JAMA Health Forum最新文献

{"title":"Opportunities and Risks of a Single-Trial Default for FDA Drug Approval.","authors":"Reshma Ramachandran, Rachel E Sachs, Patricia J Zettler, Holly Fernandez Lynch","doi":"10.1001/jamahealthforum.2026.2756","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2756","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e262756"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892998","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":"Regulatory Approaches to Addressing Cognitive Decline in Aging Physicians.","authors":"Maya Potter, Haleh Cohn, Darly Dash, Kristina M Kokorelias, Meera Bhulabhai, Daniel Myran, Lesley Wiesenfeld, Chaim M Bell, Nathan M Stall","doi":"10.1001/jamahealthforum.2026.3025","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3025","url":null,"abstract":"<p><strong>Importance: </strong>The incidence of cognitive decline increases exponentially with age, presenting important implications for professionals in cognitively demanding fields such as medicine. Despite an aging health care workforce, how jurisdictions assess for and address cognitive decline in physicians remains poorly understood.</p><p><strong>Objective: </strong>To compare existing regulatory frameworks in the US, Canada, and the other Group of Seven (G7) countries addressing cognitive decline in aging physicians.</p><p><strong>Evidence review: </strong>A comparative policy analysis was performed using qualitative case study methods involving a review of documents from the peer-reviewed and gray literature from June 2, 2025, to March 10, 2026. The focus was on policy documents, government reports, scholarly works, and other official federal or jurisdictional documents. We examined national-, state-, provincial-, and territorial-level policies concerning cognitive decline in aging physicians in the US and Canada and national-level policies in the remaining G7 countries (France, Germany, Italy, Japan, and the UK). These data were contrasted with how other safety-critical fields (judges, commercial pilots, and air traffic controllers) manage aging-related cognitive risks within their regulatory systems.</p><p><strong>Findings: </strong>The structured search identified 342 documents for analysis. No G7 country has implemented a standardized, national approach to directly assess cognition among aging physicians. Most jurisdictions rely on self-regulation, collegial oversight, and broad professional requirements for maintenance of competency rather than proactive cognitive screening. Exceptions exist in the US, where a few health systems have introduced mandatory age-based cognitive evaluations for physicians; however, implementation remains challenging. In contrast, mandatory retirement is required for most judges, commercial pilots, and air traffic controllers across all G7 countries.</p><p><strong>Conclusions and relevance: </strong>Explicit policies addressing cognitive decline in aging physicians are uncommon across G7 countries. Marked differences exist between medicine and other safety-critical professions, highlighting ethical, legal, and practical tensions surrounding age-based assessments for physicians. Efforts to integrate age-based assessments in medicine should be viewed within the broader context of population safety and public trust, emphasizing that cognitive screening can serve as a supportive measure for physicians and their patients rather than a punitive tool. Further empirical and policy work is needed to inform equitable and evidence-based strategies to address cognition among aging physicians.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263025"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946192","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":"Out-of-Pocket Payments Among Medicare Beneficiaries Who Reached the Inflation Reduction Act's Part D Spending Cap.","authors":"Alexandra G Hames, Jon Rosen, Insiya B Poonawalla","doi":"10.1001/jamahealthforum.2026.3249","DOIUrl":"10.1001/jamahealthforum.2026.3249","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263249"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002913","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":"Geographic Disparities in Access to Broadband, Ambulance Services, and Health Care and Implications for Telehealth.","authors":"Celia Jewell, Heidi O'Connor, Thomas E Griffin, Sarah M Mah, Brianna L Holston, Erin Troiano, Yvonne C Jonk","doi":"10.1001/jamahealthforum.2026.3290","DOIUrl":"10.1001/jamahealthforum.2026.3290","url":null,"abstract":"<p><strong>Importance: </strong>Telehealth has emerged as an effective way to facilitate access to health care, particularly in rural areas. The extent to which broadband services can sufficiently support the use of telehealth in rural areas with limited access to primary and acute care services is currently unknown.</p><p><strong>Objectives: </strong>To enumerate the extent to which rural residents in the US live in areas lacking broadband, ambulance services, and health care (hereafter referred to as broadband deserts [BBDs], ambulance deserts [ADs], and health care deserts [HCDs], respectively) and to estimate computer ownership and broadband subscription rates.</p><p><strong>Design, setting, and participants: </strong>This population-based cross-sectional study used AD and HCD data from September 2021 to February 2022, compiled from previous studies; broadband serviceable location data from the Federal Communications Commission 2024 Broadband Data Collection project; and the 2020 US Census Demographic and Housing Characteristics. Data were analyzed from November 2024 to July 2025.</p><p><strong>Main outcomes and measures: </strong>The number and percentage of people living in BBDs, ADs, and HCDs were estimated at national, regional, and state geographic levels and by rural residence. Populated census blocks were designated as BBDs if broadband speeds were slower than 100/20 megabits per second, as ADs if individuals lived more than a 25-minute drive from an ambulance station, and as HCDs if individuals lived more than a 30-minute drive from a health care facility.</p><p><strong>Results: </strong>The study included 41 states with a total population of 249.1 million. An estimated 11.9 million people (4.8%) resided in BBDs, with 10.5 million (88.1%) living in rural areas. Among rural residents, 946 278 individuals lived in an AD and HCD intersection with sufficient broadband available to support telehealth, and 649 225 individuals lived in a BBD, AD, and HCD intersection. A total of 95.0% of rural households had a computing device, and 88.5% had a broadband subscription, which was lower than the subscription rate among urban households (92.6%). Western states had the highest percentage of rural residents living in BBDs (31.9%); AD and HCD intersections with sufficient broadband to support telehealth (15.5%); and BBD, AD, and HCD intersections (6.7%).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that 11.9 million people resided in BBDs, with 88.1% living in rural areas; rural households had lower broadband subscription rates than urban households. The findings suggest that broadband remains a critical determinant of health care access and that the potential of telehealth to mitigate gaps in primary, specialty, and emergency care is constrained by inadequate infrastructure and broadband subscription rates.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263290"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002966","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":"Risk Factors for Loss of Hospital-Based Obstetric Care in Rural and Urban Hospitals.","authors":"Julia D Interrante, Caitlin Carroll, Kevan O'Hanlon, Emily C Sheffield, Katy B Kozhimannil","doi":"10.1001/jamahealthforum.2026.3122","DOIUrl":"10.1001/jamahealthforum.2026.3122","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Obstetric care access is declining in the US, with rural and urban hospitals closing obstetric units or closing entirely.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess hospital-level factors associated with obstetric services loss by unit or hospital closure and between rural and urban hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and setting: &lt;/strong&gt;Retrospective cohort study of all US rural and urban hospitals that provided obstetric services in 2010 as identified using 2010 to 2023 data from American Hospital Association Annual Surveys, the Centers for Medicare & Medicaid Services' Provider of Services Files, and primary data from hospital websites and news articles. Data were analyzed November 2025 to April 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Distance to nearest obstetric hospital, birth volume, average daily census, nurse staffing, ownership, Critical Access Hospital status, unprofitability, county unemployment in 2010.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes using adjusted multinomial logistic regression included whether each hospital maintained obstetric services from 2010 to 2023, remained open but closed the obstetric unit by 2023, or closed entirely by 2023; and hospital characteristics in 2023. Outcomes are reported as estimated risk-adjusted predicted probabilities and marginal effects as percentage-point (pp) differences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1126 rural obstetric hospitals open in 2010, 239 (21.2%) closed their unit and 42 (3.7%) closed entirely by 2023; among urban hospitals (n = 1982), 250 (12.6%) units and 92 (4.6%) hospitals closed. Rural and urban hospitals with lower birth volumes had from 8-pp (95% CI, 5.4-10.6 pp) higher predicted probabilities of unit closure for the second highest birth volume quartile to 31-pp (95% CI, 23.2-39.1 pp) higher predicted probabilities for the lowest birth volume quartile and 4-pp (95% CI, 0.7-7.1 pp) higher predicted probabilities of hospital closure for the second lowest birth volume quartile to 8 pp (95% CI, 3.3-12.4 pp) for the lowest birth volume quartile; birth volume had a larger marginal effect in unit than hospital closure. Unprofitable rural hospitals had a 12-pp (95% CI, 6.8-17.5 pp) higher predicted probability of unit closure than profitable ones; for urban hospitals, predicted probabilities were 4 pp (95% CI, 0.1-7.1 pp) higher for unit and 7 pp (95% CI, 3.9-9.7 pp) higher for hospital closure. Rural and urban hospitals near another obstetric hospital had greater than 7-pp (95% CI, 1.6-12.7 pp) higher predicted probabilities of unit closure than those farther away. In rural areas, for-profit hospitals had 13-pp (95% CI, 2.8-22.2 pp) higher predicted probabilities of unit closure and 6-pp (95% CI, 1.6-10.3 pp) higher predicted probabilities for hospital closure vs government-owned hospitals. In urban areas, for-profit status was only associated with hospital closure (4 pp; 95% CI, 1.2-7.6 pp). Among hospitals that maintained","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263122"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946234","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":"Profitability of Nonprofit and For-Profit Ambulatory Surgery Centers.","authors":"Elizabeth Plummer, Kahler Doyle, Ge Bai","doi":"10.1001/jamahealthforum.2026.3332","DOIUrl":"10.1001/jamahealthforum.2026.3332","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263332"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065851","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":"Overlap Between Mandatory and Voluntary Value-Based Kidney Care Model Participation and Home Dialysis Use.","authors":"Sri Lekha Tummalapalli, Yuvaram N V Reddy, Yueming Zhao, Yuhua Bao, Jingsan Zhu, Amol S Navathe","doi":"10.1001/jamahealthforum.2026.3046","DOIUrl":"10.1001/jamahealthforum.2026.3046","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;End-stage renal disease (ESRD) is a focus of Medicare value-based payment models due to suboptimal quality of care and high health care costs. In 2021 and 2022, 2 models were introduced-the mandatory ESRD Treatment Choices (ETC) model and the voluntary Kidney Care Choices (KCC) model-that included complementary incentives to increase home dialysis use. It is important to understand if participation in either or both models, compared with neither model, is associated with an increase in home dialysis use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether overlapping participation by nephrologists in the mandatory and voluntary models was associated with higher home dialysis use compared with participation in either model alone or participation in neither model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used traditional Medicare claims for a 100% sample of beneficiaries with ESRD receiving dialysis attributed to nephrologists premodel (2016-2020) vs postmodel (2022-2023) implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Nephrologist participation in the ETC only, KCC only, or both models vs neither model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Percentage of patients by nephrologist model participation group receiving home dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 839 (14.4%) nephrologists (mean [SD] age, 48.5 [9.7] years; 236 [28.1%] female) were in ETC only, 1798 (30.9%) were in KCC only (mean [SD] age, 47.0 [9.5] years; 416 [23.1%] female), 1124 (19.3%) were in both models (mean [SD] age, 46.6 [8.9] years; 284 [25.3%] female), and 2059 (35.4%) were in neither model (mean [SD] age, 49.6 [10.5] years; 556 [27.0%] female). Nephrologist participation in the mandatory ETC model only was not associated with changes in home dialysis use among their attributed patients receiving dialysis compared with neither model. Participation in the voluntary KCC model only was associated with an 8.4% relative increase (95% CI, 3.0%-13.8%; 0.95 percentage points [pp]; 95% CI, 0.34-1.56 pp) in home dialysis use, and participation in both models was associated with an 11.8% relative increase (95% CI, 5.0%-18.6%; 1.29 pp; 95% CI, 0.55-2.03 pp) compared with neither model. Nephrologist participation in both models was associated with increases in home dialysis use that were similar to participation in KCC only (incremental increase, 0.34 pp; 95% CI, -0.37 to 1.05 pp; P = .34).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that simultaneous participation in mandatory and voluntary kidney care models was common (approximately one-fifth of nephrologists) and associated with increased home dialysis use among patients with ESRD compared with participation in the mandatory payment model only, but not when compared with participation in the voluntary payment model alone. Despite complementary incentives, the results did not suggest a synergistic effect of overlappin","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263046"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946155","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":"Benchmarking Preventive Care Medicaid Rates to Private Payers.","authors":"Meredith Young, Alison Evans Cuellar, Jennifer M Mellor","doi":"10.1001/jamahealthforum.2026.3157","DOIUrl":"10.1001/jamahealthforum.2026.3157","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263157"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892989","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.2025.6027","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.6027","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e256027"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892949","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":"Consolidation of Hospital Affiliations With Group Purchasing Organizations.","authors":"Wei-Hsuan Tseng, Amelia M Bond, Emma B Dean","doi":"10.1001/jamahealthforum.2026.3151","DOIUrl":"10.1001/jamahealthforum.2026.3151","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263151"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946066","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}