Health affairs scholar最新文献_第6页

Primary care, weather, and the missed opportunity for savings. 初级保健，天气，以及失去的储蓄机会。

IF 4.1

Health affairs scholar Pub Date : 2026-08-27 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag225

Maranna Yoder, Nilesh Shinde, Guangqing Chi, Seth Freedman, Kosali Simon, Sonia Angell

{"title":"Primary care, weather, and the missed opportunity for savings.","authors":"Maranna Yoder, Nilesh Shinde, Guangqing Chi, Seth Freedman, Kosali Simon, Sonia Angell","doi":"10.1093/haschl/qxag225","DOIUrl":"10.1093/haschl/qxag225","url":null,"abstract":"Extreme weather is a recurring source of stress on healthcare delivery, yet health systems remain largely reactive. Unlike an individual medical emergency, which the system absorbs one case at a time, a heat wave, wildfire smoke episode, or storm affects an entire population simultaneously. The resulting surge degrades care for every emergency patient, not only those the weather directly harmed. Primary care that anticipates weather-related risk and intervenes proactively can blunt that surge, but a central barrier to scaling such care is economic rather than clinical. Conventional prevention accounting counts only the benefit to the treated patient, and fee-for-service payment offers primary care practices only limited and poorly matched means to fund anticipatory care. Payment models that reward keeping patients healthy, such as global budgets, can address this, but only if risk adjustment accounts for environmental exposure so that providers serving vulnerable populations are not penalized. To address this, we outline 4 priorities: evaluations that capture system-wide costs; payment that rewards anticipatory care and adjusts for environmental risk; supply-side resilience in primary care, built jointly with public health agencies; and data infrastructure linking exposure to healthcare utilization.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag225"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

"Am I a candidate for magic mushrooms?" A mystery shopper study of Oregon psilocybin service centers. “我是魔法蘑菇的候选人吗？”俄勒冈裸盖菇素服务中心的神秘顾客研究。

IF 4.1

Health affairs scholar Pub Date : 2026-08-27 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag231

Danielle R Adams, Morgan Hartman, Lisa Gong, Suraj Shankar, Ruth Ling, Jacob T Steinle, Joshua S Siegel, Ginger E Nicol, Richard A Grucza, Jacob T Borodovsky, Leopoldo J Cabassa, Kevin Y Xu

{"title":"\"Am I a candidate for magic mushrooms?\" A mystery shopper study of Oregon psilocybin service centers.","authors":"Danielle R Adams, Morgan Hartman, Lisa Gong, Suraj Shankar, Ruth Ling, Jacob T Steinle, Joshua S Siegel, Ginger E Nicol, Richard A Grucza, Jacob T Borodovsky, Leopoldo J Cabassa, Kevin Y Xu","doi":"10.1093/haschl/qxag231","DOIUrl":"10.1093/haschl/qxag231","url":null,"abstract":"Introduction: Oregon is the first US state to permit supervised psilocybin services through a nonmedical, wellness-based model. We examined what prospective clients with psychiatric histories encounter when contacting service centers, including how staff communicate about safety, eligibility, and cost.Methods: We conducted a mystery shopper study of 26 licensed service centers in Oregon (7/2025-9/2025), 4 of which closed before calls began, leaving 22 in the sample. We reviewed websites and conducted 2 waves of scripted phone calls portraying adults with depression. Website and call data were combined at the center level, counting an item as disclosed if it appeared online or during a call. Themes from call field notes were contextualized through structured debriefing interviews with service center staff.Results: Callers reached 15/22 centers, none of which permitted unsupervised consumption or immediate dosing without psychiatric assessment. Staff asked detailed questions about psychiatric comorbidities, addressing information gaps from websites, and none recommended discontinuing antidepressants. The median cost was $1900. Debriefing interviews described financial strain for service centers, with viability constrained by licensing fees and potential misalignment with cannabis-derived business models.Conclusion: Oregon's regulated model appears clinically cautious, while facing high costs for clients, facilitators, and service centers that limit scalability.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 10","pages":"qxag231"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

FDA drug quality assurance inspections: frequency, outcomes, and time to reinspection, 2008-2025. FDA药品质量保证检查：频率、结果和复检时间，2008-2025。

IF 4.1

Health affairs scholar Pub Date : 2026-08-27 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag229

Yunxiang Sun, Jeromie Ballreich, Joy Acha, Riya Modi, Mohammad Ali Alamdar Yazdi, Maqbool Dada, Tinglong Dai, Gerard Anderson, Mariana P Socal

{"title":"FDA drug quality assurance inspections: frequency, outcomes, and time to reinspection, 2008-2025.","authors":"Yunxiang Sun, Jeromie Ballreich, Joy Acha, Riya Modi, Mohammad Ali Alamdar Yazdi, Maqbool Dada, Tinglong Dai, Gerard Anderson, Mariana P Socal","doi":"10.1093/haschl/qxag229","DOIUrl":"10.1093/haschl/qxag229","url":null,"abstract":"Background: The U.S. Food and Drug Administration (FDA) inspections are central to oversight of the pharmaceutical manufacturing base, but long-term inspection and reinspection patterns remain incompletely characterized.Methods: We analyzed 25 629 FDA Drug Quality Assurance inspections conducted from October 2008 through December 2025. We described annual, regional, and outcome patterns. Linking inspections to facilities, we examined time to reinspection according to the outcome of preceding inspections.Results: Annual Drug Quality Assurance inspections declined from 1594 in 2019 to 461 in 2020 and increased to 1218 in 2025. The United States remained the largest single region of inspection activity, but its contribution declined over time. The proportion of favorable inspection outcomes (no action indicated-NAI) decreased from 40.0% before the pandemic to 19.3% during and 23.7% after. Unfavorable outcomes (voluntary action indicated-VAI-and official action indicated-OAI) increased accordingly. The mean reinspection interval was 3.18 years after NAI, 2.96 after VAI, and 2.12 after OAI (P < .001). Median times were 4.08, 3.51, and 3.02 years, respectively.Conclusion: FDA inspection activity had not returned to prepandemic levels by 2025. Unfavorable inspection outcomes were associated with earlier reinspection, consistent with risk-responsive oversight. However, the available data cannot establish whether follow-up was timely or adequate.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag229"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost and utilization outcomes of pharmacist-led medication therapy optimization in a Medicare ACO population. 药师主导的药物治疗优化的成本和利用结果在Medicare ACO人群。

IF 4.1

Health affairs scholar Pub Date : 2026-08-26 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag223

Hazem F Elewa, Joseph F Levy, Chintan Pandya, Steven E Goldberg, Travis A Morgan

{"title":"Cost and utilization outcomes of pharmacist-led medication therapy optimization in a Medicare ACO population.","authors":"Hazem F Elewa, Joseph F Levy, Chintan Pandya, Steven E Goldberg, Travis A Morgan","doi":"10.1093/haschl/qxag223","DOIUrl":"10.1093/haschl/qxag223","url":null,"abstract":"Introduction: Medication-related problems are a persistent source of avoidable spending among Medicare beneficiaries, presenting an important opportunity to improve the quality of care for seniors and reduce financial burden on the Medicare program.Methods: We evaluated a pharmacist-led medication therapy optimization (MTO) program implemented in a Medicare accountable care organization population using a regression-adjusted difference-in-differences design with propensity score matching. The analysis included 1003 treated members and 14 031 matched controls contributing 334 531 member-months of claims data (2022-2025). The MTO program combined pharmacogenomic testing, a nine-vector medication-risk algorithm, comprehensive pharmacist review, and structured recommendations to prescribers.Results: MTO participation was associated with a statistically significant reduction in total medical costs (pooled average treatment effect on the treated: -19.4%, -$246 per member per month [PMPM]; P < 0.001). The treatment effect was strongly duration-dependent, growing from -4.7% in the first three months to -31.9% (-$462 PMPM; P < 0.001) beyond nine months of program benefit. All care settings showed significant reductions: inpatient admissions -43.1% (P < 0.001), emergency department visits -41.3% (P < 0.001), and outpatient visits -28.3% (P < 0.001).Conclusion: Medication therapy optimization was associated with significant cost savings. Parallel trends validation and a pronounced dose-response relationship support a causal interpretation. Short-duration evaluations are likely to substantially underestimate the full economic value of an MTO program.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag223"},"PeriodicalIF":4.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

When nurses are held accountable for AI-driven clinical decisions, they must be engaged early and meaningfully. 当护士对人工智能驱动的临床决策负责时，他们必须尽早和有意义地参与其中。

IF 4.1

Health affairs scholar Pub Date : 2026-08-26 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag218

Meghan Reading Turchioe, Ann Wieben, Carolyn Sun, Christina Baker, Benjamin J Galatzan

{"title":"When nurses are held accountable for AI-driven clinical decisions, they must be engaged early and meaningfully.","authors":"Meghan Reading Turchioe, Ann Wieben, Carolyn Sun, Christina Baker, Benjamin J Galatzan","doi":"10.1093/haschl/qxag218","DOIUrl":"10.1093/haschl/qxag218","url":null,"abstract":"Health systems are adopting AI-powered tools faster than policy can address the implications for clinician liability. Nurses, as the largest healthcare profession and the most proximal clinicians to patients, must decide whether to accept, modify, or override AI-derived recommendations, often while managing competing cognitive demands. Yet the question of who bears responsibility when AI contributes to patient harm remains unresolved in policy and case law. At the 2025 American Medical Informatics Association Annual Symposium, a structured debate examined whether nurses should be held liable for AI-assisted clinical decisions. Proponents argued that professional ethics, existing tort precedent, and the nurse's role as human-in-the-loop require accountability. Opponents countered that AI opacity, unfair liability distribution, and limited nurse agency in AI procurement preclude fair responsibility assignment. Two reforms are essential: meaningful nurse engagement throughout the AI lifecycle and nursing-specific considerations in AI legislation and regulatory frameworks.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag218"},"PeriodicalIF":4.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Boarded patients, blurred benchmarks: an opportunity for CMS. 病人登机，基准模糊：CMS的机会。

IF 4.1

Health affairs scholar Pub Date : 2026-08-25 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag226

Elyssa F L Grogan, Natalia Sifnugel, Arjun K Venkatesh, Ula Hwang

{"title":"Boarded patients, blurred benchmarks: an opportunity for CMS.","authors":"Elyssa F L Grogan, Natalia Sifnugel, Arjun K Venkatesh, Ula Hwang","doi":"10.1093/haschl/qxag226","DOIUrl":"10.1093/haschl/qxag226","url":null,"abstract":"The Centers for Medicare & Medicaid Services recently introduced 2 clinical quality measures that intend, in part, to disincentivize hospital boarding: a patient safety concern that involves holding admitted patients in the emergency department while an inpatient bed is unavailable. The Age-Friendly Hospital Measure (AFHM), a structural measure, asks hospitals to attest to having protocols in place to reduce boarding for older patients. The Emergency Care Access and Timeliness (ECAT) measure, an intermediate outcome measure, will require hospitals to report on the proportion of boarded patients. Each measure was developed under a different parent quality reporting program-1 inpatient and 1 outpatient-which has the unintended consequence of producing meaningful variation between the measures. We describe opportunities to standardize and synergize the AFHM and ECAT to capture the prevalence of boarding uniformly, prevent gamesmanship, and enhance their impact on hospital performance. In particular, we highlight the importance of stratifying ECAT by the older-adult patient population to complement AFHM and since older adults are uniquely vulnerable to boarding and its associated safety risks.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag226"},"PeriodicalIF":4.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medicaid payment rates for substance use disorder treatment-design, data, and lack of transparency. 药物使用障碍治疗的医疗补助支付率——设计、数据和缺乏透明度。

IF 4.1

Health affairs scholar Pub Date : 2026-08-25 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag224

Kayla N Tormohlen, Erika L Crable, Emma E McGinty

引用次数: 0

Changes in documentation of social risk factor diagnosis codes: comparison of Medicaid Accountable Care Organization model types. 社会风险因素诊断代码文件的变化：医疗补助责任医疗组织模式类型的比较。

IF 4.1

Health affairs scholar Pub Date : 2026-08-25 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag220

Kevin H Nguyen, Kenneth Lim, Kathryn Thompson, Sarah H Gordon, Collette N Ncube, Lois McCloskey, Megan B Cole

{"title":"Changes in documentation of social risk factor diagnosis codes: comparison of Medicaid Accountable Care Organization model types.","authors":"Kevin H Nguyen, Kenneth Lim, Kathryn Thompson, Sarah H Gordon, Collette N Ncube, Lois McCloskey, Megan B Cole","doi":"10.1093/haschl/qxag220","DOIUrl":"10.1093/haschl/qxag220","url":null,"abstract":"Introduction: Identifying social risk factors during the perinatal period may improve pregnancy-related outcomes. In 2018, the Massachusetts Medicaid program implemented an accountable care organization (ACO)-which required social risk factor screening-under 2 ACO model types: Model A (health system/Medicaid managed care plan partnership model) and Model B (primary care practice model).Methods: Using the 2016-2020 Massachusetts All Payer Claims Database and a difference-in-differences (DiD) design, we compared changes in any social risk factor documentation (ie, ICD-10 Z-codes) for Medicaid-enrolled deliveries in non-ACOs vs ACO Model A vs Model B, measured separately for the prenatal period, 60 days postpartum, 12 months postpartum, and the perinatal period. Secondary outcomes included documentation of specific Z-codes related to homelessness and food insecurity.Results: Both Model A (DiD = 1.03 percentage points [PP], P < .001) and Model B (DiD = 0.65 PP, P < .001) were associated with significant increases in Z-code documentation of food insecurity in the perinatal period. Model B was associated with a significant increase in Z-code documentation of homelessness in the perinatal period (DiD = 1.10 PP, P < .001) but not Model A.Conclusion: Massachusetts' Medicaid ACO was associated with modest increases in Z-code documentation during the perinatal period, with some variation by ACO model type.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag220"},"PeriodicalIF":4.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Over 3 in 4 adults potentially subject to Medicaid work requirements may already have a route to exclusion or compliance. 超过四分之三的成年人可能受到医疗补助工作要求的限制，可能已经有排除或遵守的途径。

IF 4.1

Health affairs scholar Pub Date : 2026-08-24 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag219

Joshua Varcie, Shamik Bhat, Teddy Knox, Heather Howard

{"title":"Over 3 in 4 adults potentially subject to Medicaid work requirements may already have a route to exclusion or compliance.","authors":"Joshua Varcie, Shamik Bhat, Teddy Knox, Heather Howard","doi":"10.1093/haschl/qxag219","DOIUrl":"10.1093/haschl/qxag219","url":null,"abstract":"Introduction: Starting in 2027, 18.5 million Medicaid enrollees will likely be subject to new work requirements that could lead to significant coverage losses.Methods: Using American Community Survey data, we estimate the share of the population of interest that will have a route to exclusion from or compliance with the requirements. We also explore how rates of exclusion from or compliance with work requirements vary by state and demographic group.Results: We find that 46% of those in our proxy population will meet the criteria for at least one exclusion, 58% will meet the criteria for compliance, and 78% will have at least one route to exclusion or compliance. The \"exclusion or compliance\" share varies from 70% in New York to 94% in North Dakota. It also varies by demographic group, as women and younger adults are more likely than their counterparts to have a route to exclusion or compliance.Conclusion: The large \"exclusion or compliance\" share implies that an important driver of coverage loss will be states' capacity to verify exclusions or compliance, as <1 in 4 enrollees are estimated to not have a route to exclusion or compliance.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag219"},"PeriodicalIF":4.1,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Utilization and denials of skin and tissue substitutes in Medicare. 医疗保险中皮肤和组织替代品的使用和拒绝。

IF 4.1

Health affairs scholar Pub Date : 2026-08-22 eCollection Date: 2026-08-01 DOI: 10.1093/haschl/qxag214

Elsa Zhang, Yue Gao, Joshua M Liao

引用次数: 0