JAMA Health Forum最新文献

{"title":"Strengthening Patient Experience Measurement and Improvement.","authors":"Richard Evans, Dale Shaller, Susan Edgman-Levitan, Ingrid M Nembhard","doi":"10.1001/jamahealthforum.2025.1223","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1223","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251223"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188543","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":"Excess US Deaths Before, During, and After the COVID-19 Pandemic.","authors":"Jacob Bor, Rafeya V Raquib, Elizabeth Wrigley-Field, Steffie Woolhandler, David U Himmelstein, Andrew C Stokes","doi":"10.1001/jamahealthforum.2025.1118","DOIUrl":"10.1001/jamahealthforum.2025.1118","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251118"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129054","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":"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":"Postpartum Care Differences in LGBTQ+ and Non-LGBTQ+ Individuals.","authors":"Kevin H Nguyen, Jamie R Daw, Heidi L Allen","doi":"10.1001/jamahealthforum.2025.0672","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0672","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250672"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994735","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":"SNAP Work Requirements Reversal and Program Enrollment.","authors":"Hannah Factor, Jacob Wallace, Matthew Lavallee, Anthony Lollo, Chima D Ndumele","doi":"10.1001/jamahealthforum.2025.1587","DOIUrl":"10.1001/jamahealthforum.2025.1587","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251587"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188542","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":"Toward Integrating Care for Dually Eligible Beneficiaries.","authors":"Rachel M Werner, Julia Hinckley, Eric T Roberts","doi":"10.1001/jamahealthforum.2025.1112","DOIUrl":"10.1001/jamahealthforum.2025.1112","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251112"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057677","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":"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":"Medicare Eligibility and Health Care Use Among Adults With Psychological Distress.","authors":"Sungchul Park, Katherine A Koh, Michael Liu, Rishi K Wadhera","doi":"10.1001/jamahealthforum.2025.1089","DOIUrl":"10.1001/jamahealthforum.2025.1089","url":null,"abstract":"<p><strong>Importance: </strong>Although Medicare provides nearly universal health insurance coverage for individuals aged 65 years or older, clinicians and policymakers have expressed concern about access to and coverage of mental health services in the program. It is unclear how transitioning to Medicare affects adults with psychological distress, who may be particularly vulnerable to changes in mental health services.</p><p><strong>Objectives: </strong>To examine the association of Medicare eligibility with use of mental health care, general health care, and acute care services among adults with psychological distress.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study using the 2009-2019 Medical Expenditure Panel Survey and a regression discontinuity design, health care use among adults aged 59 to 64 years and those aged 66 to 71 years with psychological distress, defined as those who scored 3 or higher on the 2-item Patient Health Questionnaire or 13 or higher on the 6-item Kessler Psychological Distress Scale, was evaluated. Data were analyzed from March 2023 to February 2025.</p><p><strong>Exposures: </strong>Medicare eligibility at age 65 years.</p><p><strong>Main outcomes: </strong>Mental health care use, including outpatient mental heath visits and psychotropic medication fills, general health care use, and acute care use.</p><p><strong>Results: </strong>The study population included 3970 adults with psychological distress (mean [SD] age, 64.0 [3.6] years; 59.7% [n = 2370] female). Medicare eligibility at age 65 years was associated with a decrease in outpatient mental health visits with any health care professional (adjusted change of -3.4 percentage points [95% CI, -5.4 to -1.4 percentage points]), no change in mental health visits with psychiatrists (-0.7 percentage points [95% CI, -4.1 to 2.6 percentage points]), and a decrease in psychotropic medication fills (-5.3 percentage points [95% CI, -10.3 to -0.3 percentage points]) among adults with psychological distress. There was no change in general health care use, including all outpatient visits (0.6 percentage points [95% CI, -5.4 to 6.5 percentage points]) and prescription drug use (0.1 percentage points [95% CI, -2.2 to 2.5 percentage points]). In contrast, Medicare eligibility was associated with increases in acute care use, such as inpatient admissions (5.5 percentage points [95% CI, 2.2-8.9 percentage points]) and emergency department visits (8.1 percentage points [95% CI, 3.3-13.0 percentage points]) among adults with psychological distress.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that Medicare eligibility at age 65 years was associated with decreased use of mental health outpatient services and increased acute care use among adults with psychological distress. These findings highlight the need for policies that address gaps in mental health care in the Medicare program.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251089"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188540","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}