regression was used to analyze associations with demographic and geographic factors.</p><p><strong>Results: </strong>A total of 1515 respondents completed the survey, including 770 female individuals (50.8%), 20 American Indian or Alaska Native (1.3%), 101 Asian or Pacific Islander (6.7%), 215 Black (14.2%), 1087 White (81.7%), and 24 multiracial (1.6%); 186 (12.3%) were aged 18 to 24, 242 (16.0%) 25 to 34, 327 (21.6%) 35 to 44, 280 (18.5%) 45 to 54, 281 (18.5%) 55 to 64, 139 (9.2%) 65 to 74, and 60 (4.0%) 75 to 84 years. Among this sample, 166 (10.96%; 95% CI, 9.38%-12.52%) reported nonprescription opioid use within the past 12 months, including 114 (7.52%; 95% CI, 6.20%-8.85%) of the 1515 respondents reporting IMF use. Among those reporting nonprescription opioid use within the past 12 months, 65 (39.16%; 95% CI, 31.73%-46.58%) reported that their first opioid use involved opioids prescribed to them, whereas 60 (36.14%; 95% CI, 28.84%-43.45%) reported that their first use involved prescription opioids not prescribed to them. Only 41 (24.70%; 95% CI, 18.14%-31.26%) answered that their first exposure involved illicit opioids. Seventy-one (4.69%; 95% CI, 3.62%-5.75%) of all respondents reported that it was very likely they would have an overdose due to opioid use. This rate increased to 33.33% (95% CI, 24.68%-41.99%) among those who had used IMF within the past 12 months. Illicit opioid use was higher among men, Black respondents, and younger age groups.</p><p><strong>Conclusions and relevance: </strong>The findings of this cross-sectional study indicate a higher prevalence of illicit opioid use than previously reported, highlighting the need for more timely and accurate data to inform policy and intervention strategies. Enhanced data collection efforts are essential for understanding and mitigating the opioid crisis.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250809"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009370","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":"Racial, Ethnic, and Sex Differences in Need and Receipt of Support for Social Needs Among Veterans.","authors":"David A Frank, Lauren E Russell, Gregory T Procario, Sarah M Leder, Jennifer L McCoy, Shane Lamba, Ernest M Moy, Leslie R M Hausmann","doi":"10.1001/jamahealthforum.2025.0992","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0992","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Health-related social needs, downstream manifestations of social determinants or drivers of health, impact patients' health and well-being. To develop equity-driven social care interventions, health care systems must apply an intersectional equity lens when assessing patients' social needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate racial, ethnic, and sex differences in social needs and receipt of support among veterans receiving health care in the Veterans Health Administration (VHA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;A cross-sectional survey study of VHA primary care patients seen in January or February 2023 was carried out in a national sample of veterans, stratified by race and ethnicity (Black, Hispanic, White), and sex (male, female). Participants were invited by mail to complete a survey online or by mail. Of those invited (N = 38 759), 7095 (18.3%) responded. Data collection occurred from March 2, 2023, through May 9, 2023. Analyses were conducted from February 15, 2024, through July 16, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Intersection of self-identified race, ethnicity, and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Age-adjusted prevalence ratio (aPR) of reported need for and receipt of support across 13 social need domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analyses included 6611 respondents representing 939 467 veterans (unweighted No. of participants [weighted %]; 1089 [4.1%] Black women; 1144 [19.4%] Black men; 941 [1.6%] Hispanic women; 1281 [11.3%] Hispanic men; 805 [5.3%] White women; 1351 [58.4%] White men). After age adjustment, compared with White men, Black men had significantly higher aPRs of need for support in all domains except childcare and employment (aPRs ranged from 1.35 [95% CI, 1.09-1.69] for social isolation to 2.73 [95% CI, 1.89-3.95] for managing discrimination). Hispanic women had higher aPRs in 8 domains: childcare (aPR, 2.78; 95% CI, 1.19-6.48), discrimination (aPR, 2.69; 95% CI, 1.68-4.29), internet (aPR, 1.81; 95% CI, 1.17-2.79), housing (aPR, 1.81; 95% CI, 1.10-2.99), legal issues (aPR, 1.70; 95% CI, 1.02-2.84), loneliness (aPR, 1.67; 95% CI, 1.28-2.18), food (aPR, 1.55; 95% CI, 1.03-2.35), and social isolation (aPR, 1.40; 95% CI, 1.05-1.87). Black women had higher aPRs for discrimination (aPR, 2.68; 95% CI, 1.82-3.95), legal issues (aPR, 2.04; 95% CI, 1.40-2.97), food (aPR, 1.74; 95% CI, 1.28-2.37), loneliness (aPR, 1.60; 95% CI, 1.28-2.01), paying for basics (aPR, 1.57; 95% CI, 1.15-2.14), and social isolation (aPR, 1.48; 95% CI, 1.18-1.87). Hispanic men had higher aPRs for housing (aPR, 1.88; 95% CI, 1.18-3.02), legal issues (aPR, 1.81; 95% CI, 1.14-2.86), internet (aPR, 1.56; 95% CI, 1.13-2.16), and loneliness (aPR, 1.44; 95% CI, 1.10-1.88). White women had higher aPRs for childcare (aPR, 3.37; 95% CI, 1.36-8.35) and discrimination (aPR, 1.60; 95% CI, 1.03-2.50). There was 1 significant difference in receiving support: Black women","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250992"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044266","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}