Health Services Research最新文献

{"title":"Health System Integration and Prior Authorization in Medicare Advantage","authors":"Eunhae Shin","doi":"10.1111/1475-6773.70137","DOIUrl":"10.1111/1475-6773.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine whether Medicare Advantage (MA) plans affiliated with health systems adopt less restrictive prior authorization (PA) policies than non-affiliated plans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>We conducted a descriptive analysis comparing PA policies between system-affiliated and unaffiliated MA plans from 2016 to 2023. Using Plan Benefit Package data, we constructed enrollment-weighted measures of PA intensity based on the share of service categories requiring PA. We assessed robustness using alternative measures, including service-specific PA requirements, service mix-adjusted overall intensity, and measures without enrollment weights, and also examined results by plan type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>Analyses included 6480 MA health maintenance organization and preferred provider organization plans operating during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Enrollees in system-affiliated MA plans faced fewer PA requirements than those in unaffiliated plans. In 2023, the difference was 31 percentage points (pp): among 23 service categories, enrollees in affiliated plans were enrolled in plans that required PA for 51% of categories, compared with 82% in unaffiliated plans. Differences were especially pronounced for behavioral and mental health services and dialysis (52–59 pp).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>System affiliation is associated with less restrictive PA policies in MA, highlighting organizational structure as an important dimension of utilization management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151887","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":"HSR'S Outstanding Reviewers in 2025","authors":"Austin Frakt,&nbsp;Chris Tachibana","doi":"10.1111/1475-6773.70140","DOIUrl":"https://doi.org/10.1111/1475-6773.70140","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148173829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Sepsis Coding and Payment to U.S. Hospitals.","authors":"Andrew M Ryan, Hallie C Prescott, Yan Lin, Hayden Rooke-Ley, Jason D Buxbaum","doi":"10.1111/1475-6773.70135","DOIUrl":"10.1111/1475-6773.70135","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence and financial impact of Sepsis-3 concordant vs. Sepsis-3 discordant sepsis hospitalizations in Traditional Medicare inpatient claims.</p><p><strong>Study design and setting: </strong>This retrospective observational study used a 100% sample of Traditional Medicare inpatient claims from 2016 to 2022. The study population included acute care hospitals reimbursed under the Inpatient Prospective Payment System, excluding those in Maryland and U.S. territories.</p><p><strong>Data sources and analytic sample: </strong>All Medicare beneficiaries with hospitalizations for sepsis, identified by DRGs 870-872, who were continuously enrolled in Medicare Parts A and B. Hospitalizations were classified as Sepsis-3 concordant vs. discordant based on the presence of diagnosis codes for acute organ dysfunction.</p><p><strong>Principal findings: </strong>Among 4.2 million hospitalizations with a sepsis DRG from 2016-2022, 22.6% (95% CI: 22.3%, 22.9%) lacked a diagnosis code for acute organ dysfunction and were classified as Sepsis-3 discordant. These hospitalizations were most commonly associated with alternative diagnoses of pneumonia (27.4% (95% CI: 27.2%, 27.7%)), urinary tract infection (27.4% (95% CI: 27.2%, 27.6%)), and skin or subcutaneous tissue infections (9.7% (95% CI: 9.5%, 9.8%)). Thirty-day mortality was substantially lower among Sepsis-3 discordant (7.7% (95% CI: 7.6%, 7.8%)) versus concordant (33.4% (95% CI: 33.1%, 33.6%)) sepsis hospitalizations, suggesting meaningful clinical differences among patients with Sepsis-3 discordant sepsis diagnoses. Hospital payments for Sepsis-3 discordant sepsis hospitalizations averaged $839 (95% CI: $679, $999) more per hospitalization than alternative simple infections, leading to an estimated $114 (95% CI: $92, $136) million higher annual payments to hospitals.</p><p><strong>Conclusions: </strong>Nearly one in four inpatient sepsis hospitalizations in Traditional Medicare may be discordant with Sepsis-3, leading to substantial increases in spending. CMS could mitigate this by aligning ICD-10 coding guidelines with clinical definitions.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":"e70135"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310411","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":"Stagnation in Achieving Recommended Methadone Doses in Opioid Use Disorder Treatment.","authors":"Jemima A Frimpong, Yinfei Kong, Maya-Grace T Archer, Tenie Khachikian, Suojin Wang, Thomas D'Aunno, Daniel L Howard","doi":"10.1111/1475-6773.70145","DOIUrl":"10.1111/1475-6773.70145","url":null,"abstract":"<p><strong>Objective: </strong>To assess changes in methadone dosing practices among Opioid Treatment Program (OTP) and evaluate adherence to evidence-based guidelines recommending doses of at least 80 mg/day.</p><p><strong>Study setting and design: </strong>This observational study used a national survey of OTPs to examine longitudinal changes in methadone dosing patterns between 2017 and 2023. Key outcomes included patterns in average dose levels and the relationships between program characteristics and dosing practices.</p><p><strong>Data sources and analytic sample: </strong>Secondary data were analyzed from national OTP surveys conducted in 2017 and 2023. The sample included programs that provided data on dosing practices and program characteristics.</p><p><strong>Principal findings: </strong>The proportion of OTPs offering the recommended maintenance dose of at least 80 mg/day remained stagnant, moving from 56% in 2017 to 58% in 2023. Concurrently, private-for-profit ownership of programs increased from 36% to 53%. Approximately 42% of patients in 2023 received doses below recommended clinical levels, highlighting a significant misalignment between evidence-based guidelines and actual practice.</p><p><strong>Conclusions: </strong>National methadone dosing levels stalled between 2017 and 2023. This pattern leaves a significant gap between evidence-based guidelines and clinical practice, which may limit the effectiveness of methadone maintenance treatment. Targeted interventions are needed to identify the systematic factors hindering the adoption of evidence-based care and to maximize treatment success.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":"e70145"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304043","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":"Promoting Transplant Access Through Dialysis Facility Performance Metrics: A Double-Edged Sword.","authors":"Adam S Wilk, Stephen O Pastan, Rachel E Patzer","doi":"10.1111/1475-6773.70138","DOIUrl":"10.1111/1475-6773.70138","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":"e70138"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260678","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":"Medicare Advantage's Provision of Expanded Supplemental Benefits and Acute Care Utilization","authors":"Jeah Jung,&nbsp;Ge Song,&nbsp;Roger Feldman,&nbsp;Caroline Carlin,&nbsp;Daniel Polsky,&nbsp;Hyunjee Kim","doi":"10.1111/1475-6773.70136","DOIUrl":"10.1111/1475-6773.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine whether Medicare Advantage (MA) plans' provision of expanded supplemental benefits reduces enrollees' acute care utilization. Expanded supplemental benefits included non-medical primarily health-related (PHR) benefits such as in-home support services, starting in 2019, and Special Supplemental Benefits for the Chronically Ill (SSBCI) such as food security and housing quality benefits, starting in 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>Quasi-experimental design using staggered difference-in-differences models. We created indicators for offering the following benefits: Any expanded PHR, ≥ 2 expanded PHR, any SSBCI, and ≥ 2 SSBCI. Acute care utilization was measured by three binary indicators of adverse health events: annual emergency department (ED) use, hospitalizations, and re-admissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>We used 2017–2022 MA encounter data from a random 20% sample of enrollees. We estimated separate models for each benefit indicator, for all non-dual and all dual-eligible enrollees, and for highly frail patients within each non-dual and dual-eligible group. We used propensity score matching to balance baseline characteristics between treatment and control groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Offering expanded supplemental benefits did not generally reduce acute care utilization in all non-dual or all dual-eligible enrollees. A few significant effects were relatively small or were not robust to potential differential trends between benefit-offering and not-offering plans. However, among highly frail non-dual enrollees, offering any PHR reduced re-admissions by −2.82 percentage points (95% CI: −4.78, −0.86), offering ≥ 2 expanded PHR reduced hospitalizations by −1.79 percentage points (95% CI: −2.61, −0.98) and ED use by −1.76 percentage points (95% CI: −2.38, −1.14), and offering ≥ 2 SSBCI reduced ED use by −3.51 percentage points (95% CI: −4.96, −2.05) and hospitalizations by −2.05 percentage points (95% CI: −3.12, −0.099).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Provision of expanded supplemental benefits may reduce acute care utilization for certain enrollees. As spending on MA supplemental benefits rises, continued efforts are needed to assess impacts of those benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058269","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":"From SMS Text Messaging to Screening Completion: Understanding How SMS Responses Influence Cancer Screening Uptake in Federally Qualified Health Center Clinics","authors":"Omolola E. Adepoju,&nbsp;Tonghui Xu,&nbsp;Tracy Angelocci","doi":"10.1111/1475-6773.70134","DOIUrl":"10.1111/1475-6773.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine how patient engagement with SMS text reminder scan mediate cancer screening completion among patients at Federally Qualified Health Center clinics (FQHCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>Patients overdue for cancer screening were randomly assigned to one of two groups: a 3-week interactive SMS intervention or a 6-week theory-informed SMS intervention. The binary outcome was cancer screening completion after 90 days of SMS intervention. A mediation model was used to assess associations between text-message response rates and cancer screening completion. Exposure variables included sociodemographic characteristics, type of SMS intervention, type of cancer screening needed, and health status variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>Data were obtained from two large FQHC networks in Texas and California in 2023. We included 4,344 patients who participated in the 3-week or 6-week intervention groups, successfully received all interactive messages, had unique phone numbers, and did not opt out of the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Overall effects were statistically significant, indicating partial mediation. Full mediation was observed for insurance type: compared with Medicaid, private insurance was associated with a 5-percentage-point (PP) higher predicted probability of screening completion (Average marginal effect [AME] = 5.0 PP, 95% CI [0.01, 0.09]). Partial mediation was observed for Medicare (AME = 7.0 PP, 95% CI [0.02, 0.13]), uninsurance (AME = 5.0 PP, 95% CI [0.01, 0.09]), patient with diabetes (AME = −4.0 PP, 95% CI [−0.08, −0.01]), non-primary English language (AME = 8.0 PP, 95% CI [0.05, 0.10], <i>p</i> &lt; 0.001), and large-city residence (AME = 9.0 PP, 95% CI [0.07, 0.10]), all of which were associated with higher predicted probabilities of screening completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Engagement with SMS reminders was a significant mediator of cancer screening completion, suggesting that increasing message interactivity may improve cancer screening uptake. Theory-informed interactive messaging may promote greater patient engagement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044724","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":"Gabapentinoid Polypharmacy Among Medicare Beneficiaries During the Poststroke Recovery Period","authors":"Julianne D. Brooks,&nbsp;Rebeka Bustamante Rocha,&nbsp;Maria A. Donahue,&nbsp;Joseph P. Newhouse,&nbsp;Sebastien Haneuse,&nbsp;Alexander C. Tsai,&nbsp;Lidia M. V. R. Moura","doi":"10.1111/1475-6773.70133","DOIUrl":"10.1111/1475-6773.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe patterns of gabapentinoid (Gabapentin and Pregabalin) use and concurrent use with other central nervous system (CNS) acting pain medications (opioids and benzodiazepines) among US Medicare beneficiaries following acute ischemic stroke (AIS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>We analyzed new outpatient gabapentinoid prescriptions in older stroke survivors between 2009 and 2022. We calculated the percent of new gabapentinoid initiators within 6 months of stroke discharge and analyzed concurrent pain medications prescribed within 30 days of gabapentinoid initiation. We presented trends and geographic patterns standardized by age, discharge destination, and modified Rankin Scale (mRS) to control for variations in the sample composition by age and stroke severity over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>We analyzed a 20% sample of US Medicare beneficiaries aged 65 years or older who were hospitalized for AIS. We included those who met Medicare enrollment criteria, had no prior stroke, no prior gabapentinoid use within 6 months, and were discharged home within 30 days of hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Among 153,728 stroke survivors, 4.9% received new gabapentinoid prescriptions within 6 months postdischarge. Of the 7595 gabapentinoid initiators, 1579 (21%) had concurrent opioid and 653 (8.6%) had concurrent benzodiazepine prescriptions. In the sample, the median age was 78 years (Quartile Range: 72–84), 55% were female, and 81% were non-Hispanic White. The standardized percentage of gabapentinoid initiators increased from 3.8% in 2009 to 5.9% in 2022 (crude: 3.6% in 2009 to 5.8% in 2022). Despite increases in the number of gabapentinoid initiators, the percentage of concurrent opioid users remained low over time, around 1% of the study population. We observed variation in gabapentinoid initiation and concurrent use with opioids by geography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>From 2009 to 2022, poststroke gabapentinoid use increased in older adults, but concurrent use with opioids remained low over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Impacts in the Oncology Care Model: Medicare Payment Impacts in the 18 Months After the Model's End","authors":"Derek Hoodin,&nbsp;Sean McClellan,&nbsp;Nadine Chami,&nbsp;Caroline Ly,&nbsp;Gabriel A. Brooks,&nbsp;Nancy L. Keating,&nbsp;Colleen M. Kummet,&nbsp;Van Doren Hsu,&nbsp;Stephanie Shao,&nbsp;Matthew J. Trombley","doi":"10.1111/1475-6773.70121","DOIUrl":"10.1111/1475-6773.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate whether payment reductions achieved during the Oncology Care Model (OCM) continued after the model ended.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>OCM was a voluntary episode-based alternative payment model designed to improve the value of care for Medicare beneficiaries receiving chemotherapy for cancer. Participating practices received $160 monthly care coordination payments and could receive shared savings (or penalties) according to quality and spending goals during 6-month episodes. We extended the OCM regression-adjusted difference-in-differences (DID) payment analysis by 18 months after the model's conclusion to assess sustained effects on total episode payments (TEP) and component Parts A, B, and D, and Part B drug payments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>We used Medicare administrative data, model program data, and secondary sources describing market and provider characteristics to analyze 6-month chemotherapy episodes for Medicare fee-for-service beneficiaries initiated during January 2014–July 2015 (baseline), July 2016–December 2021 (performance), and January 2022–June 2023 (post-performance).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>In the 18 months following OCM's end, on average, OCM practices reduced TEP by −$955, driven by significant reductions in Part B payments (−$559). Part B payment reductions were primarily for non-chemotherapy drugs (−$489). Overall payment reductions totaled $328 million. Sustained payment reductions were predominantly among practices adopting two-sided risk; these practices reduced TEP by $3379, including significant reductions in Parts A (−$738), B (−$1370), and D (−$1112) payments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OCM savings following the model's end were driven by practices that adopted two-sided risk. These sustained payment reductions after OCM's conclusion provided substantial additional savings for CMS, reducing estimated model losses from $639 million to $311 million.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Caregiving Arrangements Influence Hospital Use Among Older Adults With Functional Limitations?","authors":"Erblin Shehu,&nbsp;Kanika Arora","doi":"10.1111/1475-6773.70130","DOIUrl":"10.1111/1475-6773.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine whether different caregiving arrangements influence hospitalization risk and frequency among older adults with functional limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>This longitudinal study used linear probability and Poisson regression models with individual and wave fixed effects, lagged predictors, and household-clustered standard errors to assess associations between different caregiving arrangements and hospitalization outcomes among community-dwelling older adults in the United States. Caregiving was categorized as no help, family help, formal help, or combined help. Outcomes included any hospitalization and the number of hospital stays over a two-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>Data came from eight waves of the Health and Retirement Study (2004–2018). The samples included adults aged 65 and older who reported difficulty with at least one activity of daily living and participated in at least two survey waves. The final analytic sample comprised 2926 individuals contributing 5595 person-wave observations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>While the overall hospitalization risk did not differ significantly by caregiving type, receiving combined support was associated with a reduced number of hospital stays among those hospitalized (IRR = 0.712, <i>p</i> &lt; 0.01), compared to receiving no support. Cognitive functioning modified these relationships, with formal help linked to fewer hospitalizations among those with impairment but more among those without. Differences also emerged across racial and ethnic groups, where formal help was linked to lower hospitalization rates for Black individuals, and combined help was associated with increased hospitalizations among Hispanic older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Policies that expand access to both formal and family caregiving support may help reduce hospitalizations among older adults with functional limitations, particularly when tailored to care recipient characteristics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}