Medical Care[JOURNAL]
Sun
200 papers
Perceived Health Misinformation on Social Media and Public Trust in Health Care.
Stimpson JP, Park S, Adhikari EH … +2 more , Nelson DB, Ortega AN
Med Care · 2025 Sep · PMID 40793916 · Full text
OBJECTIVES: Investigate the association between perceptions of health misinformation on social media and trust in the health care system among US adults, and to assess whether this association varies by frequency of heal...
OBJECTIVES: Investigate the association between perceptions of health misinformation on social media and trust in the health care system among US adults, and to assess whether this association varies by frequency of health care visits, perceived health care quality and experiences of medical care discrimination. METHODS: Cross-sectional survey study using data from the 2022 Health Information National Trends Survey 6 (HINTS 6). Analysis was conducted on data collected from March to November 2022. Participants included 3805 adults who reported using social media and had at least one health care visit in the past year. Survey-weighted, multivariable logistic regression models were used to assess associations. RESULTS: Among those who reported high trust in the health care system, 65.1% perceived less than substantial health misinformation on social media, whereas 34.9% perceived substantial misinformation. In multivariable models, participants who perceived substantial health misinformation on social media had higher odds of reporting low trust in the health care system (OR: 1.66; 95% CI: 1.11-2.48). This association between misinformation and trust varied by perceived health care quality and experiences of discrimination. Among those perceiving less than substantial misinformation, the probability of low trust was 11% (95% CI: 9-13) for individuals without medical care discrimination and 33% (95% CI: 20-45) for those reporting discrimination. The interactions between misinformation and health care visit frequency and quality were not statistically significant. CONCLUSIONS: Perceptions of substantial social media health misinformation were associated with lower trust in the US health care system, particularly among individuals reporting experiences of medical care discrimination.
Association of Nurse Work Environment, Staffing, and Skill Mix With Length of Stay for Patients With Intellectual and Developmental Disabilities.
Moronski L, Chittams JL, Lake ET … +1 more , McHugh MD
Med Care · 2025 Sep · PMID 40793915 · Full text
INTRODUCTION: Complex care for individuals with intellectual and developmental disability (IDD) may translate into longer than needed hospital lengths of stay (LOS). Nurses are poised to influence the outcomes of patient...
INTRODUCTION: Complex care for individuals with intellectual and developmental disability (IDD) may translate into longer than needed hospital lengths of stay (LOS). Nurses are poised to influence the outcomes of patients with IDD. But ample evidence suggests that nurses' capacity to provide optimal care may depend on key organizational features such as having sufficient staff, supportive work environments, and sufficient mix of registered nurses, termed nursing resources. This paper aims to determine the association of nursing resource factors with LOS in adults with IDD. METHODS: Linked data from 3 datasets representing 4 states were used. Zero-truncated negative binomial regression models that clustered for patients in the same hospital were used to examine the association between nursing resources and LOS for adults with IDD. RESULTS: Receiving care in a hospital with a better nurse work environment, skill mix, and staffing was associated with reduced LOS in this sample of 38,587 patients with IDD in 595 hospitals. In univariate models adjusted for hospital and patient characteristics, all 3 nursing resources were independently associated with reduced LOS. In an adjusted multivariate model, work environment and skill mix remained significant with identical effect sizes to the separate models, that is, for an increase of 1 SD, work environment is associated with a reduction in LOS of 2.7% (P=0.005), a 6 day to 5.84 day reduction, and skill mix of 2% (P=0.039), a 6 day to 5.88 day reduction. CONCLUSIONS: The appropriate deployment of nursing resources may lead to a reduction in LOS for patients with IDD.
Trends in the U.S. Health Care Workforce: A Decade of Staffing and Compensation Practices Across Care Settings.
Rodriguez N, Cho LD, Memtsoudis SG … +1 more , Poeran J
Med Care · 2025 Sep · PMID 40793914 · Publisher ↗
BACKGROUND: Nurses are integral to patient care in US hospitals, yet high burnout rates exacerbated by staffing shortages and the COVID-19 pandemic pose challenges in retaining nursing staff. Understanding staffing dynam...
BACKGROUND: Nurses are integral to patient care in US hospitals, yet high burnout rates exacerbated by staffing shortages and the COVID-19 pandemic pose challenges in retaining nursing staff. Understanding staffing dynamics and trends in the care team composition is vital to improve care and address the well-being of the health care workforce. OBJECTIVE: To examine trends in employment and compensation among registered nurses (RNs), physicians, nurse practitioners (NPs), physician assistants (PAs), medical assistants (MAs), licensed practical and vocational nurses (LPN/LVNs), and administrative staff from 2012 to 2022. METHODS: Data from the Occupational Employment and Wage Statistics (OEWS) was utilized to analyze employment and wage trends in hospitals and physician offices. The annual RN-to-physician, NP-to-physician, and PA-to-physician ratios and change in employment and compensation over time were calculated. RESULTS: Although hospital RN employment increased by 12%, this was outpaced by physician (40%), NP (105%), PA (38%), and MA (44%) employment growth. The hospital RN-to-physician ratio declined by 21%, whereas the NP-to-physician and PA-to-physician ratios increased by 46% and 28%, respectively. In offices, the NP-to-physician ratio increased by 107%, whereas the RN-to-physician ratio remained stable. Wage growth for all clinical hospital staff increased around 30%, while physicians saw wage growth of 43%. DISCUSSION: The declining RN-to-physician ratio in hospitals signals a shift in the care team composition. While APP employment has drastically risen, RN growth has lagged significantly behind. Urgent action is needed to optimize staffing strategies to safeguard patient care.
Chronic Condition Burden by Veteran Status, Veterans Health Administration Enrollment, and Age Using Nationally Representative Survey Data.
Chawla N, Govier DJ, Than C … +4 more , Rose D, Hynes DM, Hoggatt KJ, Yano EM
Med Care · 2025 Jul · PMID 40766989 · Publisher ↗
BACKGROUND: Historically, US Veterans have reported higher chronic disease burden than non-Veterans. However, whether Veteran and Veterans Affairs (VA) coverage status continue to be associated with chronic disease burde...
BACKGROUND: Historically, US Veterans have reported higher chronic disease burden than non-Veterans. However, whether Veteran and Veterans Affairs (VA) coverage status continue to be associated with chronic disease burden or how these associations vary by age, especially among younger Veterans, is unknown. OBJECTIVE: To examine the number of chronic conditions among male Veterans with and without VA coverage, and male non-Veterans, overall and by age group. DESIGN AND PARTICIPANTS: Using 2018 National Health Interview Survey data, our sample included 2301 male Veterans and 9243 male non-Veterans. MAIN MEASURES: The primary outcome was a number of chronic conditions, measured as a count (range 0-15) and categorically (0, 1, 2, 3+). We created a 3-category main independent variable (Veteran with VA coverage, Veteran without VA coverage, non-Veteran). Generalized linear regression models were used to estimate relationships between Veteran and VA coverage status and count of chronic conditions, overall and by age group (18-44, 45-64, 65+), adjusting for sociodemographic characteristics. KEY RESULTS: Veterans with VA coverage, Veterans without VA coverage, and non-Veterans had an age-standardized mean of 1.44, 1.16, and 1.09 chronic conditions, respectively. In adjusted analyses, Veterans with VA coverage had 0.36 (95% CI: 0.25-0.46) more conditions and Veterans without VA coverage had 0.12 (95% CI: 0.04-0.21) more conditions compared with non-Veterans. In age-stratified analyses, Veterans with VA coverage aged 18-44 had 0.22 (95% CI: 0.06-0.38) more conditions; 45-64, 0.71 (95% CI: 0.41-0.99) more conditions; and 65+, 0.38 (95% CI: 0.18-0.57) more conditions compared with similar-aged non-Veterans. CONCLUSIONS: Veterans with VA coverage had the greatest number of chronic conditions, including when stratified by age group.
Changes in Reimbursed Acupuncture Therapy Amidst the COVID-19 Pandemic: A Cross-Sectional Analysis.
Candon M, Dusek JA, Nielsen A
Med Care · 2025 Jul · PMID 40766988 · Full text
BACKGROUND: The COVID-19 pandemic induced a shift to telemedicine, which may have disproportionately affected in-person treatments such as acupuncture therapy. OBJECTIVES: We measured trends in reimbursed acupuncture bet...
BACKGROUND: The COVID-19 pandemic induced a shift to telemedicine, which may have disproportionately affected in-person treatments such as acupuncture therapy. OBJECTIVES: We measured trends in reimbursed acupuncture between 2018 and 2021. We also measured trends in other types of pain care among patients with low back pain (LBP), which was the most common diagnosis for acupuncture. RESEARCH DESIGN: A descriptive, retrospective, and claims-based analysis. SUBJECTS: The sample included any patient who used their insurance to pay for acupuncture, which was defined using Current Procedural Technology (CPT) codes 97810, 97811, 97813, and 97814. In secondary analysis, the sample included only patients with LBP, which were identified using the International Classification of Diseases, 10th Edition code of M54.5. MEASURES: We tracked reimbursed acupuncture and patient and provider characteristics associated with reimbursed acupuncture. Among patients with LBP, trends in acupuncture were compared with trends in chiropractic care, physical therapy, psychotherapy, as well as prescription fills for gabapentinoids, muscle relaxants, and opioids. RESULTS: After increasing between 2018 and 2019, there was a 28% decline in the number of patients receiving reimbursed acupuncture between 2019 and 2020. Although acupuncture use increased between 2020 and 2021, it did not reach pre-COVID-19 levels. Acupuncturists comprised a smaller share of providers who billed insurance for acupuncture while the share of providers who identified as rehabilitation specialists increased. Among patients with LBP, use of acupuncture fell more during COVID-19 compared with other types of pain care. CONCLUSIONS: The COVID-19 pandemic had a disproportionate impact on acupuncture therapy, which may be driven by a reduction in acupuncturists who billed insurance. Future research should assess the long-term impact of COVID-19 on acupuncture use in the United States.
Potentially Inappropriate Medication Use Among Patients With Dementia in Traditional Medicare and Medicare Advantage.
Raver E, Jung J, Carlin C … +3 more , Feldman R, Retchin SM, Xu W
Med Care · 2025 Jul · PMID 40766987 · Full text
BACKGROUND: Older adults with dementia are susceptible to receiving potentially inappropriate medications (PIMs), where the risks likely outweigh the benefits. Medicare advantage prescription drug plans (MA-PDs) cover bo...
BACKGROUND: Older adults with dementia are susceptible to receiving potentially inappropriate medications (PIMs), where the risks likely outweigh the benefits. Medicare advantage prescription drug plans (MA-PDs) cover both medical and prescription drug benefits, creating a financial incentive to reduce PIM use and unnecessary health care costs from adverse drug events, whereas standalone Medicare prescription drug plans (PDPs) used by traditional Medicare beneficiaries are only responsible for outpatient prescription drug costs. OBJECTIVE: The objective is to compare the use of PIMs between PDP and MA-PD enrollees with dementia. METHODS: Using 2016-2019 Medicare claims and encounter data, we estimated the associations between Medicare enrollment type and PIM use: (1) potentially harmful drug-disease interactions in older adults with dementia; (2) potentially harmful drug-disease interactions in older adults with dementia and a history of falls; and (3) high-risk medication use in older adults. RESULTS: MA-PD enrollees had significantly lower utilization of PIMs than standalone PDP enrollees: a 0.7 percentage-point [95% CI: 0.5, 0.8] lower prevalence of potentially harmful drug-disease interactions in older adults with dementia; a 3.1 percentage-point [2.6, 3.5] lower prevalence of potentially harmful drug-disease interactions in older adults with dementia and a history of falls; and a 0.5 percentage-point [0.4, 0.6] lower prevalence of high-risk medications in older adults. CONCLUSIONS: MA-PD enrollees with dementia experienced consistently lower prevalence of PIM use than those in PDP. As Medicare advantage enrollment continues to grow, it will be increasingly important to identify and leverage the features of MA-PD plans that promote safe medication prescribing for Medicare beneficiaries with dementia.
Hospital Ownership Type Correlated With Investments in Nursing Services: Evidence From Illinois.
Muir KJ, Sliwinski KS, Golinelli D … +2 more , McHugh MD, Lasater KB
Med Care · 2025 Aug · PMID 40758552 · Publisher ↗
BACKGROUND: The association between hospital ownership type and patient care quality has garnered increased public attention. OBJECTIVES: To describe differences in investments in nursing services, care quality and safet...
BACKGROUND: The association between hospital ownership type and patient care quality has garnered increased public attention. OBJECTIVES: To describe differences in investments in nursing services, care quality and safety, and nurse job outcomes among for-profit and not-for-profit hospitals in Illinois. RESEARCH DESIGN: Cross-sectional, descriptive case study of hospital nursing services, patient care quality and safety outcomes, and nurse job outcomes in 113 hospitals in Illinois in 2021. Three datasets were linked through a common identifier: RN4CAST-IL nurse survey, National Academy for State Health Policy (NASHP) cost data, American Hospital Association (AHA) Annual Hospital Survey. MEASURES: Nursing services included patient-to-nurse staffing ratios and the quality of the nurse work environment. Nurse job outcomes included burnout, job dissatisfaction, and intent to leave. RESULTS: For-profits had statistically significantly lower investments in nursing services, worse nurse job outcomes, and poorer patient care quality and safety outcomes relative to not-for-profit hospitals, despite having no statistically significant differences in operating margins. For-profit hospitals had poorer nurse work environments (mean score 2.5 vs. 2.9, P<.001) and worse staffing ratios (6.8 vs. 4.7 patients per nurse, P<0.01), higher percentages of nurses intending to leave their employer (36.2% vs. 22.8%, P<.01), higher job dissatisfaction (37.9% vs. 23.4%, P<.01), higher burnout (63.8% vs. 46.2%, P<.05), and worse quality and safety (e.g., poor patient safety grades 53.6% vs. 33.8%, P<.01). CONCLUSIONS: Investments in nursing services as well as quality and safety of patient care in for-profit hospitals are worse than in not-for-profit hospitals, despite having no significant differences in operating margins.
Economic Costs of Chronic Pain-United States, 2021.
Guy GP, Miller GF, Legha JK … +4 more , Rikard SM, Strahan AE, Mikosz C, Florence CS
Med Care · 2025 Sep · PMID 40730349 · Full text
BACKGROUND: Chronic pain affects more than 1 in 5 adults in the United States. Understanding the economic burden of chronic pain can inform interventions and strategies to improve the quality of life for individuals with...
BACKGROUND: Chronic pain affects more than 1 in 5 adults in the United States. Understanding the economic burden of chronic pain can inform interventions and strategies to improve the quality of life for individuals with chronic pain. OBJECTIVE: To estimate the economic cost of chronic pain in the United States in 2021. RESEARCH DESIGN: A cross-sectional analysis estimating the economic costs of chronic pain in 2021. SUBJECTS: In 2021, 6445 (representing 65.8 million) adults with chronic pain were identified using ICD-10-CM codes from the nationally representative Medical Expenditure Panel Survey. MEASURES: Direct medical costs were examined by source of payment and service type. Indirect morbidity costs were estimated from lost productivity from employment disability and missed workdays. We evaluated the economic burden of chronic pain by estimating excess costs among individuals with chronic pain compared with individuals without chronic pain using multivariable regression. RESULTS: Individuals with chronic pain had additional total annual medical expenditures of $8068 and additional lost productivity of $2923 per person compared with individuals without chronic pain. In 2021, the economic costs of chronic pain in the United States were estimated to be $722.8 billion, including $530.6 billion in medical care costs and $192.2 billion in lost work productivity. CONCLUSIONS: The economic costs of chronic pain are substantial, resulting in excess health care expenditures and lost productivity costs. These findings highlight the importance of interventions and strategies aimed at providing high-quality, accessible, low-barrier, cost-effective pain care to improve quality of life and reduce disruptions in work among adults with chronic pain.
Geographic Access to Cancer Care and Breast Cancer Treatment in Low-Income Women.
Lian M, Struthers J, Greever-Rice T … +2 more , Schmaltz C, Liu Y
Med Care · 2025 Sep · PMID 40730348 · Publisher ↗
BACKGROUND: Little is known about the role of geographic access to oncologists in breast cancer treatment among low-income patients. METHODS: Using Missouri Cancer Registry-Medicaid claims data, we identified Medicaid en...
BACKGROUND: Little is known about the role of geographic access to oncologists in breast cancer treatment among low-income patients. METHODS: Using Missouri Cancer Registry-Medicaid claims data, we identified Medicaid enrollees aged 18-64 with newly diagnosed breast cancer from 2007 to 2015 (n=3930). Census tract-level geographic access to radiation oncologists (ROs), medical oncologists (MOs), and primary care physicians (PCPs) was quantified using the 2-step floating catchment area approach and categorized into tertiles. Logistic regression was used to estimate odds ratios (ORs) of undergoing mastectomy (vs. breast-conserving surgery), utilizing (yes/no), timely initiating (≤90 d post-surgery), and completing radiotherapy and chemotherapy, as well as being adherent to (medication possession ratio ≥80%) and continuing (<90-consecutive day gap) endocrine therapy (ET) in the first year. RESULTS: Compared with patients in census tracts with the greatest access to ROs, those in census tracts with the lowest access to ROs had higher odds of mastectomy (OR=1.23, 95% CI: 1.02-1.48, Ptrend =0.04), lower odds of radiotherapy completion (OR=0.68, 95% CI: 0.49-0.95, Ptrend =0.02), and similar odds of utilization and timely initiation of radiotherapy. Patients in census tracts with the lowest (vs. highest) access to MOs had comparable odds of utilization and timely initiation of chemotherapy but lower odds of chemotherapy completion (OR=0.71, 95% CI: 0.51-0.97, Ptrend =0.06). Geographic access to MOs and PCPs was unrelated to ET. CONCLUSIONS: Geographic access to oncologists was associated with choice of surgery and completion of radiotherapy/chemotherapy for breast cancer among Medicaid enrollees, highlighting the importance of addressing geographic barriers to oncologists to improve their treatment adherence.
Impact of a Pharmacy Copayment Increase on Medication Use in the Military Health System.
Wilson IB, Gutman R, Lee Y … +6 more , Dana BA, Hiris J, Zhang T, Thompson K, Gromadzki R, Shireman TI
Med Care · 2025 Oct · PMID 40730346 · Publisher ↗
BACKGROUND: We analyzed the impact of a copayment increase instituted February 1, 2018 for persons covered by the retail or mail order Military Health System (MHS) pharmacy benefit. METHODS: We compared medication use in...
BACKGROUND: We analyzed the impact of a copayment increase instituted February 1, 2018 for persons covered by the retail or mail order Military Health System (MHS) pharmacy benefit. METHODS: We compared medication use in 2 cohorts in the 12 months before and after the copayment increase: MHS beneficiaries between 18 and 64 years old (MHS cohort), and MHS beneficiaries older than or equal to 65 years old with Medicare (Medicare cohort). Subjects with diabetes, hypertension and hypercholesterolemia were eligible. Using propensity score matching, we compared the control group of those who obtained medications at military pharmacies ($0 copay) to those who experienced a copay increase. The outcome variable was any use of condition-specific medication. RESULTS: In the MHS cohort there were 30,753, 46,965, and 59,783 non-unique persons with diabetes, hyperlipidemia, and hypertension, respectively, in the intervention and control groups. In the Medicare cohort there were 45,977, 205,363, and 365,628 non-unique persons, respectively. The post-period mPDC differences for the MHS cohort were 0.02 (95% CI: 0.01, 0.03), 0.03 (95% CI: 0.02, 0.03), and 0.03 (95% CI: 0.01, 0.03) for the diabetes, hyperlipidemia, and hypertension cohorts, respectively. The post-period mPDC differences for the Medicare cohort were 0.01 (95% CI: 0.01, 0.02), 0.03 (95% CI: 0.03, 0.04), and 0.01 (95% CI: 0.01, 0.02), respectively. CONCLUSIONS: The small (1-3 percentage point) copayment increases are unlikely to have had adverse clinical effects. Insurers and policy-makers should understand that even small copayment increases can impact the use of clinically important medications and should carefully consider the tradeoffs.
Preventive Drug Lists Reduce Income-Related Disparities in Medication Adherence Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.
Ross-Degnan D, Argetsinger S, Lu CY … +4 more , Wagner A, Lakoma M, Zhang F, Wharam JF
Med Care · 2025 Oct · PMID 40730343 · Publisher ↗
BACKGROUND: Employers add Preventive Drug Lists (PDLs) to commercial insurance plans to reduce out-of-pocket payments for medicines that treat important chronic illnesses. OBJECTIVE: This study examined the impact of PDL...
BACKGROUND: Employers add Preventive Drug Lists (PDLs) to commercial insurance plans to reduce out-of-pocket payments for medicines that treat important chronic illnesses. OBJECTIVE: This study examined the impact of PDLs among patients with pre-existing diabetes. RESEARCH DESIGN: Interrupted time series design with difference-in-difference analysis. SUBJECTS: We identified 5575 patients aged 12-64 with diabetes whose employers adopted PDL coverage for 2 years after a baseline year without; an equivalent number of matched and weighted controls were selected from employers that did not offer PDL plans. MEASURES: Utilization, out-of-pocket payments, and medication adherence overall, among lower-income patients, and for those paying full cost for medicines under high-deductible plans. RESULTS: Compared with controls, patients with PDL coverage experienced large, statistically significant 35%-55% relative reductions in OOP payments. The PDL group experienced significant relative increases in 30-day fills in follow-up year 1 for noninsulin antidiabetics (+9.5) and a nonsignificant increase for insulin (+6.2%); these were matched by similar increases in percentage of days in which medicines were available. Increases were all substantially greater in the second follow-up year, larger among lower-income patients, and greatest by year 2 for lower-income patients in high-deductible plans with health savings accounts. CONCLUSIONS: PDL coverage was associated with substantial reductions in OOP payments for medications to manage diabetes and cardiovascular risk. Patients on antidiabetic medications, especially those with lower incomes, experienced improvements in adherence, which grew over time.
The Role of Telehealth Payment Parity on Recommended Care and Emergency Department Service Utilization Among Workers With Chronic Conditions.
Zhang Z, Bundorf MK, Gong Q … +3 more , Trogdon JG, Gilleskie D, Sylvia SY
Med Care · 2025 Oct · PMID 40730341 · Publisher ↗
BACKGROUND AND OBJECTIVE: State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our...
BACKGROUND AND OBJECTIVE: State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our study is to evaluate how improved access, driven by telehealth payment parity, affected the utilization of disease-specific recommended care management services and emergency department (ED) services among insured patients with chronic conditions. RESEARCH DESIGN: We adopted a 2-way fixed-effect difference-in-differences approach using the Merative Commercial Claims and Encounters database from 2019 to 2021. SUBJECTS: We focused on insured workers aged 19-64 with pre-existing mental health disorders or cardiometabolic risks (CMRs). MEASURES: Outcomes include psychotherapy for mental health disorders, preventive care counseling for CMRs, and ED visits. RESULTS: Telehealth payment parity was associated with a significant increase in the number of psychotherapy visits and tele-psychotherapy by 0.221 visits (95% CI: 0.050-0.391) and 0.411 visits (95% CI: 0.003-0.818) per patient per quarter, respectively. The regulation significantly reduced E.D. visits among individuals with mental health disorders by 0.003 visits (95% CI: -0.007 to 0.000) per quarter, a 25% relative decrease compared with the control at preperiod. However, payment parity was not statistically associated with increasing preventive care visits and lowering ED visits among individuals with CMRs. CONCLUSION: Telehealth payment parity has effectively promoted the adoption of psychotherapy and reduced ED visits among insured workers with mental health disorders. However, it has not significantly improved the uptake of preventive care counseling for individuals with CMRs.
Hospital Selection Patterns for Emergency Surgical Care: Structural Barriers as a Contributor to Surgical Outcomes.
Han J, Wan N, Horns JJ … +2 more , Brewer S, McCrum ML
Med Care · 2025 Oct · PMID 40730340 · Publisher ↗
BACKGROUND: Structural inequities are pervasive in the US emergency care system and disproportionately affect socially vulnerable neighborhoods. Spatial patterns of hospital access for patients requiring emergency surgic...
BACKGROUND: Structural inequities are pervasive in the US emergency care system and disproportionately affect socially vulnerable neighborhoods. Spatial patterns of hospital access for patients requiring emergency surgical care are influenced by health system structure; however, neighborhood-level variation and its association with clinical outcomes has not yet been characterized. OBJECTIVE: Examine variation in spatial patterns of hospital access for adults with nontraumatic surgical emergencies and its association with clinical outcomes. DESIGN: Retrospective analysis of California State Inpatient Discharge Data (2014-2015) of adults admitted with 1 of 8 emergency general surgery (EGS) conditions. We visualized patient home-to-hospital flows, then assessed Zip Code Tabulation Areas (ZCTA) patterns of spatial access using the Dispersion Index (DI), measured by the coefficient of variation of patient travel times where higher values indicate greater dispersion. Mixed-effect regression analysis was used to examine the association of DI with in-hospital mortality, nonhome discharge, and length of stay, adjusting for relevant patient, hospital, and neighborhood characteristics. RESULTS: Among 337,695 EGS admissions, increasing DI was associated with greater neighborhood social deprivation index (SDI). After adjusting for relevant covariates, greater dispersion was associated with an increase in in-hospital mortality in the highest decile of dispersion (aOR: 1.14; 95% CI: 1.03-1.26). The magnitude of effect was greater for patients from high-SDI neighborhoods: mortality (aOR: 1.27; 95% CI: 1.11-1.44). CONCLUSIONS: High dispersion was associated with unfavorable clinical outcomes among EGS patients, with a greater effect for underserved groups. High variation in patterns of hospital access for emergency care likely reflects structural barriers to care and may be one mechanism contributing to the relationship between neighborhood social vulnerability and surgical outcomes.
Racial Disparities in Quality of Dental Care Among Publicly Insured Children.
Choi SE, Fayyad R, Normand SL
Med Care · 2025 Sep · PMID 40730339 · Full text
BACKGROUND: Reducing oral health disparities requires identifying subgroups experiencing gaps in quality of dental care and the sizes of those gaps. This study measured magnitudes and trends of racial/ethnic disparities...
BACKGROUND: Reducing oral health disparities requires identifying subgroups experiencing gaps in quality of dental care and the sizes of those gaps. This study measured magnitudes and trends of racial/ethnic disparities in overall quality of dental care and examined factors contributing to the disparities. METHODS: This retrospective cohort study used claims data from beneficiaries under age 21 enrolled in Medicaid and Children's Health Insurance Program in 6 states during 2015-2019. A standardized composite score of dental care quality was derived from 6 dental quality measures using Item Response Theory. Robust mixed-effect regression estimated the magnitudes and trends of quality disparities, adjusting for person-level covariates. A Blinder-Oaxaca decomposition quantified the relative contributions of the social and structural factors in the estimated racial/ethnic disparities. RESULTS: Among 3.4 million beneficiaries, compared with White counterparts, Black children had lower baseline quality scores in 2 states and experienced decreases in quality in most states. Children of other race had lower baseline quality scores in 4 states with the largest gap of -0.16 (95% CI: -0.18,-0.15) and experienced decreases in quality in 3 states. Hispanic children had the higher baseline quality scores in all states with the largest gap of 0.34 (95% CI: 0.34,0.35) and experienced increases in quality in 4 states. Decomposition analysis indicated that structural factors, such as residential segregation, place of dental care, and dentist supply, explained portions of the quality gaps. CONCLUSION: Dental care quality was lower among Black and children of other race and higher among Hispanic and Asian children relative to their White counterparts. Tailored quality improvement efforts and refinements in Medicaid policy would be encouraged to reduce disparities in dental care and oral health.
A Text Message Outreach Intervention to Increase Health Insurance Enrollment for Self-Pay Patients.
Lu Y, Craten KJ, Thompson CT … +4 more , Scroggins R, Claassen J, Manning J, Ojha RP
Med Care · 2025 Aug · PMID 40730237 · Publisher ↗
BACKGROUND: Self-pay patients may be unaware of their eligibility for health insurance coverage through government or hospital-based medical assistance programs. OBJECTIVES: We aimed to evaluate the effect of behaviorall...
BACKGROUND: Self-pay patients may be unaware of their eligibility for health insurance coverage through government or hospital-based medical assistance programs. OBJECTIVES: We aimed to evaluate the effect of behaviorally informed text message outreach on insurance enrollment among self-pay patients discharged from the emergency department (ED) at a safety-net hospital. RESEARCH DESIGN: We emulated a single-arm trial with a historical comparison. Our eligible population included self-pay ED patients aged 18-64 years who were discharged between October 31 and November 24, 2022 (outreach group) or between April 1 and July 31, 2022 (historical comparison). We used entropy balancing weights to adjust for baseline characteristics and estimated overall and race/ethnicity-specific risk ratios (RR), risk differences (RD), and 95% confidence limits (CL) for the effect of the text outreach on insurance enrollment. RESULTS: The study population comprised 748 patients in the intervention and 6199 in the comparison group. The median age was 36 years (interquartile range=28-47), 58% were male, and 65% were racial/ethnic minorities. Overall outreach effect on any coverage enrollment (RR=1.4, 95% CL: 1.2, 1.6; RD=7.1%, 95% CL: 3.7%, 10%) was larger than the effect on hospital-based medical assistance program and Medicaid enrollment (RR=1.2, 95% CL: 1.0, 1.4; RD=2.7%, 95% CL: -0.24%, 5.7%). The latter effect was largest in the Hispanic population. CONCLUSIONS: Our results suggest behaviorally informed text outreach increases insurance enrollment among self-pay patients discharged from the ED at a safety-net hospital and may complement broader strategies to increase health insurance enrollment. Future studies should compare different text message strategies.
Postoperative Complications and Readmission Rates in Robotic-Assisted and Manual Total Hip Arthroplasty: A Large, Multi-Hospital Study.
Howell C, Witvoet S, Scholl L … +3 more , Coppolecchia A, Bhowmik-Stoker M, Chen AF
Med Care · 2025 Jul · PMID 40497801 · Publisher ↗
OBJECTIVE: This study aims to compare 90-day postoperative complications, readmissions, and emergency department (ED) visits between robotic-assisted (RA-THA) and manual (M-THA) total hip arthroplasty. METHODS: A retrosp...
OBJECTIVE: This study aims to compare 90-day postoperative complications, readmissions, and emergency department (ED) visits between robotic-assisted (RA-THA) and manual (M-THA) total hip arthroplasty. METHODS: A retrospective review of a multi-hospital database identified primary total hip arthroplasty patients between January 2016 and December 2021. The cohorts were 1-to-1 matched based on patient sex, age, and body mass index resulting in 8033 patients in each cohort (N = 16,066). Odds of 90-day revisits, readmission with >23 hours of observation, and ED visits were compared between cohorts. Complications reported during revisits and readmission were classified according to the Clinical Classification Software schema, using the International Classification of Diseases, 10th Revision codes, and compared using mixed-effect models. RESULTS: This study found an overall 90-day revisit rate of 8.3%. RA-THA was associated with significantly reduced odds of revisit within 90 days [odds ratio (OR): 0.71, 95% CI: 0.58-0.89, P = 0.002] and readmissions with >23 hours of observation (OR: 0.61, 95% CI: 0.48-0.77, P < 0.001). RA-THA patients had fewer readmissions with >23 hours of observation due to dislocations (RA-THA: 0.09%; M-THA: 0.39%, P < 0.001), surgical site infections (RA-THA: 0.04%; M-THA: 0.20%, P = 0.004), and wound infections/cellulitis (RA-THA: 0.01%; M-THA: 0.11%, P = 0.021). No difference in ED visits was observed between cohorts (OR: 0.92, 95% CI: 0.77-1.09, P = 0.3). RA-THA patients had more ED visits for dyspnea without pulmonary embolism (RA-THA: 0.20%; M-THA: 0.06%, P = 0.03). CONCLUSION: RA-THA showed significantly lower odds of overall 90-day revisit rates and readmissions with >23 hours of observation, most notably for readmissions due to dislocation and surgical site infection/wound infections. There was no significant difference in the odds of ED visits between cohorts.
Effects of Cognitive Behavioral Therapy on Chronic Uncontrolled Diabetes: A Randomized Clinical Trial in a Shared Primary Care Setting.
Bellacov R, Novasio Y
Med Care · 2025 Aug · PMID 40471065 · Publisher ↗
BACKGROUND: In the context of escalating diabetes prevalence worldwide, this study investigates the efficacy of integrating cognitive behavioral therapy (CBT) within primary care visits for managing uncontrolled diabetes...
BACKGROUND: In the context of escalating diabetes prevalence worldwide, this study investigates the efficacy of integrating cognitive behavioral therapy (CBT) within primary care visits for managing uncontrolled diabetes. DESIGN: The randomized clinical trial in an integrated health care clinic in Oregon involved 72 adults aged 20-89 with uncontrolled diabetes. Participants were enrolled and randomly assigned to 2 groups: one receiving both cognitive behavioral health (n=36) and the other receiving traditional primary care (n=36). RESULTS: The study primarily measured clinical improvements in hemoglobin A1C levels for a year. Results indicated significant improvements in the cognitive behavioral health group compared with the traditional care group at various intervals up to 51 weeks, with notable enhancements in hemoglobin A1C and secondary outcomes of patient satisfaction scores. During the 36 th and 51st weeks, the shared visit group demonstrated significantly lower hemoglobin A1c levels (36 wk: 9.22±0.2 vs. 10.02±0.2, P <0.001; 51 wk: 9.22±0.1 vs. 10.91±0.2, P <0.001), indicating improved long-term glycemic control. CONCLUSIONS: Combining cognitive behavioral health with primary care visits significantly outperformed traditional care in improving clinical outcomes and patient satisfaction among adults with uncontrolled diabetes. The percentage of participants with clinically meaningful improvement in 36 weeks was 22.2% in the CBT versus 0.0% in the traditional primary care visit group. The positive outcomes suggest that integrated cognitive behavioral therapy can effectively contribute to diabetes management strategies, highlighting the importance of innovative approaches in addressing the diabetes epidemic.
Patterns of Medical Care Cost by Service Type Associated With Lung Cancer Screening.
Wain K, Maiyani M, Carroll NM … +6 more , Meza R, Greenlee RT, Neslund-Dudas C, Odelberg MR, Oshiro C, Ritzwoller DP
Med Care · 2025 Sep · PMID 40465674 · Full text
INTRODUCTION: Lung cancer screening (LCS) enhances early stage cancer detection; however, its impact on health care costs in real-world clinical settings is not well understood. The objective of this study was to assess...
INTRODUCTION: Lung cancer screening (LCS) enhances early stage cancer detection; however, its impact on health care costs in real-world clinical settings is not well understood. The objective of this study was to assess changes in health care costs during the 12 months before LCS compared with the 12 months after. METHODS: This retrospective study analyzed health care costs based upon Medicare's fee-for-service reimbursement system using data from the Population-based Research to Optimize the Screening Process Lung Consortium. We included individuals who met age and smoking LCS eligibility criteria and were engaged within 4 health care systems between February 5, 2015, and December 31, 2021. Generalized linear models estimated health care costs from the payer perspective during 12 months prior and 12 months post baseline LCS. We compared these costs to eligible individuals who did not receive LCS. Secondary analyses examined costs among the sample who completed LCS by positive versus negative scan results. We reported mean predicted costs with average values for all other explanatory variables. RESULTS: We identified 10,049 eligible individuals who received baseline LCS and 15,233 who did not receive LCS. Receipt of LCS was associated with additional costs of $3698 compared with individuals not receiving LCS. Secondary analyses found costs increased by $11,664 among individuals with positive scans; however, no increases occurred among individuals with negative scans. CONCLUSION: These findings suggest LCS was only associated with increased health care costs among patients with a positive scan. LCS is a potentially cost-effective approach to identify early stage lung cancer. Healthcare systems should prioritize strategies to improve LCS participation.
Toward a Better Understanding of Primary Care Physician Career Typologies.
Fraher E, Jensen T, Tran A … +3 more , Galloway E, Weiss J, Lombardi B
Med Care · 2025 Sep · PMID 40465665 · Publisher ↗
BACKGROUND: The nation faces a persistent shortage and maldistribution of primary care physicians (PCPs). A better understanding of PCP career typologies could help policy makers target interventions toward certain subgr...
BACKGROUND: The nation faces a persistent shortage and maldistribution of primary care physicians (PCPs). A better understanding of PCP career typologies could help policy makers target interventions toward certain subgroups, rather than using a "one-size fits all" approach to improving PCP supply, distribution and diversity across settings and in rural areas. METHODS: This study used cross-sectional data from 2009 and 2019, derived from the North Carolina (NC) Medical Board, on PCPs in active practice in family medicine, general internal medicine, general pediatrics, geriatrics, and obstetrics and gynecology in NC. We used latent class analysis (LCA) to investigate: (1) whether different career typologies exist in the primary care physician workforce; (2) if so, whether career typologies changed in the 10-year period before the COVID-19 pandemic (2009 and 2019); and (3) whether a physician's generational cohort, age, sex, race/ethnicity, career stage, and medical school location were associated with different career typologies. RESULTS: The LCA yielded 4 distinct career typologies in both 2009 and 2019 with high levels of class separation. The 4 typologies were relatively stable over the decade. Distinguishing factors between typologies included practice in a rural area, hospital, and ambulatory care employment, and provision of obstetric and prenatal care. CONCLUSIONS: Understanding PCP career typologies could be used to tailor interventions to improve the supply and distribution of PCP workforce. Medical schools could use this information to support trainees' decision-making about future careers and policy makers to target funding for training to support careers in rural and ambulatory settings.
Impact of Maryland's 2015 Nurse Practitioner Full Scope of Practice Law on Statewide Rates of Outpatient Potentially Harmful Medication Prescribing to Older Adults.
Lipori J, Thorpe J
Med Care · 2025 Aug · PMID 40465662 · Publisher ↗
BACKGROUND: Since 2010, there has been an increase in Full Scope of Practice (FSP) laws allowing nurse practitioners (NPs) to practice independently. We aimed to utilize synthetic control models to examine the impact of...
BACKGROUND: Since 2010, there has been an increase in Full Scope of Practice (FSP) laws allowing nurse practitioners (NPs) to practice independently. We aimed to utilize synthetic control models to examine the impact of a 2015 NP FSP laws on outpatient potentially harmful medication (PHM) prescribing to older adults (65 years and above) in Maryland. METHODS: We utilized Medicare Public Use Files to measure statewide rates of outpatient PHM prescribing to older adults with Part D from fiscal year 2013-2019. An interrupted time series analysis was performed, and geographic and health access covariates were used to create synthetic control models. Placebo tests were used to test differences in PHM prescribing after the policy change. RESULTS: The interrupted time series analysis was not significant. Maryland's synthetic control model chose a weighted average of New Jersey, Delaware, and Massachusetts. There was no significant difference in PHM prescribing after the passage of Maryland's FSP law compared with synthetic control. DISCUSSION: We found that Maryland's FSP law did not impact statewide rates of PHM prescribing. State-wide prescribing trends should be considered in states debating changes in nurse practitioner scope of practice.
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