Medical Care[JOURNAL]
Sun
200 papers
PCORnet®: Accelerating Patient-Centered Comparative Clinical Effectiveness Research.
Holve E, McTigue K
Med Care · 2026 Feb · PMID 41504741 · Full text
Abstract loading — click title to view on PubMed.
PCORnet®: Accelerating Patient-Centered Comparative Clinical Effectiveness Research.
Med Care · 2026 Feb · PMID 41504740 · Publisher ↗
Abstract loading — click title to view on PubMed.
Demonstrating the Reliability and Structural Validity of Creating Patient-Level and Clinician-Level Scores on the Person Centered Primary Care Measure.
Carle AC, Phillips RL, Bazemore A … +1 more , Peterson LE
Med Care · 2026 Feb · PMID 41503877 · Publisher ↗
BACKGROUND: The Person Centered Primary Care Measure (PCPCM) was developed to assess "aspects that contribute to patient perceptions regarding the integrating, prioritizing, and personalizing functions of primary care."...
BACKGROUND: The Person Centered Primary Care Measure (PCPCM) was developed to assess "aspects that contribute to patient perceptions regarding the integrating, prioritizing, and personalizing functions of primary care." Several psychometric issues remain unresolved. OBJECTIVES: We sought to examine the performance of the existing patient-level model, evaluate measurement bias, assess the impact of item-level missingness on reliability, examine the structural validity of creating a clinician-level score, and identify the number of patients needed to achieve a reliable clinician-level score. RESEARCH DESIGN: We used confirmatory factor analyses (CFA), item response theory, multilevel CFA, and retrospective survey data. PARTICIPANTS: Three thousand one hundred ten patients clustered within 32 clinics and 94 clinicians completed the PCPCM. RESULTS: CFA supported a single-factor patient-level model with 2 sets of correlated errors (RMSEA=0.06; CFI=0.98; TLI=0.98). Item response theory-based marginal reliability curves demonstrated that reliability drops precipitously if fewer than 6 items are answered. Multilevel CFA supported a single factor at the patient level and a single factor at the clinician level, with 2 sets of patient-level correlated errors (RMSEA=0.07; CFI=0.93; TLI=0.91). Scatter plots of clinician-level model-based and response-based scores showed nonlinearity and larger SEs when clinician scores were based on fewer than 5 patients. Reliability was >0.80 with 5 or more patients and 0.90 with 9 or more. CONCLUSIONS: Our study demonstrates the reliability and structural validity of creating a patient-level PCPCM score as the average of answers to at least 6 PCPCM questions and creating a clinician-level score as an average of the PCPCM scores from at least 5 patients within a clinician.
Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: A Replication Study.
Roblin DW, Segel JE, Hu H … +1 more , Mendiratta N
Med Care · 2026 Feb · PMID 41503876 · Publisher ↗
BACKGROUND/OBJECTIVE: Evidence about the patient benefits of alternative primary care delivery models for high-cost/high needs patients is mixed. We conducted a follow-up study of a program designed to improve outcomes o...
BACKGROUND/OBJECTIVE: Evidence about the patient benefits of alternative primary care delivery models for high-cost/high needs patients is mixed. We conducted a follow-up study of a program designed to improve outcomes of seriously ill adult patients in an integrated delivery system. METHODS: Using a quasi-experimental design, we examined the 180-day mortality of patients empaneled to a complex care program (CCP, n=1445) compared with that of eligible but unempaneled patients who continued to receive usual primary care (UPC, n=6409) for January 2019 through June 2021. Patients in the CCP and UPC were propensity score-matched on demographics, comorbidities, and frailty. In the propensity score matched samples (n=1440 in each group), the hazard of mortality was estimated using Cox proportional hazards regression. RESULTS: The CCP continued to empanel eligible adults with more comorbidities and greater frailty compared with the eligible patient population in UPC. In the matched samples, CCP patients had a significantly lower hazard of 180-day mortality compared with UPC in this replication cohort (0.71, 95% CI: 0.61-0.82). This was higher than the hazard ratio in the prior inception cohort (0.58, 95% CI: 0.47-0.70). CONCLUSIONS: A reduced hazard of death was reproduced within a second incident cohort of among seriously ill adult patients who were empaneled to a CCP in an integrated health care system compared with matched, but unempaneled patients whose care remained within UPC.
Data Resources for Conducting Patient-Centered Outcomes Research at Federally Qualified Health Centers: The National Ambulatory Medical Care Survey.
Guluma L, Ward BW, Williams SN … +2 more , Zhang C, Golden C
Med Care · 2026 Mar · PMID 41502060 · Full text
BACKGROUND: Federally qualified health centers and look-alikes are outpatient care settings that provide primary care and other health services in health professional shortage areas and to their populations. Compiling an...
BACKGROUND: Federally qualified health centers and look-alikes are outpatient care settings that provide primary care and other health services in health professional shortage areas and to their populations. Compiling and disseminating data from these centers that is accessible for patient-centered outcomes research (PCOR) is critical to understanding health care provided at these settings. OBJECTIVE: To describe the National Ambulatory Medical Care Survey Health Center (NAMCS HC) Component, and how this redesigned survey can be utilized to understand health care provided at health centers, improve data capacity, and facilitate PCOR. METHODS: Beginning in 2021, the NAMCS HC Component began collecting visit data through electronic health record (EHR) submission from a nationally representative sample of FQHCs and FQHC look-alikes. Resulting datasets are made available for researchers to analyze, used to produce readily available interactive data visualizations, and linked to external datasets. RESULTS: The NAMCS HC Component and its resulting data resources are described. Availability of restricted and public datafiles is highlighted, with an example of how these can be used to study visits across different patient characteristics. Interactive dashboards are presented, including how researchers, health centers, and patients can view biannual preliminary visit rates/counts. Finally, linkages between the NAMCS HC Component and external data sources are highlighted, including how these linkages can be used to study health outcomes among different populations. CONCLUSIONS: EHR data collected from FQHCs and look-alikes through the redesigned NAMCS HC Component fills a gap to improve PCOR capacity at these unique settings.
Patient and Health Care Staff Perspectives on Sexual Orientation and Gender Identity Data Collection: A Scoping Review.
Damiano EA, English JM, Toussaint EA … +4 more , Onsando WM, Scudder PN, Bagley P, Akré EL
Med Care · 2026 Mar · PMID 41498672 · Publisher ↗
PURPOSE: This review provides an examination of studies investigating the patient and provider perspectives on the collection of sexual orientation and gender identity (SOGI) data in the health care setting. METHODS: Sea...
PURPOSE: This review provides an examination of studies investigating the patient and provider perspectives on the collection of sexual orientation and gender identity (SOGI) data in the health care setting. METHODS: Searches were conducted using MEDLINE, CINAHL Complete, Web of Science, APA PsycINFO, Dissertations and Theses Global, Scopus, Sociological Abstracts, and Global Index Medicus for articles published January 1, 2000, to February 16, 2022, containing concepts of sexual orientation, gender identity, and data collection methods. The initial search yielded a total of 4356 records. Studies that reported results related to patient and staff perspectives on data collection for SOGI in a health care setting were analyzed as full text. Rayyan software was used for the abstract review. RESULTS: Twenty-five studies met the inclusion criteria. Two reviewers performed data extraction. All of the studies were observational, including 14 interview/focus group qualitative studies and 11 survey studies. In general, patients were favorable toward SOGI data collection; however, there were concerns about confidentiality and discrimination. Providers were less confident in collecting SOGI data, especially in situations lacking adequate training, and articulated concerns about the potential for offending patients. CONCLUSION: Patients regard SOGI data collection as an acceptable practice. However, to avoid offending or confusing patients, health care staff should receive focused training on how to ask SOGI questions, including the clinical relevance of these data.
Trends and Disparities in Post-acute Care Utilization After Hospitalization for Sepsis in the United States: A Systematic Review.
Xu Z, Lee JW, Morse-Karzen B … +7 more , Chastain AM, Dick AW, Furuya EY, Glance LG, Quigley DD, Stone PW, Shang J
Med Care · 2026 Mar · PMID 41498668 · Full text
BACKGROUND: Post-acute care (PAC) utilization following sepsis hospitalization remains understudied, particularly concerning racial and ethnic and urban-rural disparities. OBJECTIVES: To examine trends and disparities in...
BACKGROUND: Post-acute care (PAC) utilization following sepsis hospitalization remains understudied, particularly concerning racial and ethnic and urban-rural disparities. OBJECTIVES: To examine trends and disparities in PAC utilization after sepsis hospitalization, focusing on race, ethnicity, and rurality. METHODS: A comprehensive search of databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) was conducted for eligible studies using data through March 2020. The Social Ecological Model guided the review. RESULTS: Eleven studies met inclusion criteria. Our synthesis found a discontinuous increase in PAC use, with a shift from home discharges toward greater use of nursing homes and home health care after 2006. White patients had higher PAC utilization than racial and ethnic minority individuals. Rural and urban non-teaching hospitals discharged more sepsis survivors to long-term care hospitals, while urban teaching hospitals had more discharges to HHC. CONCLUSION: This review establishes a pre-reform, pre-pandemic baseline for PAC utilization among sepsis survivors. Despite overall gains, disparities in PAC utilization persist by race, ethnicity, and hospital type. As payment and care delivery models have evolved since 2016, future research should leverage this historical baseline to assess the impact of new policies on equitable PAC access for sepsis survivors.
The Unaffordability of Affordable Care Act Health Insurance Plans.
Gidwani R, Damberg CL
Med Care · 2026 Mar · PMID 41490230 · Publisher ↗
BACKGROUND: The Affordable Care Act (ACA) aimed to simplify plan choice and provide affordable health insurance. However, the complexity and cost-sharing features of ACA plans may undermine its goals. OBJECTIVES: To exam...
BACKGROUND: The Affordable Care Act (ACA) aimed to simplify plan choice and provide affordable health insurance. However, the complexity and cost-sharing features of ACA plans may undermine its goals. OBJECTIVES: To examine the affordability and choice set of all individual ACA health insurance plans, and the cost implications for taxpayers. DESIGN: Cross-sectional study. SUBJECTS: ACA marketplace plans nationwide. MEASURES: We analyzed choice set, total premiums, and total deductibles for all plans in all US ACA markets using 2023 HIX Compare data, Small Area Health Insurance Estimates, and American Community Survey data. We evaluated affordability for persons with incomes above 400% of the Federal Poverty Line (FPL), for whom ACA premium tax subsidies are set to expire, defining premiums ≥10% of annual income as unaffordable. RESULTS: In 97% of US counties, ACA consumers were offered >= 25 ACA plans, and 40% of counties offered >127 plans. Presubsidy, the median (IQR) Bronze plan premium was $4160 ($3636-4866), with a median (IQR) deductible of $7500 ($5300-$9700). The median (IQR) Silver plan premium was $5057 ($4430-5892), with a median (IQR) deductible of $2000 ($0-6800). Among persons with income at 400% of FPL, 98.6% of markets had ≥75% of their plans with unaffordable premiums for a 2-adult household, and 97.0% of markets had ≥75% of plans with unaffordable premiums for a 50-year-old individual should subsidies expire. CONCLUSIONS: Excessive plan choice creates significant challenges for consumers in selecting appropriate coverage. The magnitude of premiums and deductibles is unsustainable due to the financial burdens they place on the individual ACA consumer and/or the American taxpayer.
Examining Differences in Wait Times for Primary Care in the Veterans Health Administration by Race and Ethnicity: What Role Do Within-facility and Between-facility Differences Play?
Rosen AK, Beilstein-Wedel E, Gurewich D … +2 more , Davila H, Shwartz M
Med Care · 2026 Mar · PMID 41486581 · Publisher ↗
BACKGROUND: Prior studies at the national level indicate that primary care wait times exceeded the 20-day veterans Health Administration (VA) wait time standards set for primary care. Longer wait times were also reported...
BACKGROUND: Prior studies at the national level indicate that primary care wait times exceeded the 20-day veterans Health Administration (VA) wait time standards set for primary care. Longer wait times were also reported for Black and Hispanic versus White veterans. OBJECTIVES: Examine variation in wait time for primary care at the facility level by race and ethnicity over time and determine whether differences are due to within-facility differences (ie, at the same facility) or between-facility differences (ie, differences in facilities used). RESEARCH DESIGN: Observational study using VA and Community Care (CC) data from Fiscal Year (FY) FY2021 to FY2023. SUBJECTS: All veterans (n=642,180) who had an outpatient primary care consult in VA or CC. MEASURES: Wait time for an outpatient primary care consult. METHODS: We used multivariate regression models calculated using all 3 FYs combined and separately by FY models to predict consult wait times. We then used the Kitagawa decomposition to partition differences in mean adjusted wait times between Hispanic/Black veterans and White veterans into within-facility differences and between-facility differences. RESULTS: Overall, Hispanic veterans waited on average 6.7 days longer than White veterans, attributed to longer wait times within the same facility. Black veterans waited 1.2 days less than White veterans, partially accounted for by their higher use of facilities with shorter wait times for all veterans. Within-facility results were reasonably stable across FYs. CONCLUSIONS: Continued investigation at the local level is important for ensuring timely access to primary care for all racial and ethnic groups.
Days at Home for High-Need Medicare Patients: A Promising ACO Metric.
Ash AS
Med Care · 2026 Mar · PMID 41472331 · Publisher ↗
Abstract loading — click title to view on PubMed.
Spatiotemporal Disparities in Stroke Mortality From 1969 to 2020, by Race and Sex, in Tennessee.
Roy S, Mzayek F, Joshi A … +1 more , Yu X
Med Care · 2026 May · PMID 41466109 · Publisher ↗
BACKGROUND: Tennessee ranks sixth in stroke mortality in the United States. Yet the patterns of stroke mortality vary significantly across counties and over time. OBJECTIVES: This study aims to examine spatiotemporal dis...
BACKGROUND: Tennessee ranks sixth in stroke mortality in the United States. Yet the patterns of stroke mortality vary significantly across counties and over time. OBJECTIVES: This study aims to examine spatiotemporal disparities of stroke mortality at the county level in Tennessee from 1969 to 2020. RESEARCH DESIGN: A population-based study using the national vital statistics system of stroke mortality data through the Surveillance, Epidemiology, and End Results and National Center for Health Statistics (SEER-NCHS) database. SUBJECTS: Patients older than 35 years who died from stroke in Tennessee from 1969 to 2020. METHODS: Data from the SEER-NCHS were aggregated into 4 periods (1969-1980, 1981-1992, 1993-2004, and 2005-2020), and age-adjusted stroke mortality rates were calculated by county and by race and sex for each time period. RESULTS: The stroke mortality rates in Tennessee declined by 35.6%, 28.3%, 7.1%, and 24.4% in 1969-1980, 1981-1992, 1993-2004, 2005-2020, respectively. The degree of decline varied by race and sex groups. In the first 2 periods, the largest decline in stroke mortality was observed among Black women (43.2% and 31.5%). During 1993-2004, the largest decline was observed among Black men (22.4%), while the largest decline was observed among white women during 2005-2020 at 25.5%. There were urban-rural disparities in stroke mortality across counties and over the 4 periods. In general, urban and rural mortality rates were similar from 1969 to 1992; however, a substantial decline (24.1%) was observed in urban counties during 1993-2004, while a larger decline (34.6%) occurred later in rural counties during 2005-2020. County-level variations in stroke mortality were also evident across the 4 periods. CONCLUSION: Substantial disparities in stroke mortality by counties and race-sex subgroups persisted over the past 5 decades. The disease burden was clustered in a few counties and disproportionately higher among vulnerable populations.
Comparing Predictive Power of Area-Level Socioeconomic Status Indices Across Health Outcomes and Geographic Levels.
Rossi FM, Franchi L, Barreto N … +6 more , Chorniy A, Weston BW, Meurer JR, Whittle J, Ackermann RT, Black B
Med Care · 2026 Feb · PMID 41433210 · Full text
BACKGROUND: Many researchers want to control for both individual-level demographic/health variables and area-level socioeconomic status (area-SES) when studying health outcomes. However, comparative assessments of area-S...
BACKGROUND: Many researchers want to control for both individual-level demographic/health variables and area-level socioeconomic status (area-SES) when studying health outcomes. However, comparative assessments of area-SES indices across geographic levels and a range of health outcomes are scarce. OBJECTIVES: Compare predictive power for 3 commonly used area-SES indices: the Graham Social Deprivation Index (SDI), the Area Deprivation Index (ADI), and the CDC Social Vulnerability Index (SVI), for a variety of health outcomes, at different geographic levels (county, 5-digit zip-code, census tract, and census block group). Also compare these indices to the simpler Townsend Deprivation Index (TDI) and population percent in poverty (area-Poverty). RESEARCH DESIGN: Principal research methods are logistic and ordinary least squares regression. SUBJECTS: Medicare fee-for-service beneficiaries, COVID-19 decedents, and drug overdose decedents. MEASURES: SDI, SVI, ADI, TDI, area-Poverty. HEALTH OUTCOMES STUDIED: All-cause mortality, diabetes incidence and prevalence, hypertension, renal disease, and 30-day hospital readmission for Medicare beneficiaries; COVID-19 mortality; overdose mortality; Medicare fee-for-service spending. RESULTS: All measures predict the health outcomes, controlling for age, gender, race/ethnicity, and comorbidities, at zip code, tract, and block-group levels. Predictive power is comparable for SDI, SVI, and a standardized version of ADI, and generally superior to TDI, area-Poverty, and non-standardized ADI. Predictive power is highest at tract level, similar at block-group; reasonably strong at zip code, but weaker at county level. CONCLUSIONS: Across a range of health outcomes, we find similar predictive power for SDI, SVI, and standardized ADI, ideally measured at census tract level. SDI has the value of being more parsimonious, with similar performance. Non-standardized ADI cannot be recommended.
Magnet4Europe Intervention to Improve Clinician and Patient Well-Being: A Quasi-Experimental Study of 56 Hospitals in 6 European Countries.
Aiken LH, Sermeus W, Lasater KB … +19 more , Busse R, McKee M, Smith H, Drennan J, Maier CB, Ball J, Dello S, Kohnen D, Lindqvist R, Lerdal A, Griffiths P, Schaufeli WB, De Witte H, Eriksson LE, Rafferty AM, Köppen J, Smeds Alenius L, McHugh MD, Magnet4Europe Consortium
Med Care · 2026 Feb · PMID 41427777 · Full text
BACKGROUND: Descriptive studies have documented high hospital nurse burnout and turnover but there are few, if any, large-scale evaluations of organizational interventions to improve clinician retention. The Magnet model...
BACKGROUND: Descriptive studies have documented high hospital nurse burnout and turnover but there are few, if any, large-scale evaluations of organizational interventions to improve clinician retention. The Magnet model is an organizational hospital intervention associated with better clinician and patient outcomes but there is insufficient evidence as to whether the Magnet model based on structural empowerment of clinicians results in better outcomes or rewards hospitals with good work environments, and whether the Magnet model can be implemented at scale outside the United States. OBJECTIVE: To evaluate whether Magnet4Europe-a multiyear organizational intervention of European hospitals-could be implemented and would result in improvements in nurse well-being, care quality, and patient safety. DESIGN: Quasi-experimental longitudinal evaluation of 56 European intervention hospitals in 6 countries. Hospital-level implementation of the intervention measured by changes (from baseline to follow-up) in 77 Magnet model intervention targets. Outcome measures (eg, nurse burnout, intent to leave, quality of care, patient safety) were derived from surveys of nurses (4546 nurses at baseline; 3171 at follow-up). FINDINGS: Hospitals that implemented intervention targets during the study period observed reductions in nurse burnout, nurses' intentions to leave their jobs, and unfavorable care quality. Each 10-percentage-point increase in intervention target implementation was associated with 2.7%-point reduction in nurses who intend to leave (β -2.66; 95% CI: -4.74, -0.58, P <0.05). Hospitals which implemented more than 25% of intervention targets observed 6.3%-point reduction in nurse burnout, 7.6%-point reduction in intent to leave, 6.4%-point reduction in unfavorable care quality, and 3.7%-point reduction in unfavorable patient safety. Improvements in hospital percentages of nurses reporting staffing adequacy were associated with reductions in burnout, intentions to leave, unfavorable care quality, and patient safety. CONCLUSION: Successful implementation of Magnet4Europe demonstrates promise for international adoption at scale of Magnet as an organizational intervention for improving clinician well-being, care quality, and patient safety.
Burn Pit Smoke Exposure and Sleep Apnea in US Veterans: A Retrospective Cohort Study.
Agrawal R, Razjouyan J, Glick DR … +5 more , Jones MB, Ramezani A, Maghsoudi A, Helmer DA, Sharafkhaneh A
Med Care · 2026 Jan · PMID 41385262 · Full text
INTRODUCTION: Burn pit smoke exposure (BPSE) during military deployment has been linked to long-term cardiorespiratory conditions, but its relationship with sleep apnea (SA) remains unclear. This study examines the assoc...
INTRODUCTION: Burn pit smoke exposure (BPSE) during military deployment has been linked to long-term cardiorespiratory conditions, but its relationship with sleep apnea (SA) remains unclear. This study examines the association between BPSE and SA using Veterans Health Administration (VHA) electronic medical records (EMR) and the Airborne Hazards and Open Burn Pit Registry (AHOBPR). METHODS: We conducted a retrospective cohort study of veterans from AHOBPR with VHA sleep study data. BPSE was classified into quartiles based on the duration of exposure, and SA severity was measured using the Apnea-Hypopnea Index (AHI). Logistic regression models and Cox proportional hazards models were used to evaluate the association between BPSE and SA, adjusting for confounders such as age, body mass index, smoking status, post-traumatic stress disorder (PTSD), and comorbid disease burden. RESULTS: The study included 17,064 veterans (mean age 40.2 y; 89.6% male; 58.3% with PTSD). Veterans in the highest BPSE quartile (≥245 d) had an unadjusted OR of 1.13 for SA, which became nonsignificant after adjustment (aOR: 1.10, P=0.058). The median time to SA diagnosis was 8.8 years in the highest BPSE group versus 11.1 years in the lowest. The adjusted Hazard Ratio for earlier SA diagnosis in the highest BPSE quartile was 1.16 (95% CI: 1.10, 1.22). DISCUSSION: Although BPSE was not associated with SA prevalence, it was linked to earlier diagnosis. BPSE-related airway inflammation or increased health care use among exposed veterans may explain this pattern. Findings support early surveillance and screening for SA in highly exposed veterans.
Concordance Between Self-Report and Electronic Medical Record Diagnoses of Insomnia and Sleep Apnea: Lessons From the Airborne Hazards and Open Burn Pit Registry.
Jones MB, Sharafkhaneh S, Glick DR … +5 more , Ramezani A, Hirshkowitz M, Sharafkhaneh A, Helmer DA, Razjouyan J
Med Care · 2026 Jan · PMID 41385261 · Full text
BACKGROUND: Veteran participants in the Airborne Hazards and Open Burn Pit Registry (AHOBPR) report respiratory and sleep-related symptoms, including sleep-disordered breathing and difficulty sleeping. The AHOBPR Questio...
BACKGROUND: Veteran participants in the Airborne Hazards and Open Burn Pit Registry (AHOBPR) report respiratory and sleep-related symptoms, including sleep-disordered breathing and difficulty sleeping. The AHOBPR Questionnaire elicits sleep-related disturbances and other health outcomes potentially associated with burn pit exposures. Responses to this questionnaire may influence resource allocation and future longitudinal studies of toxic sequelae. The level of agreement between sleep apnea and insomnia responses to the AHOPBPR questionnaire and clinical diagnoses of sleep apnea and insomnia in the electronic medical record (EMR) is unclear. OBJECTIVE: In this study, we compare concordance between reports of symptoms associated with sleep apnea and insomnia to corresponding clinical diagnoses documented in EMRs among Veterans in the AHOBPR. METHODS: We included 469,179 Veterans with AHOBPR survey responses and available EMR data in the Veteran Health Administration. Concordances between reports of sleep-related symptoms on the AHOBPR questionnaire and relevant EMR diagnoses were analyzed for 469,179 Veterans. Concordance was assessed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficients. We further considered sex differences in concordance measures. RESULTS: Reports of symptoms associated with sleep apnea were common (52% overall, 54.5% in men, 28.5% in women) as were EMR diagnoses (31.6% overall, 32.8% in men, 19.8% in women). The overall concordance between self-reported and EMR diagnoses for sleep apnea was fair (kappa=0.38). Reports of symptoms associated with insomnia were highly prevalent (81% overall, 80.8% in men, 82.6% in women) but poorly aligned with EMR diagnoses (17.8% overall, kappa=0.08). Agreement between reports of symptoms associated with sleep apnea and EMR-diagnosed sleep apnea was higher for females (kappa=0.46) than for males (kappa=0.37). CONCLUSION: This study highlights significant discrepancies between self-reported symptoms and EMR diagnoses of sleep apnea and insomnia among Veterans who completed the AHOBPR survey. While fair agreement for sleep apnea suggests some alignment with clinical diagnosis, poor concordance for insomnia highlights the limitations of self-reported case identification methods.
The Association Between Self-Reported Types of Toxic Exposures and Symptom Severity Among Gulf War Era Veterans.
Phan MS, Winchell K, Hooker E … +3 more , Barton J, Helfand M, Nugent S
Med Care · 2026 Jan · PMID 41385260 · Full text
BACKGROUND: Gulf War illness is a chronic multisymptom illness impacting Veterans of the 1990-1991 Persian Gulf War. Toxic exposures are believed to be associated with the condition, but little is known about how multipl...
BACKGROUND: Gulf War illness is a chronic multisymptom illness impacting Veterans of the 1990-1991 Persian Gulf War. Toxic exposures are believed to be associated with the condition, but little is known about how multiple types of exposures can impact the disease. The aim of this study is to determine if a positive association exists between the multiplicity of exposure types and symptom severity score. METHODS: A cross-sectional survey design was used in which Persian Gulf Veterans completed a questionnaire with items related to symptom severity and types of self-reported toxic exposures. Linear regression models were used to examine the association between the number of types of toxic exposures and symptom severity scores. We also examined the association between each type of reported exposure and symptom severity score. RESULTS: Veterans with a greater number of self-reported toxic exposures reported higher scores on symptom severity. While no individual exposure type reached a statistically significant association with symptom score, radiation and biological agent exposures showed the strongest association. DISCUSSION: We found a positive association between the number of toxic exposure types and total symptom severity. Veterans who self-reported having Gulf War Illness also reported more types of toxic exposures compared with Veterans who did not report having Gulf War Illness. Radiation and biological agent exposure showed the strongest positive association with symptom scores, yet very few Veterans reported isolated exposure of these types. Our findings suggest that cumulative exposure to multiple types of toxins could be associated with the development and severity of Gulf War Illness symptoms.
Psychiatric Conditions and Symptoms After Toxic Environmental Exposures During Military Service: An Evidence Map.
Magnante AT, Nugent SM, Bourassa KJ … +13 more , Leflore-Lloyd N, Meckes SJ, Gordon AM, Boyle SH, Chen D, Alishahi Tabriz A, Wells SY, Jacobs M, Snyder J, Yang L, Cantrell S, Goldstein KM, Gierisch JM
Med Care · 2026 Jan · PMID 41385259 · Full text
BACKGROUND: US service members are often exposed to a range of service-related hazards. To date, there has been limited synthesis of the existing research conducted on military environmental exposures and subsequent psyc...
BACKGROUND: US service members are often exposed to a range of service-related hazards. To date, there has been limited synthesis of the existing research conducted on military environmental exposures and subsequent psychiatric conditions and symptoms. OBJECTIVE: To systematically review and characterize the main features of studies examining associations between military exposures and mental health outcomes. METHODS: We used evidence mapping methodology to systematically search MEDLINE, Embase, PsycINFO, and PTSDpubs for studies of toxic exposure during military service and psychiatric outcomes, which included psychiatric diagnoses, psychiatric symptoms, and neurocognitive functioning. RESULTS: We identified 49 studies; most were comprised of predominantly White, male veteran samples. Chemical exposures, including chemical munitions from the Gulf War era and Agent Orange from the Vietnam War era, were the most frequently examined military toxic exposures. Symptoms of depression, PTSD, and anxiety were the most commonly examined psychiatric outcomes. Only 9 studies assessed neurocognitive functioning. We found extensive variation in how exposures and outcomes were defined and measured. Most exposure and symptom data were based on self-reports. Overall, available evidence suggests that veterans reporting environmental toxic exposures may report relatively high levels of mental health needs. CONCLUSIONS: We found broad evidence that toxic exposure was associated with poorer mental health outcomes, though the ability to draw stronger conclusions is limited by the quality of the current literature. Future research should focus on longitudinal studies of toxic exposure and mental health that include more broadly representative military populations, including diverse samples and more recent service cohorts.
Health Care Journeys of Veterans With Gulf War Illness.
Bloeser K, Hyde JK, Helmer DA … +10 more , Bolton RE, Lesnewich LM, Phillips LA, Bayley PJ, Chandler HK, Santos SL, McFarlin ML, Reinhard MJ, Stewart RS, McAndrew LM
Med Care · 2026 Jan · PMID 41385258 · Full text
BACKGROUND: There is an acknowledged need to improve care for patients with persistent physical symptoms. Veterans who served in the 1990-91 Gulf War are a subpopulation of U.S. military Veterans who have been struggling...
BACKGROUND: There is an acknowledged need to improve care for patients with persistent physical symptoms. Veterans who served in the 1990-91 Gulf War are a subpopulation of U.S. military Veterans who have been struggling with persistent physical symptoms for decades. The current study sought to characterize Veterans' historic path through the health care system and current experience of care to identify opportunities to improve care. METHODS: Analysis of interviews conducted with 31 Veterans who met criteria for Gulf War Illness (GWI) was conducted to understand Veterans' health care journeys, from symptom onset to the present. RESULTS: Early in their journey, Veterans felt uncertain about the nature of their condition and how to explain it to clinicians. Veterans described a cycle of referrals to specialists to pursue individual symptoms and subsequent return to primary care with few actionable findings. During this cycle, Veterans often felt dismissed or invalidated by clinicians. Over time, most Veterans felt care became increasingly fragmented, with multiple clinicians caring for them without a plan to manage GWI and little acknowledgement of GWI as a discrete illness. Further in their journey, some Veterans were referred to tertiary centers where they encountered a more holistic approach. CONCLUSIONS: Findings point to the need to shift care for Veterans with GWI, and similar conditions, away from overly focusing on individual symptoms. Instead, primary care clinicians need training and support, potentially from tertiary care experts, to develop and implement holistic care plans that recognize GWI as a complex chronic condition.
Ask the Experts: Veterans' Perspectives on Communicating About Airborne Hazard Exposures.
Fix GM, Jordan JA, McDannold S … +6 more , Clayman ML, Baim-Lance A, Sullivan NL, Webber KT, McAndrew LM, Barker AM
Med Care · 2026 Jan · PMID 41385257 · Full text
OBJECTIVE: We sought to identify key areas to inform the development of Veteran-facing airborne hazard exposure communication materials. BACKGROUND: Military personnel are commonly exposed to environmental and occupation...
OBJECTIVE: We sought to identify key areas to inform the development of Veteran-facing airborne hazard exposure communication materials. BACKGROUND: Military personnel are commonly exposed to environmental and occupational hazards. Airborne hazard exposures may be particularly salient to Veterans because they are common, and the relationship to health concerns is often uncertain. VA offers a toolkit to help providers navigate caring for Veterans with airborne hazard exposure concerns. Veteran-facing materials, which address their concerns, are lacking. METHODS: Five generative, qualitative focus groups with Veterans with airborne hazard exposure concerns. Focus group discussions covered information needs, how the VA should communicate about environmental exposures when the evidence is unclear, communication preferences, and how they get health information. RESULTS: We identified 3 areas important to communicating with Veterans about their airborne hazard exposure concerns. (1) Veterans want personalized, transparent and comprehensive communication. (2) Veterans want to be able to act on the information with tangible next steps. (3) Diverse, multimodal communication strategies are needed to reach the range of Veterans with concerns about airborne hazard exposures. CONCLUSIONS: In situations of uncertainty, where robust clinical guidance is limited, Veterans want Veteran-centered, transparent, respectful communication that attends to their socially and historically rooted exposure experiences. The information they receive on airborne exposures should be actionable and delivered through a variety of modalities.
Veterans' Experiences With Legislation to Address Health Care and Disability Related to Contaminated Water Exposure at Camp Lejeune Marine Base.
Solanki P, Steiger-Chadwick R, Osteen C … +3 more , Berryman K, Luther SL, Weaver FM
Med Care · 2026 Jan · PMID 41385256 · Full text
BACKGROUND: Between 1953 and 1987, the groundwater at Marine Base Camp Lejeune in North Carolina was contaminated with chlorinated solvents. Legislation enacted by the federal government aimed to provide disability compe...
BACKGROUND: Between 1953 and 1987, the groundwater at Marine Base Camp Lejeune in North Carolina was contaminated with chlorinated solvents. Legislation enacted by the federal government aimed to provide disability compensation and access to health care to Veterans for conditions related to these exposures. OBJECTIVE: We assessed the impact of the Camp Lejeune-related legislation on Veterans' experiences with health care access and disability claims. MEASURE: A total of 8864 Veterans who were at Camp Lejeune between 1975 and 1985 were invited to complete an online survey about their experiences with health care and seeking compensation for conditions associated with toxicant exposure. RESULTS: Approximately 964 surveys (13%) were fully completed and analyzed. One-third of respondents reported a diagnosis of at least one associated or presumptive condition linked to toxicant exposure. Veterans who reported living/working in higher risk areas at the Camp had a 2.02 [CI: 1.41, 2.90] greater odds of being diagnosed with one of these conditions, controlling for demographic characteristics. While most Veterans accessed and were satisfied with Veterans Health Administration (VA) care, those who applied for disability compensation found the process to be unhelpful. CONCLUSION: Conditions associated with or presumptive for toxicant exposures at Camp Lejeune were frequently identified by respondents. Veterans who lived/worked in a high-risk area of the camp were twice as likely to have any of these conditions. There is a need for additional education of Veterans regarding the Camp Lejeune legislation, particularly around the disability claims filing process, and the increased risk of those who lived near the contaminated wells at Camp Lejeune.
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