Health Services Research最新文献

{"title":"CHOICE: A Comprehensive and Coordinated Colorectal Cancer Screening Program in a Large Urban Health System.","authors":"Emma Ghalili, Tsion Tmariam, Parth D Trivedi, Lina Jandorf","doi":"10.1111/1475-6773.14629","DOIUrl":"10.1111/1475-6773.14629","url":null,"abstract":"<p><strong>Objective: </strong>To develop a coordinated colorectal cancer (CRC) screening program within a large urban health system, with the ultimate goal of increasing system-wide screening rates of eligible patients and reducing no-show rates while increasing colonoscopy completion rates.</p><p><strong>Study setting: </strong>A large urban academic health system comprising 8 hospitals and over 400 ambulatory practices.</p><p><strong>Study design: </strong>The CHOICE Program combined patient navigation, electronic medical record (EMR) optimization, and system-wide practice changes to improve CRC screening completion by colonoscopy. The program incorporates provider and patient education, standardization of documentation and protocols, increased outreach by navigators, and streamlining of patient scheduling. The primary outcome is colonoscopy completion.</p><p><strong>Data collection: </strong>All health system patients between the ages of 45 and 75 and at average risk of CRC are the target population for the intervention. A review of screen-eligible patients' completion of colonoscopy was performed to assess program success.</p><p><strong>Principal findings: </strong>During a 2-year period (March 2022 to February 2024), 18,119 people were referred into the program, and 79% of scheduled patients completed the colonoscopy. The CHOICE program operationalized and standardized the CRC screening efforts of a large health system and offers a template that can be implemented or adapted by other hospital systems and provider networks.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14629"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Personnel's Perspectives on the Impacts of Multiple Disasters on the Workforce in Puerto Rico.","authors":"Damaris Lopez Mercado, Jonathan Purtle, Alexandra C Rivera-González, Katyana M Santiago, Angellyn Santos González, Ligia M Chavez, Jim P Stimpson, Brent Langellier, Mark Stehr, Jan M Eberth, Glorisa Canino, Alexander N Ortega","doi":"10.1111/1475-6773.70104","DOIUrl":"10.1111/1475-6773.70104","url":null,"abstract":"<p><strong>Objective: </strong>To examine how healthcare personnel in Puerto Rico perceive the impact of successive disasters on the healthcare workforce.</p><p><strong>Study setting and design: </strong>Qualitative in-depth semi-structured interviews were conducted with key informants from hospitals and Federally Qualified Health Centers (FQHCs) across Puerto Rico. Interviews were conducted via Zoom or in-person between 2023 and 2025.</p><p><strong>Data sources and analytic sample: </strong>Thirty-one (31) key informants were interviewed. Deductive and inductive thematic content analyses were conducted using both a priori codes informed by the interview questions and emergent codes following data collection. Each transcript was coded by 2-3 coders using NVivo 14 software. Coding discrepancies were discussed until a consensus was reached. This study focuses on findings from two deductive codes that align with the study's research questions.</p><p><strong>Principal findings: </strong>Repeated exposure to successive disasters in Puerto Rico contributed to a prolonged state of emotional distress among healthcare workers and staff, including feelings of stress, sadness, fear, and anxiety. These emotions contributed to burnout, staff attrition, and staff turnover. Recent healthcare graduates often lacked relevant clinical experience due to COVID-19 pandemic-related shifts to online education, which placed additional pressure on facilities to provide this essential training.</p><p><strong>Conclusions: </strong>Successive disasters led to prolonged emotional distress among the healthcare workforce, contributing to burnout, attrition, turnover, and reduced capacity to deliver high-quality care. The findings underscore the need for workforce policies that reduce disaster-related stressors and increase mental health support and clinical training opportunities for healthcare workers in Puerto Rico amid future disasters.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 2","pages":"e70104"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Trends in Market Competition for Hospital-Based Pediatric Services: 2011-2018.","authors":"Olivia Zhao, Carolyn San Soucie, Daniel A Rauch, Christina L Cifra, Lois Lee, Nancy D Beaulieu, David Cutler, Alyna T Chien","doi":"10.1111/1475-6773.70102","DOIUrl":"10.1111/1475-6773.70102","url":null,"abstract":"<p><strong>Objective: </strong>To examine, for the United States: (1) national trends in market competition using three approaches to operationalizing markets and (2) how competitive markets differ from concentrated ones for general newborn nurseries [GNNs], general pediatric inpatient units [GPIUs], neonatal intensive care units [NICUs], pediatric intensive care units [PICUs], and pediatric emergency departments [PEDs].</p><p><strong>Study setting and design: </strong>This study describes hospital markets for the above most common hospital-based pediatric service lines. Antitrust enforcement guidelines characterize market structures as: \"Competitive,\" \"Concentrated,\" or \"Unavailable\" if ≥ 5, 1-4, or zero hospitals within a market provide each service, respectively. Trends were determined by the share pediatric population residing in each market structure in 2018 compared with 2011 using three different approaches to operationalizing markets: Healthcare Referral Regions [HRR], Neonatal Intensive Care Regions [NICR], and Pediatric Emergency Referral Regions [PERR]. Competitive markets were compared with concentrated ones in 2018 using demographic data and hospital characteristics.</p><p><strong>Data sources and analytic sample: </strong>Data come from the Health Systems and Providers Database (HSPD) developed by the National Bureau of Economic Research and the American Community Survey. Since the HSPD provides a near census of US hospitals, only point estimates are presented.</p><p><strong>Principal findings: </strong>Irrespective of how markets were operationalized, the share of the national pediatric population living in competitive markets increased for NICU (3%-8% increase), PICU (21%-35%), and PED (30%-76%) services and remained stable for GNN services over the study period. Directionality of the change in share living in competitive GPIU markets depended on how markets were operationalized. Using HRRs, competitive (relative to concentrated) markets exhibited smaller declines in pediatric population size, larger non-white populations, and higher prevalence of children's hospitals.</p><p><strong>Conclusion: </strong>Market competitiveness for hospital-based pediatric services varies by service line, demographic and socioeconomic factors, and specific market definition used. Future studies should examine whether competitive markets offer better outcomes at lower prices and whether pediatric patients in concentrated markets require more protections.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 2","pages":"e70102"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Access to Methadone Treatment for Opioid Use Disorder: Measurement and Policy Considerations for the Veterans Health Administration.","authors":"Megan E Vanneman, Fatima G Rahim, Megan E Amuan, Richard E Nelson, Adam J Gordon, Audrey L Jones","doi":"10.1111/1475-6773.70114","DOIUrl":"10.1111/1475-6773.70114","url":null,"abstract":"<p><strong>Objective: </strong>To establish methods for comparing Department of Veterans Affairs (VA)-direct and VA-purchased \"community care\" (CC) for methadone medication for opioid use disorder (M-MOUD), and determine differences in access, quality, and cost.</p><p><strong>Study setting and design: </strong>Three outcome measures were constructed: wait times (from clinician referral to appointment) for access, retention on M-MOUD (number of months, from one to six) for quality, and 6-month treatment costs (M-MOUD and related services). We used generalized linear models to estimate differences in each outcome for CC versus VA.</p><p><strong>Data sources and analytic sample: </strong>VA electronic health record and CC claims. Our study included VA patients referred by clinicians for M-MOUD between April 1, 2023-March 31, 2024 in VA (n = 389) and CC (n = 219) and, secondarily, VA walk-ins (n = 1830).</p><p><strong>Principal findings: </strong>Average unadjusted wait times from clinician referral to appointment were 15.73 days (standard deviation [SD] = 16.27) in VA and 19.03 days (SD = 19.12) in CC, while there was no wait time for Veterans seen as VA walk-ins. Average unadjusted M-MOUD retention was 2.07 months (SD = 1.65) in VA and 3.13 months (SD = 1.84) in CC. Average unadjusted 6-month costs were $7360 (SD = $9554) in VA and $4376 (SD = $2171) in CC. In adjusted models, CC had greater M-MOUD retention (1.07 months longer, p < 0.0001) and lower costs ($-1720, p < 0.05) compared to VA clinician referral; wait times did not statistically differ (p = 0.12). M-MOUD retention and cost patterns did not change when considering VA walk-ins.</p><p><strong>Conclusions: </strong>An important option for expanding Veterans' access to M-MOUD is through CC. In this group of Veterans receiving M-MOUD, CC retention was greater and costs were lower. However, CC lacks the walk-in option for same-day access. This signals tradeoffs to consider when assessing the balance between VA and CC and provides methods for comparing VA and CC treatment options.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 2","pages":"e70114"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Insurance Rates Among Citizens Versus Noncitizens During the COVID-19 Public Health Emergency.","authors":"Heeun Kim, Annabelle Ng, Frances Howell, Ashley Fox, Teresa Janevic, Ellerie Weber","doi":"10.1111/1475-6773.70105","DOIUrl":"10.1111/1475-6773.70105","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the effect of Medicaid continuous coverage provision (CCP) during the COVID-19 public health emergency on postpartum insurance for low-income noncitizen immigrants compared to citizens, and to assess whether state use of the from-conception-to-the-end-of-pregnancy (FCEP) policy, which excluded many immigrants from postpartum coverage, modified this effect.</p><p><strong>Study setting and design: </strong>This study used a quasi-experimental design (difference-in-differences, or DID) to compare the insurance coverage gains between low-income postpartum noncitizens and citizens, using 2019 as the reference year. We further applied a triple difference (DDD) approach to assess the effect of the FCEP-only coverage policy, hypothesizing that noncitizens in states using FCEP as the sole pathway would experience smaller gains than in other states using various pathways to cover pregnant noncitizens otherwise ineligible.</p><p><strong>Data sources and analytic sample: </strong>Using the 2016-2022 American Community Survey individual-level data, we identified 61,572 low-income citizens (weighted N = 7,553,823) and 10,444 low-income noncitizens (weighted N = 1,487,373), with 8 FCEP-only states and 23 other states with various pathways.</p><p><strong>Principal findings: </strong>During the study period, the average postpartum uninsurance rate was 44.6% for noncitizens and 14.0% for citizens, while Medicaid coverage was 34.5% for noncitizens and 57.5% for citizens. Medicaid gains among noncitizens were statistically similar to gains among citizens in 2021 compared to 2019 in both FCEP-only states (DID = 2.3 percentage points [pp], 95% CI: -13.3, 8.7) and states with various pathways (DID = 4.6 pp, 95% CI: -1.2, 10.4), but these trends did not persist in 2022. We found no differences in insurance coverage gains among noncitizens between FCEP-only and states with various pathways.</p><p><strong>Conclusions: </strong>Findings suggest that the CCP did not substantially reduce postpartum coverage inequities for noncitizen immigrants in either FCEP-only states or states with various pathways. Postpartum coverage inequities persisted under the CCPs, leaving many noncitizens uninsured.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 2","pages":"e70105"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical Integration and Oncologists' Adoption of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer.","authors":"Xin Hu, Changchuan Jiang, K Robin Yabroff, Joseph Lipscomb, Ilana Graetz","doi":"10.1111/1475-6773.14436","DOIUrl":"10.1111/1475-6773.14436","url":null,"abstract":"<p><strong>Objective: </strong>To examine the trend in Immune Checkpoint Inhibitor (ICI) use before and after FDA approval in 2015 for patients with metastatic non-small cell lung cancer (NSCLC), and whether vertical integration of oncologists affected ICI use.</p><p><strong>Study setting and design: </strong>We conducted a retrospective cohort study of patients with metastatic NSCLC from 21 population-based cancer registries in the United States. We measured whether patients' treating oncologists were vertically integrated based on ≥ 10% of total services billed through hospital outpatient departments. We described the percentage of ICI recipients annually in 2010-2019, stratified by oncologists' integration status each year. In the post-FDA approval period (2015-2019), we used difference-in-differences (DID) modeling to compare the probability of patients' receiving ICI before and after oncologists became integrated relative to those whose oncologists remained non-integrated.</p><p><strong>Data sources and analytic sample: </strong>Using the SEER-Medicare linkage, we identified Medicare Fee-For-Service beneficiaries aged ≥ 65.5 years diagnosed with metastatic NSCLC in 2010-2019 and followed them from diagnosis until ICI receipt, death, or end of 2019.</p><p><strong>Principal findings: </strong>The overall percentage of patients receiving ICI increased from 0% before 2015 to 4.0% in 2015, and further increased to 29.2% in 2019. The percent of ICI recipients was higher among integrated (6.9%) than non-integrated oncologists (2.0%, p < 0.001) in 2015, but by 2017 adoption rates converged (19.8% vs. 19.8%, p = 0.91). DID analysis showed non-significant changes in the probability of ICI use after oncologists became integrated (1.7 percentage points, 95% CI = -1.0 to 4.4) relative to oncologists who remained non-integrated.</p><p><strong>Conclusions: </strong>Integrated oncologists were quicker to adopt ICIs in the first year after FDA approval, but this lead was not sustained over time. Vertically integrating into health systems was not associated with significant changes in ICI use. Further research is needed on the factors influencing equitable dissemination of novel cancer therapies across practice settings.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14436"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Expanding Role of Health Services Research in Cancer Prevention and Control.","authors":"Asal Pilehvari, Xin Hu, Roger Anderson","doi":"10.1111/1475-6773.70056","DOIUrl":"10.1111/1475-6773.70056","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70056"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Neurokinin-1 Receptor Antagonist Use Pre- and Post-Choosing Wisely Initiative Among Women With Invasive Breast Cancer.","authors":"Shweta Kamat, Britny R Brown, Steven A Cohen, Ami Vyas","doi":"10.1111/1475-6773.14626","DOIUrl":"10.1111/1475-6773.14626","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of Choosing Wisely (CW) on prophylactic NK1-RA use among women with breast cancer.</p><p><strong>Study setting and design: </strong>This was a retrospective cohort study conducted using administrative claims data. The exposure variable was the start of chemotherapy relative to the implementation date for the CW antiemetic measure. The outcome was prophylactic NK1-RA use. Interrupted time series using segmented regression was used to assess the effect of CW on prophylactic NK1-RA use.</p><p><strong>Data sources and analytic sample: </strong>Optum's de-identified Clinformatics Data Mart Database (2010-2018) was used. This study included women aged ≥ 18 years with breast cancer with at least one newly initiated claim for low/minimal/moderate emetic risk chemotherapy (n = 25,549).</p><p><strong>Principal findings: </strong>The prophylactic use of NK1-RAs among patients with breast cancer receiving low/minimal/moderate emetic risk chemotherapy decreased from 11.1% pre-CW to 7.7% post-CW. Segmented regression analysis showed a significant increase of 0.11 per 100 patients per quarter in the use of prophylactic NK1-RAs prior to CW recommendation (95% CI = 0.10-0.12; p < 0.0001). However, immediately after the CW (occurred in Q4 2013), there was a significant decline in the prophylactic NK1-RA use by 1.03 per 100 patients in Q2 2014 (-0.93 to -1.13; p < 0.0001). For the time after intervention, there was a significant decline in NK1-RA use by 0.37 per 100 patients per quarter in the post-CW period compared to the pre-CW period (95% CI = -0.36 to -0.38; p < 0.0001).</p><p><strong>Conclusion: </strong>This study highlights a significant but modest decline in the use of prophylactic NK1-RAs. Educational efforts for the dissemination of CW recommendations are needed to facilitate appropriate prophylactic NK1-RAs use.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14626"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transactional and transformative diversity, equity, and inclusion activities in health services research departments (Retracted 28 March 2023).","authors":"Janette Dill, Stuart Grande, Tongtan Chantarat","doi":"10.1111/1475-6773.14130","DOIUrl":"10.1111/1475-6773.14130","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14130"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9549681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Medicaid Audio-Only Telehealth Coverage Policy on Mental Health Visits in Federally Qualified Health Centers.","authors":"Khyathi Gadag, Kanika Arora, Brian Kaskie, Whitney E Zahnd","doi":"10.1111/1475-6773.70107","DOIUrl":"10.1111/1475-6773.70107","url":null,"abstract":"<p><strong>Objective: </strong>We examined how the expansion of Medicaid audio-only coverage (MAOC) was associated with changes in mental health visit rates at Federally Qualified Health Centers (FQHCs).</p><p><strong>Data: </strong>We used publicly available FQHC-level Uniform Data Systems (UDS) data (N = 9606 FQHC-years) from 2016 to 2022. We used information from the Center for Connected Health Policy, Casetext, National Law Review, LegiScan, and other publicly available state telehealth laws and guidelines to map MAOC and other state-level Medicaid and telehealth policy variables.</p><p><strong>Study design: </strong>We employed a two-way fixed effects generalized difference-in-differences (DiD) estimator, followed by the Callaway-Sant'Anna DiD estimator, to assess the effect of MAOC on mental health visit rates in FQHCs. The outcome was defined as mental health visit rates, and the key independent variable was MAOC policy implementation. Time-varying state-level covariates, including mental health provider ratio, broadband access, Medicaid and telehealth policies, as well as FQHC-level covariates including the percentage of Medicaid-insured and low-income patients served, were included in the analysis. Subgroup analyses were conducted based on FQHC characteristics including rural/urban location and the presence of telemental health services (TMHS).</p><p><strong>Principal findings: </strong>DiD analysis showed no significant effect of MAOC on mental health visit rates across FQHCs. However, subgroup analyses revealed that FQHCs without an existing TMHS experienced a 20.5% increase in visit rates (p < 0.05), while those with a TMHS saw a 19.73% decrease (p < 0.05).</p><p><strong>Conclusion: </strong>Audio-only telehealth appears to serve as a substitute rather than a complementary modality for in-person or video-based mental health services in FQHCs. Providing MAOC increased mental health visit rates at FQHCs without an established telemental health service, indicating improved accessibility. Given the quality concerns surrounding audio-only telehealth, further research is needed to validate this substitution effect and assess the quality of introducing these services as an option for FQHCs.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 2","pages":"e70107"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}