Medical Care[JOURNAL]
Sun
200 papers
Impacts of a Rural Hospital Global Budget Alternative Payment Model on Patterns of Cancer Surgery.
Sabik LM, Whitman J, Bourne DS … +7 more , Sun Z, Roberts ET, Yabes JG, Bhattacharya M, Bartlett D, Kahn JM, Jacobs BL
Med Care · 2026 Aug · PMID 42065351 · Publisher ↗
BACKGROUND: Rural patients often experience barriers accessing high-quality surgical care. The Pennsylvania Rural Health Model (PARHM) aimed to improve rural health through all-payer hospital global budgets and transform...
BACKGROUND: Rural patients often experience barriers accessing high-quality surgical care. The Pennsylvania Rural Health Model (PARHM) aimed to improve rural health through all-payer hospital global budgets and transformation plans, which may influence hospitals' incentives and capacity to provide various surgical services, including cancer surgery. OBJECTIVES: Examine the association between PARHM and patterns of cancer surgery overall, by timing of entry into PARHM, and by cancer type. RESEARCH DESIGN: Stacked difference-in-differences (DID) models including hospital service area (HSA)-level propensity score weights, comparing patients living in HSAs with hospitals participating in PARHM to those in HSAs with eligible nonparticipating hospitals. SUBJECTS: Patients in eligible HSAs who had surgery between 2016 and 2023 for one of 11 cancers with evidence of surgical volume-outcome relationships. MEASURES: Surgery at a high-volume, Commission on Cancer (CoC) accredited, or National Cancer Institute (NCI)-designated hospital, and travel distance to the surgical hospital. RESULTS: The sample included 22,728 cancer surgeries for patients across 60 HSAs. Pooled estimates indicate no statistically significant differential changes in outcomes. In HSAs served by the 2019 cohort of PARHM hospitals (smaller and more remote facilities), PARHM was associated with a differential increase in surgery at CoC hospitals (DID estimate: 8.7 percentage points, 95% CI: 1.5- 16.0). We observed differential increases in surgery at CoC hospitals for colon and rectal cancers, and decreases in surgery at CoC and high-volume hospitals for liver cancer and at NCI centers for bladder cancer. CONCLUSION: PARHM had limited overall effects on surgical cancer care, with some variation across hospitals and cancer types.
Safe Minimum Nurse Staffing Requirements for Hospitals: Evidence From Pennsylvania.
Muir KJ, Aiken LH, Brom H … +3 more , Hovsepian V, Lasater KB, McHugh MD
Med Care · 2026 Jul · PMID 42060836 · Full text
BACKGROUND: The Pennsylvania legislature is considering limiting the number of patients nurses care for to promote safe care. OBJECTIVE: To determine whether variation in nurse workloads is associated with adverse conseq...
BACKGROUND: The Pennsylvania legislature is considering limiting the number of patients nurses care for to promote safe care. OBJECTIVE: To determine whether variation in nurse workloads is associated with adverse consequences for patients, nurses, and hospital costs in Pennsylvania. METHODS: Observational study of 547,689 medical and surgical patients and 2782 direct care nurses in 132 Pennsylvania hospitals. The independent variable was medical-surgical nurse staffing ratios. Patient outcomes included 30-day mortality, 30-day readmissions, and length of stay. Nurse outcomes included burnout, job dissatisfaction, intent to leave, and evaluations of hospital management and patient care. Hospital outcomes were HCAHPS Star Ratings and cost offsets associated with better staffing. RESULTS: Hospital nurse staffing ranged from 3 to 9 patients per nurse (average 5.9). Each additional patient per nurse was associated with higher odds of 30-day mortality (AOR: 1.08, 95% CI: 1.03, 1.13, P <0.001), longer length of stay (IRR: 1.02, 95% CI: 1.00, 1.04, P <0.05) and higher odds of readmission (AOR: 1.04, 95% CI: 1.01, 1.07, P <0.05). Worse staffing was associated with higher odds of nurse burnout, job dissatisfaction, and intent to leave, and lower patient satisfaction. Cost savings from patient outcomes and nurse retention were projected to offset costs of additional nurses needed for hospitals to meet a minimum safe nurse staffing level proposed in legislation. CONCLUSIONS: Large differences across Pennsylvania hospitals in the amount of nursing care patients receive are associated with negative consequences. A state policy establishing minimum safe nurse staffing requirements in hospitals is in the public's interest.
Association Between Team-Based Continuity of Care Measures and End-of-Life Health Care Outcomes: A Retrospective Cohort Study in Ontario, Canada.
Hafid S, Isenberg S, Jones A … +9 more , Wills A, Shorting T, Gayowsky A, Fernandes A, Quinn KL, Webber C, Gallagher E, Tanuseputro P, Howard M
Med Care · 2026 Aug · PMID 42048177 · Full text
BACKGROUND: Continuity of care (COC) measurements that reflect relational continuity have been used as quality indicators, yet their applicability near the end of life may be limited. Modified continuity indices-UPC-Team...
BACKGROUND: Continuity of care (COC) measurements that reflect relational continuity have been used as quality indicators, yet their applicability near the end of life may be limited. Modified continuity indices-UPC-Team (Usual Provider of Care) and BB-Team (Bice-Boxerman)-were developed to reflect escalating care needs and capture associations with patient-centered outcomes. OBJECTIVES: To measure associations between the modified COC indices, UPC-Team, and BB-Team during the last year of life and end-of-life (EOL) health care outcomes. METHODS: Retrospective cohort study of adults who died between January 1, 2018, and December 31, 2022, with advanced chronic obstructive pulmonary disease and/or heart failure prevalent ≥2 years before death, using health administrative data from Ontario, Canada. Multivariate regressions measured associations between the indices and days spent in community during the last 30 and 14 days of life, and place of death. RESULTS: Among 175,323 included individuals (median age at death=80; 55.4% male), the median number of community days was 23 and 10 in the last 30 and 14 days of life; 56.5% died in a health care institution. Higher UPC-Team and BB-Team scores were associated with increased odds of institutional deaths and fewer community days. CONCLUSIONS: Higher continuity scores were associated with increased odds of institutional death and fewer days spent in the community, suggesting limited utility of these modified indices in predicting favorable EOL health care outcomes. Findings highlight the need for future research to incorporate all aspects of continuity (ie, relational, informational, and management) to better capture care coordination in this context.
Success Rates of Venture Capital Investment in Biopharmaceutical Development.
Kang SY, Liu M, Huang SS
Med Care · 2026 Jul · PMID 42047301 · Publisher ↗
BACKGROUND: Large biopharmaceutical companies increasingly outsource early research and development (R&D) to startups funded by venture capital (VC). Yet little is known about how effective VC funding is at advancing new...
BACKGROUND: Large biopharmaceutical companies increasingly outsource early research and development (R&D) to startups funded by venture capital (VC). Yet little is known about how effective VC funding is at advancing new drugs to market. OBJECTIVES: To examine the outcomes of clinical trials conducted by VC-backed startups and identify factors associated with their progression. RESEARCH DESIGN: Retrospective cohort study of VC-backed biopharmaceutical clinical trials. SUBJECTS: Index phase 1 trials initiated between January 2006 and December 2015, tracked through April 2024. MEASURES: Progression to phase 2, phase 3, and US Food and Drug Administration (FDA) approval. Associations between trial characteristics and progression were estimated using multinomial logistic regression. RESULTS: Among 1357 VC-backed phase 1 trials, 10.9% failed to complete phase 1, 13.3% completed phase 1 and stopped, 42.5% progressed only to phase 2, 19.2% only to phase 3, and 14.1% ultimately received FDA approval. Cancer-related trials achieved FDA approval in 8.7% of cases. Compared with small-molecule trials, biological trials were less likely to progress to phase 3 [-11.3 percentage points (pp), P <0.001] or receive FDA approval (-14.1 pp, P <0.001). Greater initial investment in phase 1 was associated with higher progression, including a 6.2 pp higher probability of FDA approval ( P <0.001). CONCLUSIONS: Clinical trial success rates among VC-backed startups were within the range of approval rates previously reported for large manufacturers. Progression varied substantially by drug modality, therapeutic focus, and initial investment size, underscoring how capital allocation and development strategy shape R&D outcomes.
The Paradoxical Association of Disaggregated Data Collection With Diabetes Control Among Latino Patients.
Heintzman JD, Dinh D, Kaufmann J … +6 more , Lucas J, Bensken WP, Crookes DM, Florez K, Echeverria S, Marino M
Med Care · 2026 Jul · PMID 42047292 · Publisher ↗
BACKGROUND: Data disaggregation in Latino patients has been called for by national organizations. However, analyses of the association between the collection of this data point, especially the place of birth, and common...
BACKGROUND: Data disaggregation in Latino patients has been called for by national organizations. However, analyses of the association between the collection of this data point, especially the place of birth, and common disease-specific factors, including disease severity, are lacking. OBJECTIVE: To examine the relationship between the collection of place of birth data and diabetes control in a national network of community health centers (CHCs). PARTICIPANTS: Hispanic/Latino adult patients, aged 18 to 79 years, with diabetes. MEASURES: We described the following groups by demographic, clinical, and neighborhood factors, and compared odds of hemoglobin a1c (HbA1c) always <7% or ever >9%, stratified by preferred language: (1) patients whose clinics never collected place of birth; (2) those whose clinics did collect this information, but they personally did not have a country of birth in their record; and (3) those with country of birth documented. RESULTS: In our study population (n=81,107), Spanish-preferring Latinos with their place of birth recorded (HbA1c always <7: OR=0.75, 95% CI: 0.65-0.87; HbA1c ever >9: OR=1.68, 95% CI: 1.44-1.95) had worse HbA1c measures than Spanish-preferring Latino patients in clinics that did not collect country of birth. CONCLUSIONS: In a national CHC network, Spanish-preferring Latino patients with country of birth information in their records had less well-controlled HbA1cs than those who were served by clinics that did not collect these data. These surprising findings underscore the need to assess disaggregated data collection in Latino patients to better understand the data necessary for high-quality primary care in Latino communities.
Diabetes Diagnosis Patterns in Medicaid: How State Policy, Managed Care, and Social Vulnerability Shape Detection in Medicaid.
Alva ML, Booppasiri S, Crowell A … +2 more , Magee MF, Peng Ng B
Med Care · 2026 Jul · PMID 42025132 · Full text
OBJECTIVE: To describe patterns of type 2 diabetes diagnosis prevalence in Medicaid administrative data by individual and contextual factors. METHODS: Diagnosed prevalence was estimated using the 2016-2021 Transformed Me...
OBJECTIVE: To describe patterns of type 2 diabetes diagnosis prevalence in Medicaid administrative data by individual and contextual factors. METHODS: Diagnosed prevalence was estimated using the 2016-2021 Transformed Medicaid Statistical Information System (T-MSIS) and a Bayesian multilevel regression framework. The first level included patient characteristics (age, sex, and race/ethnicity), the Social Vulnerability Index (SVI), plan-level characteristics, payment models, and federal level of poverty (FLP) eligibility thresholds. The second level incorporates partial pooling over the state to model state fixed effects. Adults ages 21-64 years with 24+ months consecutive enrollment were included. States with a high degree of missing data were excluded. RESULTS: Among 4.41 million eligible Medicaid beneficiaries in N=11 states with high-quality T-MSIS data, 10.3% had a type 2 diabetes diagnosis record. State-level diagnosed prevalence based on administrative data ranged from 6.5%-13.0%, and increased with age (4.1% for 21-35 vs. 23.9% for 55-64 y), was higher among "Other" race (14.3%), Hispanic (12.0%), and Black (10.9%) enrollees versus White (9.1%). Higher county-level obesity was associated with increased odds (third vs. first tertile OR 1.26, 95% CI: 1.25-1.27), while living in urban areas (OR 0.91, 95% CI: 0.90-0.91) and in the highest SVI quartile (OR 0.74, 95% CI: 0.73-0.75) with lower odds. Race interactions were most pronounced for contextual socioeconomic modifiers (SVI, FPL, and plan type). CONCLUSIONS: Evidence generated confirms that odds of having a recorded type 2 diabetes diagnosis are shaped by age, comorbidities, race/ethnicity, and social vulnerability. Notable variations by state and care plans were identified. Documentation and data improvements are needed.
US Medicaid Spending and Health Insurance Coverage for People Involved in the Criminal Legal System as Children.
Silver IA, Dole JL, Semenza DC
Med Care · 2026 Jul · PMID 41988953 · Publisher ↗
INTRODUCTION: Early involvement in the US criminal legal system (CLS) is linked to persistent health disadvantages, including reduced health insurance coverage in adulthood. OBJECTIVES: The current study examined the inf...
INTRODUCTION: Early involvement in the US criminal legal system (CLS) is linked to persistent health disadvantages, including reduced health insurance coverage in adulthood. OBJECTIVES: The current study examined the influence of increases and cuts to federal and state Medicaid expenditures on health insurance enrollment among individuals with varying levels of CLS involvement before age 18. RESEARCH DESIGN: The current study is a cohort study of individuals who participated in the National Longitudinal Survey of Youth 1997 (2003-2021). PATIENTS AND METHODS: The total sample included 8240 participants. This study applied Bayesian lagged random-intercept logistic regression to assess associations between Medicaid spending and uninsurance among individuals with and without CLS contact before age 18. MEASURES: Federal and State Medicaid expenditures were measured in total dollars spent by the federal government and state governments, respectively. Contact with the CLS before 18 was measured as arrested before 18, incarcerated in a juvenile facility before 18, or incarcerated in an adult facility before 18. Uninsurance was measured as the absence of insurance on the date of the interview. RESULTS: Greater CLS severity was associated with higher odds of being uninsured, while higher federal Medicaid expenditures were associated with a lower uninsurance rate. Simulations indicated that a 50% federal Medicaid spending cut could increase uninsurance for those with CLS involvement before 18, whereas a 20% spending increase would increase the probability of insurance. CONCLUSIONS: Findings highlight the federal Medicaid's role in mitigating coverage inequities and suggest that reducing expenditures could exacerbate ongoing health disparities rooted in early CLS involvement.
Anesthesia Provider Type and Veteran Satisfaction: The Authors' Reply.
Griffith KN, Harris J, Darna J … +2 more , Dutton RP, Mull HJ
Med Care · 2026 Jun · PMID 41983472 · Publisher ↗
Abstract loading — click title to view on PubMed.
RE: Compliance With Recommendations of the Surveillance, Epidemiology, and End Results (SEER) Treatment Data Use Agreement.
Semprini J
Med Care · 2026 Jul · PMID 41973407 · Publisher ↗
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Response to Letter to the Editor: Compliance With Recommendations of the Surveillance, Epidemiology, and End Results (SEER) Treatment Data Use Agreement: A Review of Published Studies.
Hong YD, Mariotto AB, Lewis DR … +4 more , Noone AM, Howlader N, Scoppa S, Feuer EJ
Med Care · 2026 Jul · PMID 41973400 · Publisher ↗
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Comparing Approaches to Identify Mobile Crisis Services in Medicaid Administrative Claims.
Anderson A, Walker B, Kennedy-Hendricks A … +3 more , Li JM, Eisenberg M, Shen K
Med Care · 2026 Jun · PMID 41940505 · Publisher ↗
BACKGROUND: Mobile crisis services offer a community-based alternative to law enforcement and emergency departments for individuals experiencing behavioral health crises. Medicaid claims represent a promising but underus...
BACKGROUND: Mobile crisis services offer a community-based alternative to law enforcement and emergency departments for individuals experiencing behavioral health crises. Medicaid claims represent a promising but underused tool for national surveillance of these services. Despite growing federal investment and expansion of crisis response systems, there is no standardized method for identifying mobile crisis encounters in administrative claims, limiting the ability to monitor access, evaluate implementation, or compare delivery across states. OBJECTIVE: To develop and evaluate claims-based approaches for identifying mobile crisis service delivery in Medicaid administrative data. METHODS: We conducted a cross-sectional analysis of 2021 Medicaid claims from the Transformed Medicaid Statistical Information System Analytic Files. We used the 2022 KFF Behavioral Health Services Survey data as the most recent standardized benchmark for Medicaid mobile crisis coverage. We tested 3 claims-based identification approaches that combine national and state-specific procedure codes (eg, H2011) with mobile-relevant place-of-service (POS) codes: strict [POS 15 (mobile unit)], moderate [POS 15 (mobile unit), POS 12 (home), or POS 04 (homeless shelter)], and inclusive [POS 15, POS 12, POS 04, or POS 99 (other)]. We additionally constructed a claims-based score summarizing state-level use of mobile-relevant POS codes and examined its alignment with reported coverage in exploratory analyses. RESULTS: Among 44 states and the District of Columbia with complete survey data, 33 reported Medicaid coverage of mobile crisis services. We identified 97,088 claims under the strict approach, 395,141 under the moderate approach, and 1,152,653 under the inclusive approach. Across all approaches, states reporting coverage had higher median claim counts than noncoverage states, though substantial overlap remained. Under the strict approach, median claim counts were 0 in both coverage and noncoverage states. The moderate approach demonstrated the greatest separation (median, 1324 vs. 364), while the inclusive approach captured larger volumes overall but with greater overlap between groups. Predicted probabilities derived from a claims-based score increased monotonically across score values, indicating stronger directional alignment with reported coverage at higher score levels. CONCLUSION: A claims-based approach combining mobile unit (POS 15), home (POS 12), and homeless shelter (POS 04) codes with crisis intervention procedure codes provides a practical framework for identifying billed mobile crisis encounters in Medicaid data. This moderate approach showed the strongest directional alignment with state-reported coverage and may support cross-state monitoring of crisis service delivery. Further work is needed to validate these methods using provider-level or encounter-level data.
Physician Recommendations Against Pregnancy Among Young Women With Disabilities in the United States.
Akobirshoev I, Powell R, Horner-Johnson W … +3 more , Siegel R, Wu J, Mitra M
Med Care · 2026 Jun · PMID 41914514 · Publisher ↗
BACKGROUND: Women with disabilities face systematic barriers to reproductive autonomy, yet physician bias in pregnancy counseling has not been quantified using nationally representative data. METHODS: We analyzed pooled...
BACKGROUND: Women with disabilities face systematic barriers to reproductive autonomy, yet physician bias in pregnancy counseling has not been quantified using nationally representative data. METHODS: We analyzed pooled data from 4 waves of the National Survey of Family Growth (2011-2019), including 8018 US women aged 15-25. Disability status was defined using the American Community Survey's 6-item measure. The primary outcome was self-reported physician recommendation against pregnancy. Among women who received such recommendations (n=122), we examined physician-reported reasons using categories: "dangerous for you," "dangerous for your baby," and "some other reason." Poisson regression was used to estimate adjusted prevalence ratios (aPRs). RESULTS: Disabled women comprised 21.2% of the sample and were significantly more likely to report receiving physician recommendations against pregnancy compared with nondisabled women (2.6% vs. 1.1%; aPR:1.91, 95% CI: 1.10-3.29). The disparity was highest among women with physical disabilities (aPR:5.73, 95% CI: 1.79-18.29), followed by those with hearing (aPR: 4.24, 95% CI: 1.49-12.07) and vision disabilities (aPR:3.99, 95% CI: 1.60-9.99). A substantial proportion of recommendations were attributed to "some other reason" (disabled women: 44%; nondisabled women: 40%). CONCLUSIONS: Young disabled women face systematic bias during reproductive health care counseling, with nearly double the likelihood of receiving recommendations against pregnancy. The high proportion of recommendations under "some other reasons," beyond maternal or fetal health concerns, suggests potential subjective biases may influence clinical recommendations. These findings underscore the need for evidence-based clinical guidelines and monitoring to ensure respectful, individualized, and medically appropriate reproductive health care regardless of disability status.
Community-Based Proactive Primary Care Reduces Emergency Health Care Use for Adults Without Insurance.
Kitzman H, Mamun A, Fleming N … +2 more , Sykes K, Zsohar J
Med Care · 2026 Jul · PMID 41914492 · Publisher ↗
BACKGROUND: Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a...
BACKGROUND: Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a reliance on emergency care. OBJECTIVE: To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs. RESEARCH DESIGN: This retrospective study evaluated the volume and costs of emergency department (ED) and inpatient hospitalization for patients accessing community-based integrated primary care (BCC) located near hospital centers as compared with those receiving usual care (non-BCC). SUBJECTS: The BCC group included 16,069 patients, and a propensity score-matched control group included 16,069 non-BCC patients. Patients less than 18 years old, with documented mental health issues, or whose electronic health record data were incomplete were excluded from the study. MEASURES: ED and inpatient hospitalization (IP) visits and direct costs. RESULTS: Overall, the average per-person-year direct IP costs of BCC patients was 48% lower ( P <.001) and direct ED costs 43% lower ( P <.0001) than non-BCC patients. BCC patients had ∼44% fewer IP visits, and 29% fewer ED visits compared with non-BCC at 1-2 years of follow-up. BCC patients with diabetes related complications had 28% less IP costs and 27% less ED costs compared with non-BCC patients over 4 years ( P =.03, P =.01, respectively). CONCLUSIONS: This study supports the strategic navigation of uninsured patients from emergency departments and community settings to community-based primary care clinics offering integrated services, highlighting a promising population health approach.
The Patient Experience Divide: How Income Relates to Care Quality in the Primary Care Setting.
Martino SC, Reynolds KA, Parker AM … +5 more , Zelazny SM, Slaughter M, Grob R, Elliott MN, Hays RD
Med Care · 2026 Jun · PMID 41910999 · Full text
BACKGROUND: Income is closely linked to morbidity and mortality in the United States, potentially due in part to differences in patient experience. However, existing studies on income and care experiences are outdated an...
BACKGROUND: Income is closely linked to morbidity and mortality in the United States, potentially due in part to differences in patient experience. However, existing studies on income and care experiences are outdated and have other important limitations. METHODS: Using data from a recent national sample of adults (N=5016), we conducted a mixed-methods investigation of the relationship between income and primary care experiences. Patient experience was measured using the CAHPS Clinician and Group survey (CG-CAHPS) and its associated Narrative Item Set (NIS). Closed-ended responses were used to create 4 composite measures, for example, access to care, while open-ended NIS responses were coded for positive and negative mentions of 7 aspects of care: access, coordination, communication, office staff, efficiency, thoroughness, and emotional rapport. RESULTS: Contingent on mentioning an aspect of care in their narratives, low-income participants had lower unadjusted odds of making positive mentions of access, coordination, communication, office staff, efficiency, and emotional rapport (all P- values ≤0.02). Conversely, they had higher unadjusted odds of making negative mentions of coordination, communication, efficiency, and thoroughness (all P -values ≤0.006). Patterns were similar after controlling for education and other characteristics. Low-income participants also had scores on all CG-CAHPS composite measures that were 3-5 points lower than scores for higher-income participants (all P- values <0.001). CONCLUSION: Low-income patients report fewer positive and more negative health care experiences than higher-income patients across multiple aspects of care. These deficits may contribute to their higher morbidity and mortality. Further research is needed to uncover underlying causes and inform policies and practices to ensure high-quality care for all patients.
Defining and Measuring Delays in Postacute Care: Toward a Standardized Definition of Rehabilitation Access.
Nam S, Li CY, Tahashilder MI … +2 more , Kuo YF, Reistetter TA
Med Care · 2026 Jun · PMID 41910020 · Publisher ↗
BACKGROUND: Studying delays in postacute care (PAC) rehabilitation using Medicare data is challenging due to the absence of a standardized definition of PAC access timeframes across rehabilitation provider types. METHODS...
BACKGROUND: Studying delays in postacute care (PAC) rehabilitation using Medicare data is challenging due to the absence of a standardized definition of PAC access timeframes across rehabilitation provider types. METHODS: We used 100% Medicare claims data for beneficiaries aged 66 and older discharged to PAC with one of 8 common medical conditions. PAC initiation was examined for inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). Daily utilization curves were generated for each PAC setting. Joinpoint regression identified the time points where the rate of PAC initiation changed significantly, based on 2019 data. These joinpoints mark thresholds beyond which fewer patients accessed PAC at a slower pace and were used to define delayed access for each setting. We evaluated the stability of joinpoints using 2018 data. RESULTS: Among over 8.9 million hospitalizations, IRFs and SNFs showed a consistent joinpoint at day 2 postdischarge. In contrast, HHA access increased more gradually, with a joinpoint at day 12. CONCLUSIONS: Patients typically access facility-based PAC (IRF and SNF) within 2 days, whereas initiation of home-based PAC (HHA) occurs around 12 days. These findings on the joinpoint provide empirical evidence to define PAC delay for each setting. However, it also indicates a systemic gap in defining timely postacute transitions, underscoring the need for standardizing the lengths of accessing postacute services with empirical evidence.
Assessing the Utility of a Population Segmentation Tool to Determine Medical Vulnerability Among Adults Experiencing Homelessness.
Drake C, Rader A, Langan E … +6 more , Gamble J, Matchar D, Vashishtha R, Hatch D, Cho A, Biederman DJ
Med Care · 2026 Mar · PMID 41891422 · Publisher ↗
BACKGROUND: Patients experiencing homelessness (PEH) have intersecting medical, social, and behavioral needs. To meet their needs, promising medical respite and integrated care models have been developed. The use of vali...
BACKGROUND: Patients experiencing homelessness (PEH) have intersecting medical, social, and behavioral needs. To meet their needs, promising medical respite and integrated care models have been developed. The use of validated population segmentation screening tools is paramount for equitable triage and tailored service delivery. The Simple Segmentation Tool (SST), consisting of global impression categories (GI) and complicating factors (CFs), was developed to identify health and social service needs for whole-person care planning but has not been used to assess medical vulnerability among PEH. OBJECTIVE: Evaluate the association between SST scores and medical vulnerability among PEH. DESIGN: Retrospective cohort study conducted between November 2018 and November 2020 of a medical respite program using electronic health record (EHR) data. PARTICIPANTS: PEH referred to a transitional care program in the southeastern United States. MAIN MEASURES: We describe GI categories and CFs as the independent variables of interest and report their unadjusted and adjusted relationship using a Poisson regression modeling approach with outcomes of interest including bed days, emergency department (ED) visits, inpatient and observation admissions, and Elixhauser comorbidity index score after adjusting for demographic characteristics. RESULTS: Among 267 adults (mean age 51.2, 72% African American, 70.8% male), in an adjusted model, the presence of CFs was associated with a higher number of hospital stays, ED visits, and inpatient admissions. GI scores were associated with higher rates of bed days, ED visits, and Elixhauser conditions but lower observation admissions. CONCLUSION: SST scores were associated with utilization patterns and comorbidity burden after adjusting for age, gender, and race among an adult population experiencing homelessness. These findings suggest that the SST may be a preferable assessment than existing triage tools to objectively capture medical vulnerability and support care planning.
Leveraging Machine Learning to Predict Mental Health Referral Follow-Up Among US Military Personnel.
Vera JD, Jurick SM, Dougherty AL … +1 more , MacGregor AJ
Med Care · 2026 Jun · PMID 41880182 · Publisher ↗
BACKGROUND: Noncompliance with mental health referrals among US military personnel remains a significant barrier to care. Operational deployments and military stressors contribute to mental health challenges, impacting t...
BACKGROUND: Noncompliance with mental health referrals among US military personnel remains a significant barrier to care. Operational deployments and military stressors contribute to mental health challenges, impacting treatment access and increasing costs for the Department of Defense. Identifying service members unlikely to follow through on referrals may enable targeted interventions. OBJECTIVES: To develop machine learning (ML) models to predict noncompliance with mental health referrals and identify key predictors among active-duty personnel. RESEARCH DESIGN: This study utilized retrospective data to create predictive models for referral noncompliance. SUBJECTS: The study sample consisted of 14,289 active-duty personnel who received mental health referrals through the Periodic Health Assessment (PHA) from 2016 to 2020. MEASURES: Predictors included demographics, health screenings, medical history, and prior health care utilization. Outcome measures focused on noncompliance within 90 days of referral. RESULTS: Noncompliance with referrals occurred in 34.0% of the sample. Among predictive models, extreme gradient boosting (XGBoost) achieved the highest performance (AUC ≈ 0.80), with prior health care utilization (eg, previous clinic visits and mental health diagnoses) identified as the strongest predictor, followed by alcohol screening and age. CONCLUSIONS: ML models demonstrated strong potential for identifying at-risk individuals, supporting targeted interventions to improve mental health care follow-up. Future research will emphasize validation and explore mechanisms influencing noncompliance.
Can Patient-Reported Outcome Measures Help Predict Unplanned Hospital Readmission?
Yu M, Harrison M, Wong H … +7 more , Trenaman L, Bryan S, Lix L, Sawatzky R, Cuthbertson L, Al Sayah F, Bansback N
Med Care · 2026 Jun · PMID 41861120 · Full text
BACKGROUND: Administrative data used to predict unplanned hospital readmissions often lack patient-reported symptoms and functional status. Integrating patient-reported outcome measures (PROMs) may improve risk predictio...
BACKGROUND: Administrative data used to predict unplanned hospital readmissions often lack patient-reported symptoms and functional status. Integrating patient-reported outcome measures (PROMs) may improve risk prediction. OBJECTIVES: To assess the incremental value of PROMs in predicting unplanned readmissions to inform postdischarge monitoring and ongoing care management. METHODS: This population-based retrospective cohort study used linked administrative and PROMs data from British Columbia, Canada. Adults discharged from acute care who provided response to the EQ-5D-5L and Veterans RAND 12-Item Health Survey (VR-12) within 60 days were included. Aggregated Cox proportional hazards models were fitted to estimate unplanned readmission risk across 30-, 180-, and 360-day horizons. The primary prediction horizons were 30 and 180 days. The 360-day horizon was a secondary focus. Model performance was assessed using the concordance statistics and calibration, with subgroup analysis for Ambulatory Care Sensitive Conditions (ACSC). RESULTS: Among 11,177 individuals, observed unplanned readmission rates within 30, 180, and 360 days of discharge were 5.6%, 18.4%, and 25.0%, respectively. Conditional on surviving to weekly landmarks (23-60 days postdischarge), PROMs modestly improved discrimination. For the 180-day horizon following landmarks, the C-index was 0.762 (95% CI, 0.761-0.763) using predictors from administrative data alone, increasing to 0.774 (95% CI, 0.773-0.774) with EQ-5D-5L and 0.782 (95% CI, 0.781-0.783) with VR-12. Similar gains in discrimination were observed at 30-day and 360-day horizons. All models showed adequate calibration. Among patients with ACSCs, including PROMs improved discrimination by 2.4%-3.0%. CONCLUSIONS: PROMs added predictive value for unplanned hospital readmissions, particularly among patients with ACSCs.
A Qualitative Study of the Implementation of Referral Coordination for Specialty Care Referrals in the Veterans Health Administration.
Zogas A, Vimalananda VG, McCullough MB … +3 more , Linsky AM, Chatelain LJ, Mattocks KM
Med Care · 2026 May · PMID 41853896 · Publisher ↗
BACKGROUND: Veteran enrollees of the Veterans Health Administration (VA) have increasing options for where and how to access health care, including within VA in person or virtually and through VA-purchased community care...
BACKGROUND: Veteran enrollees of the Veterans Health Administration (VA) have increasing options for where and how to access health care, including within VA in person or virtually and through VA-purchased community care. To promote Veterans' informed choice and streamline access to appointments, VA initiated referral coordination, which entails clinical review and conversations with Veterans before scheduling all specialty care referrals. OBJECTIVE: Identify how VA facilities implemented referral coordination and local contextual factors influencing the implementation. RESEARCH DESIGN: Qualitative formative evaluation, using process maps to compare implementation approaches by hospital system and thematic analysis to identify contextual influences on implementation. SUBJECTS: Between March and August 2022, we interviewed VA referral coordinators (n=27) for acupuncture, cardiology, endocrinology, and hematology/oncology at 8 VA hospital systems in a geographic region with urban and rural settings. RESULTS: We identified 2 implementation approaches for referral coordination. Three facilities added clinical review to employees' existing responsibilities ("expanders"), and 5 created new roles dedicated to referral coordination ("creators"). "Expander" facilities relied minimally on VA-purchased care and received little implementation support from local leadership. "Creator" facilities relied heavily on VA-purchased care and local leadership was actively involved in implementation. The effort employees dedicated to referral coordination tasks varied according to other demands on their time. CONCLUSIONS: This work provides an empirically grounded way to identify different implementation approaches (ie, expanders and creators), which we conceptualize as a framework for interpreting the outcomes of referral coordination on waiting times, utilization of different types of care, and Veterans' experiences seeking care.
Does Anesthesia Provider Type Affect Veteran Satisfaction With Care?
Sah SS, Kumbhalwar A
Med Care · 2026 Jun · PMID 41816991 · Publisher ↗
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