JAMA Health Forum最新文献

{"title":"Contemporary Patterns of End-of-Life Care Among Medicare Beneficiaries With Advanced Cancer.","authors":"Youngmin Kwon, Xin Hu, Kewei Sylvia Shi, Jingxuan Zhao, Changchuan Jiang, Qinjin Fan, Xuesong Han, Zhiyuan Zheng, Joan L Warren, K Robin Yabroff","doi":"10.1001/jamahealthforum.2024.5436","DOIUrl":"10.1001/jamahealthforum.2024.5436","url":null,"abstract":"<p><strong>Importance: </strong>Considerable efforts have been dedicated to improving the quality of end-of-life care among patients with advanced cancer in the past decade. Whether the quality has shifted in response to these efforts remains unknown.</p><p><strong>Objective: </strong>To examine contemporary patterns of end-of-life care among patients with advanced cancer.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used a recent linkage of Surveillance, Epidemiology, and End Results and Medicare data to characterize patterns of end-of-life care. The cohort included fee-for-service Medicare decedents aged 66 years or older who were originally diagnosed with distant-stage breast, prostate, pancreatic, or lung cancers and died between 2014 and 2019. Analyses were conducted between June 1, 2023, and July 31, 2024.</p><p><strong>Main outcomes and measures: </strong>Outcomes included monthly use of acute care, systemic therapy, and supportive care (ie, palliative and hospice care and advanced care planning) in the last 6 months of life. Additionally, a claims-based indicator was evaluated of potentially aggressive care in the last 30 days of life, defined as experiencing more than 1 acute care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry.</p><p><strong>Results: </strong>The study included 33 744 Medicare decedents with advanced cancer (mean [SD] age, 75.7 [6.9] years; 52.1% male). From 6 months before death to month of death, there was an increase in the mean (SE) number of acute care visits (from 14.0 [0.5] to 46.2 [0.5] per 100 person-months), hospice use (from 6.6 [0.4] to 73.5 [0.5] per 100 person-months), palliative care (from 2.6 [0.2] to 26.1 [0.6] per 100 person-months), and advanced care planning (from 1.7 [0.6] to 12.8 [1.1] per 100 person-months). Overall, 45.0% of decedents experienced any indicator of potentially aggressive care.</p><p><strong>Conclusions and relevance: </strong>This study found persistent patterns of potentially aggressive care, but low uptake of supportive care, among Medicare decedents with advanced cancer. A multifaceted approach targeting patient-, physician-, and system-level factors associated with potentially aggressive care is imperative for improving quality of care at the end of life.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 2","pages":"e245436"},"PeriodicalIF":9.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469961","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":"Overpayment for Generic Drugs Under Medicare Part D.","authors":"Inmaculada Hernandez, Nico Gabriel, Yuvraj Pathak, Ryan N Hansen, Sean D Sullivan","doi":"10.1001/jamahealthforum.2025.0012","DOIUrl":"10.1001/jamahealthforum.2025.0012","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 2","pages":"e250012"},"PeriodicalIF":9.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525235","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 and Ethnic Differences in Out-of-Pocket Spending for Maternity Care.","authors":"Rebecca A Gourevitch, Jessica L Cohen, Tara Shakley, Katie Camacho Orona, Sung Min Park, Mary Beth Landrum, Meredith B Rosenthal, Mark W Friedberg, Anna D Sinaiko","doi":"10.1001/jamahealthforum.2024.5565","DOIUrl":"10.1001/jamahealthforum.2024.5565","url":null,"abstract":"<p><strong>Importance: </strong>Rising out-of-pocket costs of maternal health care for people with commercial insurance may affect use of health care and outcomes. There are stark racial and ethnic disparities in outcomes, but little is known about differences in spending.</p><p><strong>Objective: </strong>To measure differences in out-of-pocket spending for maternity care by race and ethnicity.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study used administrative data from Blue Cross Blue Shield of Massachusetts from January 1, 2018, through December 31, 2022, for pregnancies, deliveries, and 42-day postpartum care. Participants were continuously enrolled during pregnancy, delivery, and 42 days post partum (collectively termed maternity episode).</p><p><strong>Exposures: </strong>The primary characteristic of interest was the birthing person's race and ethnicity.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was total out-of-pocket spending during the maternity episode. Out-of-pocket spending was measured separately for the pregnancy period, prenatal services, and delivery, by type of cost sharing, and as a percentage of the median household income in the patient's census tract (using American Community Survey data). Race and ethnicity were measured via self-report and imputation.</p><p><strong>Results: </strong>The analytic sample included 87 253 maternity episodes among 76 826 unique birthing persons (mean [SD] age, 32.4 [4.7] years; 99.8% female) between 2018 and 2022; among maternity episodes, 8572 birthing persons (9.8%) were Asian, 3331 (3.8%) were Black, 6872 (7.9%) were Hispanic, and 68 478 (78.5%) were White. Mean out-of-pocket spending for the maternity episode was highest among Black birthing people ($2398 [$426]), followed by Hispanic ($2300 [$572]), Asian ($2202 [$603]), and White ($2036 [$1547]) birthing people (P < .001). These differences remained statistically significant after adjusting for health and demographic characteristics. The differences were largest in the prenatal period and for coinsurance payments. Black (1003 [30.1%]) and Hispanic (2302 [33.5%]) birthing people were more likely than Asian (1569 [18.3%]) and White (12 600 [18.4%]) birthing people to be enrolled in plans with high coinsurance, but not plans with high deductibles (3317 [38.7%] for Asian, 1232 [37.0%] for Black, 2350 [34.2%] for Hispanic, and 24 515 [35.8%] for White birthing people).</p><p><strong>Conclusions and relevance: </strong>In this study, differences in out-of-pocket maternity spending among the commercially insured were associated with differences in coinsurance rates. These costs could lead people to forgo needed health care or other basic needs that support health (eg, food or housing). Changes to health plan benefit design could improve equity in out-of-pocket maternity spending and its consequences.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 2","pages":"e245565"},"PeriodicalIF":9.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525236","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 Value of Academic Health Research.","authors":"Sandro Galea, Kirsten Bibbins-Domingo","doi":"10.1001/jamahealthforum.2025.0509","DOIUrl":"10.1001/jamahealthforum.2025.0509","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 2","pages":"e250509"},"PeriodicalIF":9.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442543","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-Paving the Way for the Future of Health Policy Science and Scholarship.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2024.4677","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4677","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e244677"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923896","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":"Advanced Child Tax Credit Monthly Payments and Substance Use Among US Parents.","authors":"J Travis Donahoe, Brittany L Brown-Podgorski, Sabin Gaire, Elizabeth E Krans, Marian Jarlenski","doi":"10.1001/jamahealthforum.2024.4699","DOIUrl":"10.1001/jamahealthforum.2024.4699","url":null,"abstract":"<p><strong>Importance: </strong>2021 Advance child tax credit (ACTC) monthly payments were associated with reduced US child poverty rates; however, policymakers have expressed concerns that permanent adoption would increase parental substance use.</p><p><strong>Objective: </strong>To assess whether 2021 ACTC monthly payments were temporally associated with changes in substance use among parents compared with adults without children.</p><p><strong>Design, setting, and participants: </strong>The primary sample included adults aged 18 to 64 years who responded to the National Survey on Drug Use and Health in 2021. Difference-in-differences models were used to test whether substance use changed for parents compared with adults without children after ACTC monthly payments went into effect. Additional National Survey on Drug Use and Health data from 2018 to 2020 were used to assess pretrends in substance use for parents and adults without children. Analyses were survey weighted and conducted from September 2023 to November 2024. The treatment group was defined as adults with dependent children in the home who would have been eligible for the tax credit from July to December 2021. Adults without children, who would not have been eligible for the tax credit, comprised the comparison group.</p><p><strong>Main outcomes and measures: </strong>Outcomes included binary measures of any self-reported use of tobacco, alcohol, cannabis, and illicit substances (eg, cocaine, opioids, or other stimulants or sedatives) during the previous 30 days; counts of the number of days of use of tobacco, alcohol, cannabis, and illicit substances during the previous 30 days among people who used these substances; and counts of the number of cigarettes and alcoholic beverages consumed during the previous 30 days among people who used these substances.</p><p><strong>Results: </strong>Of 41 853 adults, 17 308 were parents and 24 545 were adults without children. ACTC monthly payment implementation was associated with a -4.3-percentage point (95% CI, -6.6 to -2.0) decline in the probability of using tobacco during the previous 30 days for parents compared with adults without children. Among parents who smoked, payments were associated with a -46.8-percentage point (95% CI, -93.1 to -0.5) decline in the number of cigarettes smoked during the previous 30 days. Estimated changes in the probability, frequency, and quantity of other substance use (alcohol, cannabis, and illicit substances) for parents were null and not significant.</p><p><strong>Conclusions: </strong>The study results suggest that 2021 ACTC monthly payments were not associated with increased parental substance use.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e244699"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923888","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 Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act.","authors":"Renuka Tipirneni, Eric T Roberts, Helen G Levy, Andrei R Stefanescu, Kenneth M Langa, Kara Zivin, Donovan T Maust, John Z Ayanian","doi":"10.1001/jamahealthforum.2024.5025","DOIUrl":"10.1001/jamahealthforum.2024.5025","url":null,"abstract":"<p><strong>Importance: </strong>The Affordable Care Act (ACA) expanded Medicaid and Marketplace insurance to nonelderly adults in 2014, but whether these policies improved outcomes later in life is unknown.</p><p><strong>Objective: </strong>To examine whether exposure to ACA expansions during middle age (50-64 years) was associated with changes in health, utilization, and spending after these adults entered Medicare at 65 years of age.</p><p><strong>Design, setting, and participants: </strong>This serial analysis of the Health and Retirement Study cohort linked to Medicare enrollment and claims data from January 1, 2010, to December 31, 2018. Adults aged 65 to 68 years entering Medicare after the ACA (exposed to ACA expansions during middle age) were compared with adults entering Medicare before the ACA (4452 person-years). Interrupted time series analyses were used to assess overall changes associated with exposure to ACA expansions and difference-in-differences analyses to isolate changes associated with Medicaid expansion among low-income adults (incomes ≤400% of the federal poverty level for any ACA coverage and ≤138% for Medicaid expansion coverage). Data were analyzed from March 1, 2023, to May 1, 2024.</p><p><strong>Exposures: </strong>ACA coverage expansion overall in 2014 and Medicaid expansion as of 2018.</p><p><strong>Main outcomes and measures: </strong>Health (self-reported overall, activities of daily living [ADL], instrumental ADL, and depressive symptoms), utilization (outpatient visits, emergency department visits, and hospital admission), and costs (self-reported out-of-pocket and Medicare costs).</p><p><strong>Results: </strong>Among the analytic sample of 2782 participants (mean age, 66.4 [95% CI, 66.3-66.5] years), a weighted 59.1% (95% CI, 55.3%-62.7%) were female. In interrupted time series analyses, reductions across cohorts were found in use of chronic disease medications (-5.0 [95% CI, -9.8 to -0.3] percentage points), hospitalizations per year (-0.2 [95% CI, -0.4 to -0.03]), and out-of-pocket costs (-$417 [95% CI, -$694 to -$139]) but no significant changes across cohorts in health status, outpatient or emergency visits, or Medicare costs. In difference-in-differences analyses relative to nonexpansion states, greater reductions were found in the number of ADL limitations (-0.4 [95% CI, -0.8 to -0.02]) and lesser reductions in out-of-pocket costs ($900 [95% CI, $275-$1526]) in Medicaid expansion states but otherwise similar changes in other outcomes.</p><p><strong>Conclusions and relevance: </strong>This study found modest evidence of reductions in out-of-pocket costs and improvements in health among adults entering Medicare after the ACA. Insurance coverage and financial assistance should be preserved and enhanced to improve health and health care access among vulnerable older adults.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e245025"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016118","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":"Error in Funding/Support in Article Information.","authors":"","doi":"10.1001/jamahealthforum.2024.5462","DOIUrl":"10.1001/jamahealthforum.2024.5462","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e245462"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068675","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":"Persistence of Social Norms Feedback on Postsurgery Opioid Prescribing Behavior: Secondary Analysis of a Randomized Clinical Trial.","authors":"Kyle A Zanocco, Zachary Wagner, Louis T Mariano, Allison Kirkegaard, Xiaowei Yan, Craig R Fox, Noah J Goldstein, Chad M Brummett, Katherine E Watkins","doi":"10.1001/jamahealthforum.2024.5279","DOIUrl":"10.1001/jamahealthforum.2024.5279","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e245279"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069066","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":"Marketing and Safety Concerns for Compounded GLP-1 Receptor Agonists.","authors":"T Joseph Mattingly, Rena M Conti","doi":"10.1001/jamahealthforum.2024.5015","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.5015","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e245015"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016119","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}