JAMA Health Forum最新文献

{"title":"Telehealth Use in Community Health Clinics by Ethnicity and Language.","authors":"Miguel Marino, Dang Dinh, Jennifer A Lucas, Gretchen Mertes, Nathalie Huguet, Beverly B Green, John Heintzman","doi":"10.1001/jamahealthforum.2025.3336","DOIUrl":"10.1001/jamahealthforum.2025.3336","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253336"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978270","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 Engagement and Transparency in Public Health Policymaking.","authors":"Joshua M Sharfstein","doi":"10.1001/jamahealthforum.2025.4252","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.4252","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e254252"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796106","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":"Prescription Drug Utilization and Spending by Race, Ethnicity, Payer, Health Condition, and US State.","authors":"Maitreyi Sahu, Tyler D Wagner, Azalea Thomson, Meera Beauchamp, Jonathan D Campbell, Sawyer Crosby, Drew DeJarnatt, Haley Lescinsky, Rayan K Salih, Kayla Taylor, Maxwell Weil, Laura Dwyer-Lindgren, Annie Haakenstad, John W Scott, Andy Stergachis, Utibe R Essien, Joseph L Dieleman","doi":"10.1001/jamahealthforum.2025.2329","DOIUrl":"10.1001/jamahealthforum.2025.2329","url":null,"abstract":"<p><strong>Importance: </strong>Achieving equitable access to medicines requires understanding of how pharmaceutical use and spending vary by race and ethnicity across the US.</p><p><strong>Objective: </strong>To quantify variation in prescription drug utilization and spending per capita and per prevalent case by race, ethnicity, health condition, payer, and US state.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, the US Disease Expenditure project was extended to incorporate disaggregation by race and ethnicity for state-level retail prescription drug utilization and spending-in addition to 143 health conditions, 38 age and sex groups, and 4 payers (Medicare, Medicaid, private insurance, and out of pocket)-across the 2019 population in all 50 states and Washington, DC. Data were analyzed from October 2023 to April 2025.</p><p><strong>Exposure: </strong>Four mutually exclusive racial and ethnic groups (Asian or Pacific Islander, Black, Hispanic, and White).</p><p><strong>Main outcome and measures: </strong>Outcomes include prescriptions dispensed and spending for retail pharmaceuticals. Estimates were standardized by population size, population age, and-where data permitted-by disease burden (52 conditions). Das Gupta decomposition was used to estimate the relative contribution of 3 factors (disease prevalence, prescriptions per prevalent case, and spending per prescription) on observed disparities in age-standardized per capita pharmaceutical spending.</p><p><strong>Results: </strong>In 2019, age-standardized pharmaceutical utilization and spending per person with a given disease was substantially lower than the all-population mean for Black populations, close to the mean for Hispanic populations, and often higher than the mean for Asian or Pacific Islander and White populations. These trends-particularly those for the Black population-were generally consistent across 52 health conditions but varied widely across payers and US states. The decomposition analysis for these 52 conditions showed that differences in per capita pharmaceutical spending across race and ethnicity groups were primarily explained by disease prevalence for Black populations (associated with increased per capita spending) and by utilization rates per prevalent case for Hispanic populations (also associated with increased spending). In contrast, differences in drug price or product type (spending per prescription) contributed less to observed spending disparities.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, racial and ethnic disparities in medication use persisted, most notably the underutilization of medicines relative to disease burden among Black populations. These patterns varied by state, highlighting the need for local- and condition-specific approaches to advancing pharmacoequity in the US.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252329"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800905","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 Hospital Inpatient-Outpatient Payment Differential-An Opportunity to Reduce Costs and Improve Fairness.","authors":"David H Howard","doi":"10.1001/jamahealthforum.2025.3293","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3293","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253293"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978338","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":"Inaction on Artificial Intelligence Regulation in a Time of Upheaval.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2025.1246","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1246","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251246"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610312","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":"COVID-19 Vaccination Saved Lives and This Matters in 2025.","authors":"Monica Gandhi","doi":"10.1001/jamahealthforum.2025.2237","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2237","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e252237"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709877","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":"Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates.","authors":"David J Meyers, Eliza Macneal, Kendra Offiaeli, Eric T Roberts","doi":"10.1001/jamahealthforum.2025.1748","DOIUrl":"10.1001/jamahealthforum.2025.1748","url":null,"abstract":"<p><strong>Importance: </strong>Medicare beneficiaries dually enrolled in Medicare and Medicaid have some of the highest care needs. Finding ways to support dually eligible beneficiaries in the Medicare Advantage (MA) program has become a policy goal.</p><p><strong>Objective: </strong>To determine if enrollment in different MA plan types is associated with differences in disenrollment.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included Medicare enrollment data from dually eligible Medicare beneficiaries in 2021. Analyses were conducted between March 2024 and February 2025. Data were analyzed from January through March 2025.</p><p><strong>Exposure: </strong>Enrollment in different MA plan types, including those that exclusively serve dual-eligible beneficiaries (coordination-only, dual-eligible special needs plans [D-SNPs] and fully integrated D-SNPs [FIDE-SNPs]), standard MA plans that serve dual-eligible and non-dual-eligible beneficiaries, and D-SNP look-alike plans, defined as standard MA plans that primarily enroll dual-eligible beneficiaries.</p><p><strong>Main outcomes and measures: </strong>One-year disenrollment from one plan to another or to traditional Medicare.</p><p><strong>Results: </strong>Among 2 698 434 dually eligible beneficiaries in 2021, the mean (SD) age was 66.9 (14.1) years, and 62.5% were female individuals. Of dual-eligible beneficiaries enrolled in FIDE-SNPs in 2021, 19 001 (8.1%) disenrolled by 2022. Of those enrolled in coordination-only D-SNPs, D-SNP look-alikes, and standard MA plans in 2021, disenrollment rates were 18.3%, 30.5%, and 28.2%, respectively. Disenrollment rates were higher for Black beneficiaries and those who used more health services, including inpatient stays and more days of nursing home care.</p><p><strong>Conclusions and relevance: </strong>The results of this cross-sectional study suggest that FIDE-SNPs retained their members at higher rates, which could be a sign of improved care experiences. Understanding how FIDE-SNPs may be affecting patient care will be important moving forward.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251748"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555707","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":"Projected Health System and Economic Impacts of 2025 Medicaid Policy Proposals.","authors":"Sanjay Y Basu, Sadiq Patel, Seth A Berkowitz","doi":"10.1001/jamahealthforum.2025.3187","DOIUrl":"10.1001/jamahealthforum.2025.3187","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e253187"},"PeriodicalIF":11.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644149","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 Problem With California's Plan to Contain Health Care Costs.","authors":"Lanhee J Chen","doi":"10.1001/jamahealthforum.2025.3383","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3383","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e253383"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602190","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":"Measurement Bias in Documentation of Social Risk Among Medicare Beneficiaries.","authors":"Paula Chatterjee, Eliza Macneal, Eric T Roberts","doi":"10.1001/jamahealthforum.2025.1923","DOIUrl":"10.1001/jamahealthforum.2025.1923","url":null,"abstract":"<p><strong>Importance: </strong>Health care organizations are increasingly measuring social risk using Z codes. Types of social risk captured in Z codes include issues related to employment, housing, education, or other psychosocial circumstances. Prior work has found low use of Z codes overall, but measurement may be biased in other ways that have implications for risk adjustment and resource allocation.</p><p><strong>Objective: </strong>To characterize Z code measurement among hospitalized Medicare beneficiaries across levels of clinical complexity and historical health care utilization and examine implications of these patterns for mortality prediction.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included Medicare beneficiaries with an inpatient hospital admission in 2022. Data were analyzed from May 2024 to June 2025.</p><p><strong>Main outcomes and measurements: </strong>Presence of Z codes (codes Z55 to Z65) in any diagnosis field for a hospital admission, variation in Z code documentation across beneficiaries categorized by clinical risk (Elixhauser Comorbidity Index risk scores and predicted 30-day mortality risk) and historical utilization levels (number of hospitalizations in the prior year), and the association between Z code documentation and observed 30-day mortality, controlling for hospital fixed effects.</p><p><strong>Results: </strong>Among 7 069 611 hospitalized Medicare beneficiaries in 2022, 3 816 420 (54.0%) were female, and 6 093 932 (86.1%) were 65 years or older. A total of 148 592 (2.1%) had at least 1 Z code on the index hospital claim. Within-hospital Z code prevalence was higher for beneficiaries with lower Elixhauser Comorbidity Index clinical risk scores (2.8% vs 1.5%) and higher among patients with at least 2 hospitalizations in the prior year (2.6%) than patients with zero (1.8%) or 1 (2.1%) prior hospitalizations. Despite known population-level associations between social risk and increased mortality, Z code prevalence was highest among beneficiaries with the lowest predicted 30-day mortality risk (4.4%) and lowest among beneficiaries with the highest mortality risk (1.6%). Correspondingly, in within-hospital analyses that did not adjust for patient-level covariates such as demographic characteristics and clinical risk, the presence of a Z code was associated with a lower probability of observed 30-day mortality (5.1% vs 4.2%; difference, -0.9 percentage points; 95% CI, -1.0 to -0.8).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that Z code use patterns likely underrepresent social risk among clinically complex patients, resulting in a spurious negative association between documented social risk and mortality. Alternative socioeconomic indicators, including data collected for population and public health surveillance, may offer more reliable measures of social risk than Z codes.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251923"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661061","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}