JAMA Health Forum最新文献

{"title":"The Alarming Risks for Dually Eligible Beneficiaries During Heat Waves.","authors":"Jose F Figueroa","doi":"10.1001/jamahealthforum.2024.3912","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.3912","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 11","pages":"e243912"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607390","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":"Psychedelic and MDMA-Related Adverse Effects-A Call for Action.","authors":"Otto Simonsson, Matthew W Johnson, Peter S Hendricks","doi":"10.1001/jamahealthforum.2024.3630","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.3630","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 11","pages":"e243630"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607389","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":"Dental Coverage and Care When Transitioning From Medicaid to Medicare.","authors":"Hawazin W Elani, Benjamin D Sommers, Dan Yuan, Ichiro Kawachi, Meredith B Rosenthal, Renuka Tipirneni","doi":"10.1001/jamahealthforum.2024.4165","DOIUrl":"10.1001/jamahealthforum.2024.4165","url":null,"abstract":"<p><strong>Importance: </strong>Millions of adults with low incomes lose Medicaid eligibility when transitioning to Medicare at age 65 years. However, it remains unclear how this transition is associated with dental care.</p><p><strong>Objective: </strong>To examine the consequences of transitions from Medicaid to Medicare on coverage and use of dental services.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional data from the Health and Retirement Study from 2014 to 2020 and a regression discontinuity design were used to compare changes in outcomes before and after turning age 65 years among a population likely to be Medicaid-eligible before age 65 years. The sample included adults aged 50 to 90 years who had not attended college in 28 states.</p><p><strong>Exposure: </strong>Transitions from Medicaid to Medicare at age 65 years.</p><p><strong>Main outcomes and measures: </strong>Health insurance (Medicaid, Medicare, dual coverage, private, and uninsurance), dental coverage (Medicaid, Medicare, private, or none), and having a dental visit and out-of-pocket dental spending during the previous 2 years.</p><p><strong>Results: </strong>Of the 15 837 study participants, 9510 (56.2% weighted) were female, 6984 (28.7% weighted) were Black individuals, Hispanic individuals, and individuals of other race (including American Indian, Alaskan Native, Asian, Native Hawaiian, and Pacific Islander individuals), and 8853 (71.3% weighted) were White; the mean (SD) age was 69.2 (10.3) years. Turning age 65 years was associated with an increase in Medicare coverage in states with Medicaid dental benefits (66.5 percentage points [pp]; 95% CI, 58.3-74.7) and those without dental benefits (67.8 pp; 95% CI, 52.6-83.0). There was a concurrent reduction in private coverage, Medicaid, and uninsured rates. For dental outcomes, in states providing Medicaid dental benefits, turning age 65 years was associated with a 13.1-pp decrease in the likelihood of dental coverage (95% CI, 10.7-15.5), largely due to the loss of Medicaid dental coverage. Among adults reporting being Black, Hispanic, or other race, there was a 3.9-pp decline in dental visits during the previous 2 years (95% CI, -6.1 to -1.7). In states without Medicaid dental benefits, turning age 65 years was associated with no change in the likelihood of dental coverage and a 15.6-pp increase in dental visits (95% CI, 6.3-25.0). Out-of-pocket dental spending decreased in both groups of states (-13.0% [95% CI, -24.2 to -0.1] and -19.2% [95% CI, -33.6 to -1.6], respectively).</p><p><strong>Conclusions and relevance: </strong>The results of this cross-sectional study suggest that transitioning from Medicaid to Medicare at age 65 years was associated with a lower level of dental coverage and may increase barriers to accessing dental care for beneficiaries who had Medicaid dental coverage before age 65 years. However, for adults living in states without Medicaid dental benefits, the transition was asso","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 11","pages":"e244165"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689659","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 Care Utilization With Telemedicine and In-Person Visits in Pediatric Primary Care.","authors":"Scott D Casey, Jie Huang, Daniel D Parry, Tracy A Lieu, Mary E Reed","doi":"10.1001/jamahealthforum.2024.4156","DOIUrl":"10.1001/jamahealthforum.2024.4156","url":null,"abstract":"<p><strong>Importance: </strong>Telemedicine is an increasingly used yet understudied vehicle to deliver pediatric primary care. Evidence detailing downstream health care utilization after telemedicine visits is needed.</p><p><strong>Objective: </strong>To compare pediatric primary care conducted via telemedicine (video or telephone) with in-person office visits with regard to physician medication prescribing and imaging and laboratory ordering and downstream follow-up office visits, emergency department (ED) visits, and hospitalizations.</p><p><strong>Design, setting, and participants: </strong>This cohort study included all patients younger than 18 years who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the Kaiser Permanente Northern California health system, a large integrated health care delivery system offering in-person office visits, video visits, or telephone visits for pediatric primary care.</p><p><strong>Exposure: </strong>Pediatric primary care in-person visit, telephone visit, or video visit.</p><p><strong>Main outcome and measures: </strong>Rates of physician medication prescribing and imaging and laboratory ordering during an index telemedicine or office visit and rates of in-person office visits, ED visits, and hospitalizations within 7 days after the visit, adjusted for patient and clinical characteristics.</p><p><strong>Results: </strong>Of 782 596 total appointments (51.1% male) among 438 638 patients, telemedicine was used for 332 153 visits (42.4%). After adjustment, there was more medication prescribing for in-person visits (39.8%) compared with video visits (29.5%; adjusted difference, -10.3%; 95% CI, -10.6% to -10.0%) or telephone visits (27.3%; adjusted difference, -12.5%; 95% CI, -12.5% to -12.7%). There was also more laboratory ordering for in-person visits (24.6%) compared with video visits (7.8%; adjusted difference, -16.8%; 95% CI, -17.0% to -16.6%) or telephone visits (8.5%; adjusted difference, -16.2%; 95% CI, -16.3% to -16.0%). There was more imaging ordering for in-person visits (8.5%) compared with video visits (4.0%; adjusted difference, -4.5%; 95% CI, -4.6% to -4.4%) and telephone visits (3.5%; adjusted difference, -5.0%; 95% CI, -5.1% to -4.9%). After adjustment, fewer in-person follow up visits occurred for index visits that were in-person (4.3%) compared with video (14.4%; adjusted difference, 10.1%; 95% CI, 9.9%-10.3%) or telephone (15.1%; adjusted difference, 10.8%; 95% CI, 10.7%-11.0%) visits. The rate of ED visits following an in-person visit was slightly lower (1.75%) compared with after video visits (2.04%; adjusted difference, 0.29%; 95% CI, 0.21%-0.38%) or telephone visits (2.00%; adjusted difference, 0.25%; 95% CI, 0.18%-0.33%). There was no statistically significant difference in the 7-day rate of hospitalizations.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, telephone and video visits for pediatric primary care were ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 11","pages":"e244156"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689666","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.2024.0535","DOIUrl":"10.1001/jamahealthforum.2024.0535","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e240535"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373564","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":"Unwinding Medicaid Eligibility: Lessons for Health Policy.","authors":"Michelle Bedoya, Joshua M Sharfstein","doi":"10.1001/jamahealthforum.2024.4487","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4487","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e244487"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512792","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":"Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits.","authors":"Lawrence P Casalino, Shachar Kariv, Daniel Markovits, Raymond Fisman, Jing Li","doi":"10.1001/jamahealthforum.2024.3383","DOIUrl":"10.1001/jamahealthforum.2024.3383","url":null,"abstract":"<p><strong>Importance: </strong>Altruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.</p><p><strong>Objective: </strong>To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.</p><p><strong>Exposure: </strong>Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.</p><p><strong>Main measures: </strong>Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.</p><p><strong>Results: </strong>In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e243383"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401936","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 Table 2 and eTables 1 and 3.","authors":"","doi":"10.1001/jamahealthforum.2024.3865","DOIUrl":"10.1001/jamahealthforum.2024.3865","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e243865"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480544","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 Unintended Consequences of Individual Market Reinsurance.","authors":"Coleman Drake, David M Anderson","doi":"10.1001/jamahealthforum.2024.3188","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.3188","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e243188"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512791","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":"Error in Text.","authors":"","doi":"10.1001/jamahealthforum.2024.3633","DOIUrl":"10.1001/jamahealthforum.2024.3633","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e243633"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373563","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}