JAMA Health Forum最新文献

{"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":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposures: </strong>Nephrologist participation in the ETC only, KCC only, or both models vs neither model.</p><p><strong>Main outcomes and measures: </strong>Percentage of patients by nephrologist model participation group receiving home dialysis.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions and relevance: </strong>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}

{"title":"Cost-Effectiveness of Community-Based Rehabilitation for People With Schizophrenia: A Secondary Analysis of a Cluster Randomized Trial.","authors":"Ruoxi Ding, Miaomiao Zhao, Yanshang Wang, Yiqi Xia, Xiaolong Guan, Zhenyu Shi, Ping He","doi":"10.1001/jamahealthforum.2026.3280","DOIUrl":"10.1001/jamahealthforum.2026.3280","url":null,"abstract":"<p><strong>Importance: </strong>Schizophrenia imposes a substantial disease burden in resource-constrained settings such as China, yet rigorous evidence on the cost-effectiveness of community-based rehabilitation (CBR) remains limited.</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of a group-based CBR intervention plus facility-based care (FBC) compared with FBC alone for adults with schizophrenia in China.</p><p><strong>Design, setting, and participants: </strong>This prespecified secondary analysis evaluated a cluster randomized trial conducted across 18 urban and rural subdistricts in Weifang, Shandong Province, China, from March 2023 to October 2024. Participants were community-dwelling, clinically stable adults aged 18 to 59 years with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of schizophrenia and illness duration of at least 12 months.</p><p><strong>Intervention: </strong>The CBR program comprised 18 group sessions over 12 months (12 biweekly sessions, then 6 monthly sessions) covering psychoeducation, medication adherence, physical health promotion (including tai chi), life and social skills training, and caregiver support. FBC consisted of psychiatrist-led medication management and monthly consultations.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were incremental cost per quality-adjusted life-year (QALY) gained and per-unit improvement in symptom severity (Positive and Negative Syndrome Scale [PANSS]), social functioning (Personal and Social Performance Scale [PSP]), and caregiver burden (Burden Assessment Scale [BAS]), assessed from health care system, multipayer, and societal perspectives.</p><p><strong>Results: </strong>A total of 334 participants were enrolled and randomized; 172 were randomized to CBR plus FBC and 162 to FBC alone. At 12 months, 161 participants (93.6%) and 154 participants (95.0%) were retained, respectively. Mean (SD) baseline age was 46.7 (9.3) years; 180 participants (53.9%) were male; 204 (61.1%) resided in rural areas. CBR was associated with significantly improved clinical outcomes and lower costs at 12 months. Incremental cost-effectiveness ratios indicated savings of $24 636 to $27 847 per QALY gained across perspectives, with $20.70 to $46.90 saved per unit improvement in PANSS, PSP, and BAS scores. The probability of cost-effectiveness ranged from 91.0% to 98.7% for QALYs and exceeded 95% for clinical outcomes at derived threshold values of $24.30 to $52.00 per unit. Sensitivity analyses confirmed robustness.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a cluster randomized trial, group-based CBR for schizophrenia in China was associated with improved outcomes and a high probability of cost savings, supporting its scaled implementation in resource-constrained settings.</p><p><strong>Trial registration: </strong>ChiCTR.org.cn Identifier: ChiCTR2200","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263280"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002843","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":"Mental Health Utilization Gap by Insurance Type Among US Adults With Chronic Pain.","authors":"Fenan S Rassu, Kevin J Psoter, Claudia M Campbell, Stephen T Wegener, Rachel V Aaron, Richard L Skolasky","doi":"10.1001/jamahealthforum.2026.2946","DOIUrl":"10.1001/jamahealthforum.2026.2946","url":null,"abstract":"<p><strong>Importance: </strong>Chronic pain affects roughly 50 million US adults and often co-occurs with mental health conditions. Although mental health treatment can improve outcomes, little is known about how insurance type relates to utilization among adults with chronic pain.</p><p><strong>Objective: </strong>To examine how insurance type relates to mental health service utilization among adults with chronic pain, whether this association varies by mental health need, and cost-related barriers to care.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed data from the National Institutes of Health's All of Us Research Program Mental Health and Well-Being off-cycle survey. Survey responses spanned June 2018 through September 2023. Participants were adults aged 18 years or older at survey completion with a chronic pain diagnosis documented before survey completion. Data were analyzed in January 2026.</p><p><strong>Exposures: </strong>Insurance type: private only (reference), Medicare only, Medicare plus supplement, Medicaid only, dual eligible, military or Veterans Affairs (VA), and other.</p><p><strong>Main outcomes and measures: </strong>Self-reported mental health professional visit in the past 12 months (primary) and cost-related barrier to needed mental health care (secondary). The utilization gap was defined as the percentage of participants with mental health need who reported no utilization.</p><p><strong>Results: </strong>Among 36 275 adults with chronic pain (mean [SD] age, 57.2 [15.0] years; 68.0% female), 34.0% reported seeing a mental health professional in the past 12 months. Among 7305 with mental health need, the utilization gap was 34.2% (n = 2497). Gaps varied by insurance: military or VA, 18.7% (95% CI, 15.8%-21.7%); dual eligible, 25.9% (95% CI, 22.8%-29.0%); Medicaid, 34.8% (95% CI, 32.8%-36.7%); Medicare, 36.6% (95% CI, 33.7%-39.7%); private, 40.9% (95% CI, 38.8%-43.0%), a private vs military or VA difference of 22.2 (95% CI, 18.6-25.6) percentage points. Cost-related barriers were highest among the privately insured (532 of 2070 [25.7%]) and lowest among military or VA enrollees (50 of 626 [8.0%]; adjusted prevalence ratio, 0.42; 95% CI, 0.32-0.55).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, among adults with chronic pain and mental health need, utilization gaps were more than double under private insurance vs military or VA coverage, and cost barriers were substantially more common among the privately insured. These patterns are consistent with a role for affordability and integrated care delivery, though cross-sectional data cannot distinguish insurance design from selection into coverage types.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e262946"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892931","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":"Roles for AI in Implementation of Medicaid Work Requirements.","authors":"Michelle M Mello, Himaja Nagireddy","doi":"10.1001/jamahealthforum.2026.4102","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.4102","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e264102"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889184","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":"Designing Social Media Health Warnings for Teenagers and Young Adults: A Randomized Clinical Trial.","authors":"Anna H Grummon, Clayton Ulm, Amanda B Zeitlin, Marissa G Hall, Jennifer Falbe, Nathan A Kline, Thomas N Robinson","doi":"10.1001/jamahealthforum.2026.3014","DOIUrl":"10.1001/jamahealthforum.2026.3014","url":null,"abstract":"<p><strong>Importance: </strong>Social media use is nearly ubiquitous among US teenagers and young adults and has been associated with increased risk for negative health outcomes such as depression and anxiety. Policymakers in several states have proposed or adopted policies requiring warnings on social media platforms.</p><p><strong>Objective: </strong>To test whether teenagers and young adults perceive that social media warnings discourage them from wanting to use social media and increase their awareness of the harms of social media.</p><p><strong>Design, setting, and participants: </strong>This within-participants randomized clinical trial was conducted online in December 2025 among US teenagers and young adults aged 13 to 29 years.</p><p><strong>Interventions: </strong>Participants viewed 15 messages shown in random order: 13 health warnings about different harms (eg, negative body image, and depression and anxiety), a screen time break warning similar to messages voluntarily displayed on some social media platforms, and a neutral control message. Messages were displayed on a mock social media page.</p><p><strong>Main outcomes and measures: </strong>Participants rated each message on a 1 to 5 scale for perceived message effectiveness for discouraging social media use (primary outcome) and awareness of the harms of social media (secondary outcome). Linear mixed models were used to estimate differences in outcomes between message topics, expressed as average differential effects (ADEs).</p><p><strong>Results: </strong>A total of 1012 participants (mean [SD] age, 19.3 [4.5] years; 509 women and girls [50%], 491 men and boys [49%], and 12 individuals who identified as nonbinary or another gender [1%]) completed the study. Participants perceived all health warnings as well as the screen time break warning as more effective than the control message (range of ADEs, 0.32 [95% CI, 0.24 to 0.41] to 0.62 [95% CI, 0.53 to 0.71]). Participants perceived all health warnings as more effective than the screen time break warning (range of ADEs, 0.16 [95% CI, 0.08 to 0.24] to 0.30 [95% CI, 0.22 to 0.37]), except for the health warning about addiction (ADE, 0.07 [95% CI, -0.004 to 0.14]). Similarly, participants perceived all warnings as increasing their awareness of the harms of social media more than the control message (range of ADEs, 0.19 [95% CI, 0.10 to 0.28] to 0.63 [95% CI, 0.54 to 0.72]) and all health warnings as increasing their awareness more than the screen time break warning (range of ADEs, 0.21 [95% CI, 0.13 to 0.28] to 0.44 [95% CI, 0.36 to 0.52]).</p><p><strong>Conclusions and relevance: </strong>These findings of this randomized clinical trial suggest that requiring warnings on social media platforms could increase awareness of the harms of social media and discourage teenagers and young adults from wanting to use social media.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT07199660.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263014"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892945","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":"Prediction Markets in Clinical Trials and Drug Approval.","authors":"Genevieve P Kanter","doi":"10.1001/jamahealthforum.2026.2953","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2953","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e262953"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065860","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}