Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

{"title":"Digital Access and Primary Care Use in Chronic Disease Management: Preliminary Evidence From Three Caribbean Cities in Colombia.","authors":"Mario de la Puente, Hernán Guzmán, Denis Adriana González Sánchez, Anderson Domínguez, Juan Lamby","doi":"10.1177/00469580261463910","DOIUrl":"10.1177/00469580261463910","url":null,"abstract":"<p><p>IntroductionChronic disease management depends on sustained interaction with primary care services, yet these interactions may be shaped by digital inequalities in urban middle-income settings. This study examines whether household digital access is associated with differences in primary care utilization and hospitalization outcomes among adults with chronic diseases in three Caribbean cities of Colombia: Barranquilla, Cartagena, and Santa Marta.MethodsThis study used a quantitative, observational, cross-sectional, and exploratory design based on secondary anonymized data from national household surveys, SISPRO administrative health records, and national ICT indicators. The analytical sample included adults aged 18 years and older living in urban households in Barranquilla, Cartagena, and Santa Marta who had at least one chronic disease identified through survey or administrative records and had complete information for the dependent variable and all covariates included in the multivariable models. Individuals younger than 18 years, residents of rural areas, persons without evidence of chronic disease, and observations with missing data in key analytical variables were excluded. Descriptive comparisons were combined with binary logistic regression models including household internet access, age, gender, education, income quintile, insurance regime, and city fixed effects, and a probit model was estimated as a robustness check.ResultsDescriptive findings show that individuals living in households with internet access reported more primary care visits than those without access. Across the pooled sample, predicted probabilities of hospitalization were lower among individuals with household internet access, with the largest difference observed in Santa Marta. The robustness analysis using a probit specification confirmed the same negative association between household internet access and hospitalization probability.ConclusionThe findings provide preliminary evidence that household digital access is associated with greater primary care utilization and lower hospitalization risk among adults with chronic diseases in the three cities studied. Although the cross-sectional design does not allow causal inference, the results suggest that digital inclusion may be a relevant complementary component of primary care-centered strategies for chronic disease management in urban middle-income contexts.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261463910"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public-Private Partnership Governance in Health System Transformation: Stakeholder Evidence From Saudi Arabia's Vision 2030.","authors":"Nada Abdullah Alsubki, Saad Abdullah Alghanim","doi":"10.1177/00469580261444278","DOIUrl":"10.1177/00469580261444278","url":null,"abstract":"<p><p>Under Saudi Arabia's Vision 2030, public-private partnerships (PPPs) have become a key mechanism for implementing the Health Sector Transformation Program (HSTP). However, limited quantitative evidence identifies which governance capacities stakeholders perceive as most critical to PPP implementation. This study examines how health sector stakeholders assess PPP governance and how key governance dimensions relate to perceived achievement of HSTP objectives. An exploratory cross-sectional survey was conducted among 505 public and private stakeholders in Riyadh with knowledge of healthcare PPPs. A structured questionnaire assessed 3 governance capacities regulatory financial governance, technical capacity, and institutional risk climate and their perceived contribution to HSTP objectives. Data were analyzed using exploratory factor analysis, correlations, and multiple linear regression. Overall perceptions of PPP contributions to HSTP objectives were positive (<i>M</i> = 4.08). Institutional risk climate (<i>M</i> = 4.12) and regulatory financial governance (<i>M</i> = 3.98) were rated positively, whereas technical capacity scored substantially lower (<i>M</i> = 2.75). Greater PPP exposure was associated with more negative technical ratings. Institutional risk climate was the strongest predictor of perceived HSTP goal achievement (β = .795), followed by technical capacity (β = .092) and regulatory financial governance (β = .083). Stable regulation and strong institutional governance were the leading enablers, while unclear contracts and limited specialized expertise were the main barriers. In the Saudi reform context, PPP implementation appears to depend more on institutional governance and public stewardship than on financial structuring alone. Future contracts should include explicit provisions for innovation, knowledge transfer, and workforce development.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261444278"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Applicability of Value-Based Healthcare in Military Health Systems: Results From a Pilot Survey Study.","authors":"Henk van der Wal, Veronika Sedivcova, Fleur Maas, Brett Nishikawa, Diane Lamb, Iris Dijksma, Jacopo Frassini, Marián Ivan, Rigo Hoencamp, Hynek Schvach","doi":"10.1177/00469580261427434","DOIUrl":"10.1177/00469580261427434","url":null,"abstract":"<p><p>Value-Based Healthcare (VBHC) is gaining traction in civilian systems, but its relevance and feasibility for Military Health Systems (MHSs) in Central and Eastern Europe (CEE) remain unclear. This pilot study explored familiarity, perceived applicability and desirability of VBHC among military healthcare stakeholders. A pilot cross-sectional perception study was conducted during the 2024 VIMIMED Military Medicine Conference, combining a brief expert introduction with a structured survey. The survey assessed baseline familiarity, perceived applicability in home-base and operational care, and desirability of VBHC implementation. Descriptive statistics were used. The association between familiarity and desirability was explored using Fisher's exact test. Among 65 workshop participants, 37 completed the survey. Over half of respondents reported low baseline familiarity with VBHC (51.4%). Despite this, VBHC was widely perceived as desirable (89.1%). No statistically significant association was found between familiarity and desirability (Fisher's exact test, <i>P</i> = .672). Thirty-five respondents considered VBHC applicable in at least one domain and were included in component-level analyses. The components \"multidisciplinary team,\" \"educate, innovate & improve,\" and \"IT & data\" were most frequently endorsed as applicable. Respondents who perceived VBHC as applicable in both home-base and operational care tended to endorse more components than those who perceived applicability in home-base care only. Despite limited baseline familiarity, VBHC was widely perceived as desirable and contextually applicable within CEE MHSs. These exploratory findings suggest potential for targeted, phased integration of selected VBHC components. Larger and, more representative studies are needed to assess implementation feasibility, pathways, and sustainability of VBHC in MHSs.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261427434"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Quality and Reliability of Hepatitis B-Related Short Videos on BiliBili and TikTok: A Cross-Sectional Study.","authors":"Bowen Cheng, Wenjie Shi, Shu Wang, Huanbing Liu, Jing Xiong, Xiaoyan Chen","doi":"10.1177/00469580261441434","DOIUrl":"10.1177/00469580261441434","url":null,"abstract":"<p><p>Hepatitis B is a significant global health concern and poses a substantial burden on public health systems. Short video platforms such as TikTok and Bilibili have become important channels for health information dissemination. However, the quality and reliability of Hepatitis B-related content on these platforms remain unclear. The objective of our research is to evaluate the quality of information regarding Hepatitis B disseminated on the TikTok and Bilibili short video platforms. On April 1, 2025, we systematically collected the top 100 Hepatitis B-related short videos from TikTok and Bilibili, totaling 200 videos. Basic video information was extracted, and video quality and reliability were assessed using the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and JAMA benchmarks. Spearman correlation analysis was performed to examine the relationship between engagement metrics and quality scores. TikTok videos demonstrated greater user engagement, as evidenced by higher metrics for likes, comments, and shares, and also achieved superior reliability scores compared to Bilibili. Specifically, the median reliability scores for TikTok videos were mDISCERN: 4 (3-4) and JAMA: 3 (3-3), whereas for Bilibili videos, these scores were mDISCERN: 3 (3-4) and JAMA: 2 (2-3). In terms of content quality, as assessed by the GQS, both platforms exhibited similar levels (TikTok: 4 [3-4], Bilibili: 4 [3-4]). Additionally, videos uploaded by hepatologists consistently showed higher quality and reliability. Spearman correlation analysis indicated significant but weak positive correlations between engagement metrics (likes, comments, shares, saves) and both GQS and JAMA scores; however, no significant correlation was observed with mDISCERN scores. The overall quality and reliability of Hepatitis B-related short videos were moderate, with TikTok videos outperforming Bilibili videos in reliability. Videos created by hepatologists demonstrated higher quality and reliability. We recommend that the public exercise caution when consuming health information from short videos to avoid potential misinformation.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261441434"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an Integrated Psychosocial Intervention for Health Care Professionals in an Intensive Care Unit: Controlled Quasi-Experimental Trial.","authors":"Sophie Felicitas Nickel, Simone Korger, Karl Christian Hirning, Klaus Hönig, Christian Rainer Wirtz, Ferdinand Keller, Harald Otto Gündel","doi":"10.1177/00469580261428687","DOIUrl":"10.1177/00469580261428687","url":null,"abstract":"<p><p>Intensive care units (ICUs) are challenging environments for healthcare professionals (HCPs), patients, and families. Up to 75% of HCPs experience psychosomatic symptoms and 30% intend to leave their job. To address this, a German ICU implemented an integrated psychosocial care model. Its implementation and evaluation are described. In a quasi-experimental design, a psychologist was integrated part-time into an ICU team for 7 months (June 2022-January 2023), tasked to deliver low-threshold psychosocial support to HCPs. Additional components were one-on-one interactions, clinical supervisions, a feedback survey and health circles. Pre- and post-measures from a voluntary sample of the intervention ward (N = 65) and a control ward receiving usual psychosocial care (N = 33) were taken via online surveys assessing the psychosocial safety climate (PSC), emotional and cognitive irritation and intention to leave. Groups were compared using linear mixed-effect models. The intervention was implemented as planned, and HCPs expressed satisfaction with the changes experienced on the ward. Statistical testing revealed no significant interaction effects between point of measurement and group allocation on irritation and intention to leave (<i>P</i> > .01). The PSC interaction effect did not reach the significance (α = .01, <i>P</i> = .02) but indicated a trend towards improvement in the intervention group. The intervention successfully provided accessible psychosocial support and fostered a more positive PSC within the ICU team. Statistical effects were limited, likely due to the quasi-experimental study design, small sample size and group imbalances, highlighting the need for larger, more controlled studies.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261428687"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Cost-Revenue Technical Efficiency in Fragmented Outpatient Care: A Comparative DEA and SFA Analysis.","authors":"Iveta Vrabková, Dominik Bauer","doi":"10.1177/00469580261437001","DOIUrl":"10.1177/00469580261437001","url":null,"abstract":"<p><p>Fragmented outpatient care systems dominated by small providers require reliable efficiency measurement tools to inform benchmarking and reimbursement design. However, it remains unclear to what extent efficiency estimates depend on methodological choice, particularly when cost-based data are used. This study evaluates cost-revenue technical efficiency of 344 dental practices observed between 2017 and 2020 using input-oriented Data Envelopment Analysis (DEA) under constant and variable returns to scale and Stochastic Frontier Analysis (SFA). Inputs include labor and material costs; output is annual revenue, standardized per employee. Correlation, robustness testing, and temporal analysis were performed. Average technical efficiency ranged from 0.50 (SFA) to 0.61 (DEA_VRS), indicating substantial unused production potential. Strong correlation was observed between DEA variants (<i>r</i> = .763), while correlations between DEA and SFA were weak (<i>r</i> < .30), suggesting that the methods capture distinct dimensions of inefficiency. Efficiency increased modestly over time but dispersion across providers widened. The 2020 results may partially reflect pandemic-related service disruptions. Efficiency estimates in fragmented outpatient care are highly sensitive to methodological specification. The results reflect financial production efficiency rather than clinical or value-based performance. A combined DEA-SFA framework provides complementary insights for benchmarking and policy design, but operational implementation requires explicit decision rules and contextual adjustment.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261437001"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Commentary on Documenting Birth Outcomes and Fetal Death as a Result of Hanford Site, Washington, Radioactive Airborne and River-Borne Emissions Beginning November 1944.","authors":"Olivia M Vaz, Trisha T Pritikin, Elizabeth S McClure","doi":"10.1177/00469580261483972","DOIUrl":"10.1177/00469580261483972","url":null,"abstract":"<p><p>Fallout containing radioactive byproducts of plutonium production at the Hanford atomic weapons facility near Richland, WA secretly blanketed downwind civilian populations, called \"Downwinders\", throughout the Inland Northwest. Research into health impacts has been hindered by the decades-long delay between these releases which began with the site's start-up in November 1944 and declassification of Hanford operational records disclosing these releases in 1986. Downwinders observed and prior analyses suggested an apparent excess in fetal and neonatal deaths during the 1940s and 1950s. Analysis of radiation released by Hanford, the possible cause of these deaths, has been hampered by data access and time. The few existing studies relied on uncertain, estimated exposure doses from the heavily criticized government-sponsored Hanford Environmental Dose Reconstruction project. Women and children, lower-socioeconomic status, non-white, and Indigenous communities are commonly overburdened by exposures to radioactive contamination and lack of subsequent care and study. This commentary highlights the unanswered questions surrounding pregnancy outcomes impacted by exposures to airborne and river-borne radiation from Hanford, documents the process and barriers to addressing these questions, and calls for increased accessibility of information, especially for impacted communities.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261483972"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Digital Literacy and Physical and Mental Health Among Middle-Aged and Older Adults: The Mediating Effect of Social Interaction-A Cross-Sectional Study Based on CHARLS 2020.","authors":"Mei Hui Qi, Jian Min Cao","doi":"10.1177/00469580261495610","DOIUrl":"https://doi.org/10.1177/00469580261495610","url":null,"abstract":"<p><p>IntroductionCurrently, middle-aged and older adults face the compounded challenges of a dual \"digital divide\" and \"health divide.\"MethodUsing data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), this study constructed a digital literacy index via polychoric confirmatory factor analysis (Polychoric CFA). Ordered logit (ologit) models were employed to estimate the associations between digital literacy and physical and mental health among middle-aged and older adults. The Karlson-Holm-Breen (KHB) method with 1,000 bootstrap resamples was utilized to examine the mediating effect of social interaction in these relationships. Additionally, heterogeneity analyses across gender and household registration (hukou) status were conducted.ResultsThe findings reveal that digital literacy is significantly and positively associated with both the physical health and mental health of middle-aged and older adults. After incorporating social interaction, the indirect effect remains statistically significant, indicating that social interaction serves as an important pathway linking digital literacy to physical and mental health. Heterogeneity analysis further indicates gender-specific patterns: digital literacy maintains a significant positive association with physical health among men, but this association is not statistically significant among women; conversely, digital literacy exhibits a significant positive association with mental health among women, whereas this association does not reach statistical significance among men. Regarding household registration (hukou), formal inter-group difference tests reveal no statistically significant differences, suggesting that the positive associations between digital literacy and health outcomes are highly consistent and generalizable across urban and rural middle-aged and older populations.ConclusionBy disentangling the transmission pathway of \"digital technology→social interaction→health outcomes,\" this study provides empirical evidence for developing countries to address digital health inequalities against the backdrop of population aging. We propose the following policy recommendations: (1) Advance national initiatives to enhance digital literacy among middle-aged and older adults, lower technological barriers, and help older cohorts overcome obstacles to digital technology adoption; (2) Improve the accessibility and age-friendliness of the digital society, with an emphasis on age-adapted product interfaces and community-based digital support networks; and (3) Formulate targeted health interventions for multiply vulnerable subgroups to enhance the precision and efficacy of public health policies.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261495610"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Speech and Language Therapy: A Qualitative Comparative Analysis of Clinical Applications and Outcomes.","authors":"İbrahim Can Yaşa, Muhsin Dölek, Seda Eyilikeder Tekin, Ayşe Serra Kaya, Pınar Akgün, Sakine Deniz Yılmaz, Selin Tokalak","doi":"10.1177/00469580261445316","DOIUrl":"10.1177/00469580261445316","url":null,"abstract":"<p><p>Large language models (LLMs) such as ChatGPT are entering clinical practice, yet how their clinical reasoning compares with speech-language therapists (SLTs) is not well understood. This comparative multi-case qualitative study used 3 hypothetical vignettes. Ten experienced SLTs (≥10 years) participated in semi-structured interviews, providing assessment, diagnosis and therapy plans for each vignette. ChatGPT-4o was presented with identical, standardized Turkish prompts over five consecutive days to evaluate the model's temporal consistency in clinical reasoning. All outputs were analyzed with content analysis, and day-to-day consistency of ChatGPT themes was examined. ChatGPT-4o and SLTs showed substantial overlap in core practices such as case history, spontaneous speech analysis, key diagnostic labels, and emphasis on generalization and caregiver involvement. However, SLTs utilized broader, locally normed assessment tools and offered more flexible, individualized and context-sensitive therapy approaches. ChatGPT-4o's responses were more standardized and showed stable thematic patterns across days, yet they did not reflect the clinical nuance or contextual adaptation observed in SLTs' reasoning. ChatGPT-4o can approximate expert-like reasoning in structured scenarios and may serve as a clinical decision support aid. Nonetheless, it does not replace experienced SLTs, particularly for culturally grounded, person-specific assessment and intervention planning.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261445316"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Large Language Models Identify When an Upper Extremity Problem Needs Nonurgent Attention? An Assessment of Multiple LLM Chatbots.","authors":"Jefferson Hunter, David Ring, Prakash Jayakumar","doi":"10.1177/00469580261485819","DOIUrl":"10.1177/00469580261485819","url":null,"abstract":"<p><p>IntroductionSeeking emergency care regarding musculoskeletal sensations is far more prevalent than limb or life-threatening pathophysiology. We studied the ability of an LLM to distinguish between urgent and nonurgent upper extremity symptoms and provide an accurate diagnosis.MethodsFive LLMs (ChatGPT-4, ChatGPT-4o, Co-Pilot, Gemini, and PerplexityChat) were presented with descriptions of seven urgent and seven nonurgent symptom scenarios written below a sixth grade reading level. LLM responses were identified as appropriate if immediate urgent medical attention was recommended after an initial and ongoing inquiry (\"What additional information do you need to diagnose my condition?\"). Diagnoses provided were identified as correct, partially correct, or incorrect. The analysis was repeated 24 months later with the current LLM versions and results were compared.ResultsLLMs discerned nonurgent conditions with 97% positive predictive value (PPV) and an 89% negative predictive value (NPV) on initial query, which improved to 96% and 97% respectively after ongoing inquiry. Compartment syndrome was misidentified as nonurgent in 80% of scenarios on initial inquiry, although four of five LLMs corrected on continued inquiry. Diagnosis was correct or partially correct for 115 of 150 (82%) on initial inquiry. An updated analysis 24 months later demonstrated marked improvement in LLM ability to identify emergencies with 100% PPV and 95% NPV on initial query and 98% NPV after ongoing inquiry.ConclusionThe finding that LLMs can distinguish urgent from nonurgent upper extremity conditions suggests that artificial intelligence tools could help reduce unnecessary use of high-cost emergency services, allowing those resources to be reserved for patients who require timely care.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"63 ","pages":"469580261485819"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}