Risk Management and Healthcare Policy最新文献

{"title":"Optimizing Health Insurance Claims Processing: The Role of Clinical Documentation Improvement (CDI).","authors":"Arwa Alumran, Lamis Ibrahim Aljurbua, Nada Bashmakh, Zahraa Alakrawi, Saja A Alrayes, Saad M AlQahtani","doi":"10.2147/RMHP.S586134","DOIUrl":"https://doi.org/10.2147/RMHP.S586134","url":null,"abstract":"<p><strong>Background and objectives: </strong>Clinical Documentation Improvement (CDI) programs have been identified as a financial risk reduction strategy and are becoming increasingly important in payer-provider alignment. This study aimed to evaluate the effect of CDI on insurance claim denials in the context of the healthcare sector in Saudi Arabia and the Vision 2030 healthcare transformation plan.</p><p><strong>Methods: </strong>A cross-sectional study of secondary data from two public healthcare facilities in Eastern Saudi Arabia. A total of 203 insurance claim denials (2023-2024 data) were analyzed. Denial reasons, CDI implementation, and patient characteristics were the study variables.</p><p><strong>Results: </strong>Among the rejected insurance claims, 52.7% of the denials were due to policy, declaration, and billing issues, and 47.3% were due to documentation issues. Denial reasons were significantly different between the two study hospitals. Documentation-related denials were significantly higher in the absence of CDI implementation (86.2%), whereas policy and billing issues were predominant in the hospital with CDI implementation (92%). The absence of CDI implementation was strongly associated with documentation-related denials (OR=73.07). Female patients had lower odds of insurance claim denials (OR=0.055, p<0.001). Diagnosis was significantly associated with denial reasons (χ²=119.152, p<0.001).</p><p><strong>Conclusion: </strong>CDI implementation is associated with a substantial reduction in documentation-related insurance claim denials and policy and billing issues. This study highlights the role of documentation in financial risk reduction and the importance of CDI implementation in healthcare facilities in the context of the healthcare sector in Saudi Arabia and the Vision 2030 healthcare transformation plan.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"586134"},"PeriodicalIF":2.0,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700849","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":"Risk Assessment of Emergency Medical Resource Exhaustion Under Major Infectious Disease Outbreaks: Based on Discrete-Event Simulation Models.","authors":"Hongyuan Wang, Qiuyi Li, Change Xiong, Jiayi Zheng, Jue Wang, Yihuan Ma, Jing Cheng","doi":"10.2147/RMHP.S593287","DOIUrl":"https://doi.org/10.2147/RMHP.S593287","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the risk of emergency medical resource exhaustion during the early stages of major infectious disease outbreaks and proposed resource allocation optimization strategies.</p><p><strong>Methods: </strong>This study integrated discrete event simulation and patient flow theory to develop a dynamic medical resource allocation simulation system in Hubei Province from January 23 to February 21, 2020. This period referred to the first 30 days interval following the implementation of the lockdown in Wuhan. The system simulated the utilization of general hospital beds, ICU beds, and ventilators under three distinct resource supply scenarios: baseline (Expected), optimal (Best case), and worst (Worst case). Simulation outputs including cumulative depletion days, waiting time, and deaths attributable to delayed access to critical resources were summarized using descriptive statistical analysis.</p><p><strong>Results: </strong>In the Best case scenario, the cumulative depletion days of ICU beds and ventilators persisted for 4 days and 6 days respectively, while no shortages occurred for general beds; 384 deaths were attributable to waiting for resources. In the Expected scenario, the cumulative depletion days of ICU beds, ventilators, and general beds were 11 days, 17 days, and 1 day respectively, with 766 deaths attributable to waiting for resources. In the Worst case scenario, the cumulative depletion days of both ICU beds and ventilators were 28 days, and general beds also experienced severe congestion resulting in an average wait time of 4.18 days, a maximum wait time of 11.28 days, and with 15,029 deaths attributable to waiting for resources.</p><p><strong>Conclusion: </strong>The abrupt surge in cases at the onset of the epidemic exerted considerable pressure on medical resources. The intensity of resource supply is highly correlated with the risk of patient death, and ventilators and ICU beds are the key resources affecting the death risk. This simulation model can provide a scientific tool for emergency resource reserve and allocation in public health emergencies.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"593287"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635447","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":"Development and Evaluation of a Risk Prediction Model for Intrahospital Transport Adverse Events in Critically Ill Gynecological Patients.","authors":"Tifang Qin, Qian Zhou, Jian Zhou","doi":"10.2147/RMHP.S593604","DOIUrl":"https://doi.org/10.2147/RMHP.S593604","url":null,"abstract":"<p><strong>Objective: </strong>To develop and evaluate a risk prediction model for intrahospital transport adverse events in critically ill gynecological patients, providing a scientific basis for early identification of high-risk individuals and optimization of transport decision-making.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted, including 650 patients who underwent intrahospital interdepartmental transport. Patients were randomly assigned in a 7:3 ratio to a model training set (455 patients) and an internal validation set (195 patients). Data collected included patient demographics, pre-transport condition assessment indicators, transport process parameters, and adverse event occurrences. Potential predictive variables were identified through univariate analysis and least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate Logistic regression to construct the risk prediction model. Model discrimination was evaluated using the receiver operating characteristic (ROC) curve, calibration was assessed by the Hosmer-Lemeshow test, and clinical utility was evaluated via decision curve analysis (DCA).</p><p><strong>Results: </strong>Baseline characteristics were comparable between the training and validation sets (all P>0.05). Multivariate analysis identified mechanical ventilation, Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and transport duration (minutes) as independent predictors of intrahospital transport adverse events in critically ill gynecological patients. Calibration curves demonstrated high consistency between predicted probabilities and observed outcomes, and the Hosmer-Lemeshow test indicated good calibration.</p><p><strong>Conclusion: </strong>The developed risk prediction model for intrahospital transport adverse events in critically ill gynecological patients demonstrates good discrimination and calibration. This study may provide a quantitative tool to support safe intrahospital transport management.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"593604"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635441","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":"Characterization of the Adverse Drug Reactions Associated with Psychotropic Medications Based on a Spontaneous Reporting Systems Database: A Retrospective Analysis.","authors":"Yassin Eltorki, Oraib Abdallah, Zeana Alkudsi, Waad Elamin, Ahmed Gharaibeh, Mariam Mustafa, Noor Abu Shameh, Sadaf Riaz, Islam Mahran, Noriya Al-Khuzaei, Ovais Wadoo, Monica Zolezzi","doi":"10.2147/RMHP.S578820","DOIUrl":"https://doi.org/10.2147/RMHP.S578820","url":null,"abstract":"<p><strong>Purpose: </strong>Adverse Drug Reaction (ADR) reports using spontaneous reporting systems are known to assist in the identification of new, rare, and serious ADRs in clinical practice. Research characterizing ADRs in patients taking psychotropics in Qatar is scarce. This study aims to describe psychotropic-related ADRs' characteristics, risk factors, severity, causality, and preventability.</p><p><strong>Patients and methods: </strong>This is a retrospective chart review of patients within Hamad Medical Corporation's (HMC) Mental Health Services (MHS) between 2018-2022. ADR reports submitted to the Spontaneous Reporting System database were electronically extracted and analyzed. Data on the type, frequency, onset, severity, and outcomes of adverse reactions, along with patient demographics and comorbidities, were extracted and summarized using quantitative methods.</p><p><strong>Results: </strong>A total of 908 reports were analyzed. Most ADRs were reported in males (543, 59.83%), in the year 2020 (256, 28.2%). Most reactions were categorized as \"moderate\" (67.7%), followed by \"mild\" reactions (30.9%). Extrapyramidal symptoms (EPS) were the highest reported ADRs (46.5%) followed by gastrointestinal side effects (13.3%) and hyperprolactinemia (13.2%) with Haloperidol as the most reported offending agent. Around half of the ADRs were classified as probable and 65.0% were deemed not preventable Psychotropic polypharmacy remained a significant independent risk factor for EPS, increasing the odds of by 45% (OR = 1.45, 95% CI [1.08-1.95], p = 0.015).</p><p><strong>Conclusion: </strong>This is the first study to describe the characteristics of psychotropic-related ADRs reported within HMC mental health services in Qatar. Most ADRs were moderate in severity with EPS being the most common ADR and haloperidol as the most reported suspected offending agent. Patterns discovered in this study can aid in enhancing patient safety through educating health care providers on predicting and minimizing preventable ADRs.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"578820"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635406","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":"Mitigating Systemic Risks in Aging Services: An Evolutionary Game Analysis of Fiscal Policy, Service Quality, and Workforce Supply.","authors":"Xiaohong Shen, Xin Zhang, Han Wang","doi":"10.2147/RMHP.S592071","DOIUrl":"https://doi.org/10.2147/RMHP.S592071","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid population aging imposes escalating fiscal and operational pressures on public health and long-term care systems, increasing the likelihood of supply-demand imbalances and workforce shortages. Understanding how government agencies, aging service institutions, and the professional education system interact is essential for mitigating systemic risks and ensuring sustainable service provision.</p><p><strong>Methods: </strong>This study develops a tripartite evolutionary game model that integrates talent supply dynamics into a comprehensive risk-governance framework. The model links workforce development with institutional performance and fiscal sustainability. System stability and evolutionary trajectories were examined through MATLAB simulations under multiple policy scenarios involving subsidies, incentives, and professional education reform.</p><p><strong>Results: </strong>Simulation results reveal that exclusive reliance on government subsidies may heighten long-term fiscal pressures and weaken systemic resilience. In contrast, a market-oriented self-organizing mechanism helps maintain service quality while reducing dependence on public funding. The analysis also identifies a bidirectional feedback loop: institutional demand can stimulate educational reform, while an adequately trained workforce lowers marginal service costs. Nevertheless, insufficient practice-oriented education may create a talent bottleneck that destabilizes the system even when financial support is present.</p><p><strong>Discussion: </strong>The findings indicate that the sustainability of aging care systems depends more on dynamic incentive structures that align workforce development with service quality evaluation than on static fiscal expansion. Strengthening the coordination of education, institutional performance incentives, and government regulation can mitigate market failure risks and foster more equitable resource allocation.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"592071"},"PeriodicalIF":2.0,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13044804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624785","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":"The Effect of Situational Leadership on Healthcare Service Quality Through Crisis Management and Resources Availability: The Moderating Role of Leader Experience.","authors":"Abduallateef Ghallab, Fahmi Sallam","doi":"10.2147/RMHP.S589078","DOIUrl":"https://doi.org/10.2147/RMHP.S589078","url":null,"abstract":"<p><p>Healthcare organizations operating in fragile and conflict-affected environments face persistent challenges in maintaining service quality due to recurrent crises and severe resource constraints. In such contexts, leadership adaptability becomes a critical determinant of organizational resilience and service performance. Drawing on Situational Leadership Theory, this study examines the effect of situational leadership on healthcare service quality in private hospitals in Sana'a, Yemen, while exploring the mediating roles of crisis management and resource availability, and the moderating role of leader experience. A quantitative, cross-sectional design was employed using a stratified sampling approach. The data were collected from 319 healthcare professionals working in private hospitals in Sana'a using a structured questionnaire. Partial Least Squares Structural Equation Modeling (PLS-SEM) was applied to test the hypothesized relationships, including direct, mediating, and moderating effects. The results indicate that situational leadership has a strong and statistically significant direct effect on healthcare service quality (β = 0.52, p < 0.001). Situational leadership also significantly enhances crisis management (β = 0.61, p < 0.001) and resource availability (β = 0.47, p < 0.001). Both crisis management (β = 0.36, p < 0.001) and resource availability (β = 0.21, p < 0.01) positively influence service quality, with crisis management demonstrating a stronger mediating effect. Leader experience significantly moderates the relationship between situational leadership and service quality (β = 0.14, p < 0.05), such that the relationship is stronger among more experienced leaders. The model explains a substantial proportion of variance in healthcare service quality (<i>R²</i> = 0.48), indicating strong explanatory power. This study contributes to leadership and healthcare management literature by extending situational leadership theory to a fragile, resource-constrained healthcare context and by highlighting crisis management as a critical mechanism linking leadership to service quality. Practically, the findings underscore the importance of developing adaptive leadership capabilities, strengthening crisis management systems, and leveraging leader experience to enhance healthcare service quality in conflict-affected settings.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"589078"},"PeriodicalIF":2.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596424","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":"Risk Factors of Thyroid Dysfunction in Patients with Acute Pancreatitis and Predictive Value of TSH for Disease Severity.","authors":"Lujiao Li, Xiaohui Li, Bing Liu, Hengchi Yu, Mingxia Yuan","doi":"10.2147/RMHP.S575782","DOIUrl":"https://doi.org/10.2147/RMHP.S575782","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute pancreatitis (AP) commonly present with thyroid dysfunction in clinic. The present study aimed to characterize thyroid dysfunction in AP patients, identify the risk factors, assess its dynamics during AP resolution and evaluate its value for predicting AP severity.</p><p><strong>Methods: </strong>A total of 182 AP patients and 61 age- and gender-matched patients with chronic pancreatitis (CP) were enrolled. Demographic characteristics, biochemical parameters and thyroid function were collected.</p><p><strong>Results: </strong>AP patients had an average age of 53.3±16.7 years and 61.5% were males; CP patients had an average age of 52.7±11.9 years and 59.0% were males. Compared with CP group, the level of T3, T4, FT3 and TSH was significantly lower in AP group. A high prevalence of thyroid dysfunction (87.4%), manifested as decreased thyroid hormones and TSH, was observed in AP patients. The extent of hormone reduction was progressively exacerbated with increasing the disease severity. Albumin (Alb) was independently positive correlation, and hs-CRP and lactate (Lac) were independently negatively correlated with thyroid function. The levels of thyroid hormones and TSH increased during AP resolution. TSH demonstrated superior predictive value for moderate-to-severe AP compared to traditional markers (hs-CRP, Alb, Ca) and established severity scores (APACHE II, BISAP). The cut-off value of TSH was 0.42 µIU/mL with the highest AUC (0.772 (0.693-0.851)) and the highest Youden's index (0.478).</p><p><strong>Conclusion: </strong>Thyroid dysfunction was common in AP patients, characterized by a reduction in thyroid hormones and TSH. Lower Alb and higher hs-CRP and Lac were independent risk factors of thyroid dysfunction. During AP resolution, thyroid dysfunction could spontaneously recover. Furthermore, a low level of TSH at admission showed promising predictive value for moderate to severe AP in the early stage.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"575782"},"PeriodicalIF":2.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596365","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":"Assessment of Functional Capacity and Its Sociodemographic and Health Determinants in Older Adults from a Region of Peru.","authors":"Susan Míriam Oblitas-Guerrero, Ana Milagro Salazar Barrios, Iris Amanda Benel Alarcón, Flor Cecilia Salgado Montenegro, Mary Judith Heredia Mondragón, Susan Del Rosario Santamaría Oblitas, Jacksaint Saintila","doi":"10.2147/RMHP.S579813","DOIUrl":"10.2147/RMHP.S579813","url":null,"abstract":"<p><strong>Background: </strong>Functional capacity is a key component of healthy aging, as it reflects the degree of autonomy of older adults in their daily activities. In regions of Peru such as Lambayeque, information on factors associated with functionality in this population is still limited, which makes it difficult to plan preventive and social support interventions.</p><p><strong>Objective: </strong>Assess functional capacity and its sociodemographic and health determinants in older adults in the Lambayeque region, Peru.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 2025 with a sample of 657 adults aged 60 years and older selected through stratified sampling. Functional capacity was evaluated using the Katz Index and the Lawton and Brody Scale for basic and instrumental activities of daily living (BADL and IADL). Descriptive statistics, bivariate tests, and binary logistic regression were applied.</p><p><strong>Results: </strong>Among participants, 58.9% were women, and more than half presented some degree of functional dependence. Logistic regression showed that being male was associated with lower odds of functional dependence (OR = 0.33; 95% CI: 0.17-0.63; p = 0.001). In contrast, age ≥75 years (OR = 2.71; 95% CI: 1.56-4.71; p = 0.001), unemployment (OR = 2.50; 95% CI: 1.12-5.56; p = 0.041), and multimorbidity (two or more chronic conditions; OR = 1.89; 95% CI: 1.07-3.34; p = 0.028) were significantly associated with higher odds of functional dependence.</p><p><strong>Conclusion: </strong>Older adults who are unemployed, have multiple chronic diseases, or are of advanced age are more vulnerable to functional dependence. These findings underscore the importance of early detection, functional health monitoring, and programs promoting independence and active aging in older populations in Peru.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"579813"},"PeriodicalIF":2.0,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522817","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":"Associations Between Longitudinal Changes in Frailty and Incident Arthritis: A Multi-Cohort Study.","authors":"Zhiyan Han, Haiyan Qu, Xinping Wang, Huifen Ma, Suhang Song","doi":"10.2147/RMHP.S591789","DOIUrl":"https://doi.org/10.2147/RMHP.S591789","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the associations between baseline frailty, longitudinal changes in frailty status, and the risk of incident arthritis in older adults across diverse international populations.</p><p><strong>Methods: </strong>We analyzed harmonized longitudinal data from four large ageing cohorts: CHARLS (China), ELSA (England), SHARE (Europe), and MHAS (Mexico). A total of 48,480 participants aged 45 years and older were included in the baseline analysis, among whom 18,820 were included in the longitudinal frailty change analysis. Frailty was assessed using a standardized frailty index. We employed Cox proportional hazards models to estimate the associations of baseline frailty and frailty transitions over two years with subsequent incident arthritis, adjusting for sociodemographic and lifestyle covariates.</p><p><strong>Results: </strong>Higher baseline frailty levels were prospectively associated with an increased risk of incident arthritis, with Hazard Ratios (HRs) for the highest versus lowest frailty tertiles ranging from 1.26 (95% CI 1.10-1.44) to 1.71 (95% CI 1.31-2.23) across the cohorts. Regarding dynamic changes, worsening frailty was associated with a significantly elevated risk; specifically, transitioning from pre-frail to frail was associated with HRs ranging from 1.45 (95% CI 1.08-1.95) in SHARE to 2.06 (95% CI 1.42-2.98) in MHAS. In contrast, improvement in frailty status was not associated with a significant reduction in arthritis risk in any cohort.</p><p><strong>Conclusion: </strong>The relationship between frailty and arthritis risk is markedly asymmetric. While frailty progression significantly elevates risk, restoring a robust state does not immediately reverse this vulnerability. This suggests that preventing decline is far more effective than attempting to reverse risk once damage has occurred.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"591789"},"PeriodicalIF":2.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500922","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":"Construction and Validation of a Nomogram Prediction Model for Recurrent Lumbar Disc Herniation After Percutaneous Endoscopic Lumbar Discectomy.","authors":"Zeyu Jiang, Ziying Cui, Yiping Yang, Haijun Li","doi":"10.2147/RMHP.S578901","DOIUrl":"https://doi.org/10.2147/RMHP.S578901","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) and to develop and internally validate a nomogram.</p><p><strong>Methods: </strong>This retrospective, single-center study included 607 patients who underwent PELD between January 2018 and December 2023. Thirty candidate predictors were collected. Predictor selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression. A nomogram was constructed in accordance with the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) recommendations. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC); for a binary outcome, the concordance index (C-index) is numerically equivalent to the AUC and was therefore reported for internal validation. Calibration was evaluated using the Hosmer-Lemeshow test and calibration curves. Internal validation was conducted using bootstrap resampling (1,000 iterations) and 10-fold cross-validation. Decision curve analysis (DCA) was applied to evaluate clinical utility.</p><p><strong>Results: </strong>During follow-up, 70 of 607 patients (11.5%) developed rLDH. Seven independent predictors were identified: postoperative activity, body mass index (BMI), smoking, ligamentum flavum (LF) thickness, sagittal range of motion (sROM), Modic change, and Pfirrmann grade. The nomogram achieved an AUC of 0.793 (95% CI: 0.736-0.850) and good calibration (Hosmer-Lemeshow P = 0.668). Internal validation showed a C-index of 0.763 (95% CI: 0.682-0.844) in bootstrap resampling and 0.775 in 10-fold cross-validation. The calibration curve showed close alignment with the ideal curve. DCA demonstrated favorable clinical utility of the model.</p><p><strong>Conclusion: </strong>This internally validated nomogram integrates clinical and imaging predictors to provide individualized rLDH risk prediction after PELD. It may assist in identifying patients at higher risk of recurrence who could benefit from closer postoperative surveillance and individualized decision-making. External validation is warranted before broad clinical implementation.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"578901"},"PeriodicalIF":2.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12996042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488644","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}