JAMA Health Forum最新文献

英文中文

The Alarming Risks for Dually Eligible Beneficiaries During Heat Waves. 热浪期间双重资格受益人面临的令人担忧的风险。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-11-01 DOI: 10.1001/jamahealthforum.2024.3912

Jose F Figueroa

引用次数: 0

Promoting the Resilience of Health Care Information Systems-The Day Hospitals Stood Still. 促进医疗保健信息系统的复原力--医院停滞不前的那一天。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-11-01 DOI: 10.1001/jamahealthforum.2024.3968

Daniel B Kramer, Kevin Fu

引用次数: 0

Psychedelic and MDMA-Related Adverse Effects-A Call for Action. 迷幻药和摇头丸相关不良反应--行动呼吁。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-11-01 DOI: 10.1001/jamahealthforum.2024.3630

Otto Simonsson, Matthew W Johnson, Peter S Hendricks

引用次数: 0

Dental Coverage and Care When Transitioning From Medicaid to Medicare. 从医疗补助过渡到医疗保险时的牙科保险和护理。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-11-01 DOI: 10.1001/jamahealthforum.2024.4165

Hawazin W Elani, Benjamin D Sommers, Dan Yuan, Ichiro Kawachi, Meredith B Rosenthal, Renuka Tipirneni

Importance: Millions of adults with low incomes lose Medicaid eligibility when transitioning to Medicare at age 65 years. However, it remains unclear how this transition is associated with dental care.Objective: To examine the consequences of transitions from Medicaid to Medicare on coverage and use of dental services.Design, setting, and participants: Cross-sectional data from the Health and Retirement Study from 2014 to 2020 and a regression discontinuity design were used to compare changes in outcomes before and after turning age 65 years among a population likely to be Medicaid-eligible before age 65 years. The sample included adults aged 50 to 90 years who had not attended college in 28 states.Exposure: Transitions from Medicaid to Medicare at age 65 years.Main outcomes and measures: Health insurance (Medicaid, Medicare, dual coverage, private, and uninsurance), dental coverage (Medicaid, Medicare, private, or none), and having a dental visit and out-of-pocket dental spending during the previous 2 years.Results: Of the 15 837 study participants, 9510 (56.2% weighted) were female, 6984 (28.7% weighted) were Black individuals, Hispanic individuals, and individuals of other race (including American Indian, Alaskan Native, Asian, Native Hawaiian, and Pacific Islander individuals), and 8853 (71.3% weighted) were White; the mean (SD) age was 69.2 (10.3) years. Turning age 65 years was associated with an increase in Medicare coverage in states with Medicaid dental benefits (66.5 percentage points [pp]; 95% CI, 58.3-74.7) and those without dental benefits (67.8 pp; 95% CI, 52.6-83.0). There was a concurrent reduction in private coverage, Medicaid, and uninsured rates. For dental outcomes, in states providing Medicaid dental benefits, turning age 65 years was associated with a 13.1-pp decrease in the likelihood of dental coverage (95% CI, 10.7-15.5), largely due to the loss of Medicaid dental coverage. Among adults reporting being Black, Hispanic, or other race, there was a 3.9-pp decline in dental visits during the previous 2 years (95% CI, -6.1 to -1.7). In states without Medicaid dental benefits, turning age 65 years was associated with no change in the likelihood of dental coverage and a 15.6-pp increase in dental visits (95% CI, 6.3-25.0). Out-of-pocket dental spending decreased in both groups of states (-13.0% [95% CI, -24.2 to -0.1] and -19.2% [95% CI, -33.6 to -1.6], respectively).Conclusions and relevance: The results of this cross-sectional study suggest that transitioning from Medicaid to Medicare at age 65 years was associated with a lower level of dental coverage and may increase barriers to accessing dental care for beneficiaries who had Medicaid dental coverage before age 65 years. However, for adults living in states without Medicaid dental benefits, the transition was asso

重要性：数百万低收入成年人在 65 岁过渡到医疗保险时失去了医疗补助资格。然而，这种过渡与牙科保健的关系如何仍不清楚：研究从医疗补助过渡到医疗保险对牙科服务的覆盖和使用的影响：我们使用了 2014 年至 2020 年健康与退休研究（Health and Retirement Study）的横截面数据和回归不连续设计，以比较 65 岁之前可能符合医疗补助资格的人群在 65 岁之前和之后的结果变化。样本包括美国 28 个州 50 至 90 岁未上过大学的成年人。调查对象：65 岁时从医疗补助计划过渡到医疗保险计划的人群：主要结果和衡量标准：医疗保险（医疗补助、医疗保险、双重保险、私人保险和未保险）、牙科保险（医疗补助、医疗保险、私人保险或无保险）以及前两年的牙科就诊和自付牙科费用：在 15 837 名研究参与者中，9510 人（加权 56.2%）为女性，6984 人（加权 28.7%）为黑人、西班牙裔和其他种族（包括美国印第安人、阿拉斯加原住民、亚裔、夏威夷原住民和太平洋岛民），8853 人（加权 71.3%）为白人；平均（标清）年龄为 69.2（10.3）岁。在有医疗补助牙科福利的州，年满 65 岁与医疗保险覆盖率的增加有关（66.5 个百分点 [pp]；95% CI，58.3-74.7），而在没有牙科福利的州，年满 65 岁与医疗保险覆盖率的增加有关（67.8 个百分点；95% CI，52.6-83.0）。同时，私人保险、医疗补助和无保险的比例也有所下降。就牙科治疗结果而言，在提供医疗补助牙科福利的州中，65 岁与牙科保险可能性下降 13.1 个百分点有关（95% CI，10.7-15.5），这主要是由于失去了医疗补助牙科保险。在报告自己是黑人、西班牙裔或其他种族的成年人中，前两年看牙医的人数下降了 3.9 个百分点（95% CI，-6.1 到-1.7）。在没有医疗补助（Medicaid）牙科福利的州，年满 65 岁与牙科保险的可能性没有变化有关，但看牙次数增加了 15.6 个百分点（95% CI，6.3-25.0）。两组州的自付牙科费用均有所下降（分别为-13.0% [95% CI, -24.2 to -0.1]和-19.2% [95% CI, -33.6 to -1.6] ）：这项横断面研究的结果表明，65 岁时从医疗补助计划过渡到医疗保险计划与较低的牙科保险水平有关，可能会增加 65 岁前拥有医疗补助计划牙科保险的受益人获得牙科保健的障碍。然而，对于生活在没有医疗补助牙科福利的州的成年人来说，过渡与牙科服务使用的增加有关，而总体牙科保险率没有变化。

{"title":"Dental Coverage and Care When Transitioning From Medicaid to Medicare.","authors":"Hawazin W Elani, Benjamin D Sommers, Dan Yuan, Ichiro Kawachi, Meredith B Rosenthal, Renuka Tipirneni","doi":"10.1001/jamahealthforum.2024.4165","DOIUrl":"10.1001/jamahealthforum.2024.4165","url":null,"abstract":"Importance: Millions of adults with low incomes lose Medicaid eligibility when transitioning to Medicare at age 65 years. However, it remains unclear how this transition is associated with dental care.Objective: To examine the consequences of transitions from Medicaid to Medicare on coverage and use of dental services.Design, setting, and participants: Cross-sectional data from the Health and Retirement Study from 2014 to 2020 and a regression discontinuity design were used to compare changes in outcomes before and after turning age 65 years among a population likely to be Medicaid-eligible before age 65 years. The sample included adults aged 50 to 90 years who had not attended college in 28 states.Exposure: Transitions from Medicaid to Medicare at age 65 years.Main outcomes and measures: Health insurance (Medicaid, Medicare, dual coverage, private, and uninsurance), dental coverage (Medicaid, Medicare, private, or none), and having a dental visit and out-of-pocket dental spending during the previous 2 years.Results: Of the 15 837 study participants, 9510 (56.2% weighted) were female, 6984 (28.7% weighted) were Black individuals, Hispanic individuals, and individuals of other race (including American Indian, Alaskan Native, Asian, Native Hawaiian, and Pacific Islander individuals), and 8853 (71.3% weighted) were White; the mean (SD) age was 69.2 (10.3) years. Turning age 65 years was associated with an increase in Medicare coverage in states with Medicaid dental benefits (66.5 percentage points [pp]; 95% CI, 58.3-74.7) and those without dental benefits (67.8 pp; 95% CI, 52.6-83.0). There was a concurrent reduction in private coverage, Medicaid, and uninsured rates. For dental outcomes, in states providing Medicaid dental benefits, turning age 65 years was associated with a 13.1-pp decrease in the likelihood of dental coverage (95% CI, 10.7-15.5), largely due to the loss of Medicaid dental coverage. Among adults reporting being Black, Hispanic, or other race, there was a 3.9-pp decline in dental visits during the previous 2 years (95% CI, -6.1 to -1.7). In states without Medicaid dental benefits, turning age 65 years was associated with no change in the likelihood of dental coverage and a 15.6-pp increase in dental visits (95% CI, 6.3-25.0). Out-of-pocket dental spending decreased in both groups of states (-13.0% [95% CI, -24.2 to -0.1] and -19.2% [95% CI, -33.6 to -1.6], respectively).Conclusions and relevance: The results of this cross-sectional study suggest that transitioning from Medicaid to Medicare at age 65 years was associated with a lower level of dental coverage and may increase barriers to accessing dental care for beneficiaries who had Medicaid dental coverage before age 65 years. However, for adults living in states without Medicaid dental benefits, the transition was asso","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 11","pages":"e244165"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Health Care Utilization With Telemedicine and In-Person Visits in Pediatric Primary Care. 儿科初级保健中远程医疗和亲诊的医疗利用率。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-11-01 DOI: 10.1001/jamahealthforum.2024.4156

Scott D Casey, Jie Huang, Daniel D Parry, Tracy A Lieu, Mary E Reed

Importance: Telemedicine is an increasingly used yet understudied vehicle to deliver pediatric primary care. Evidence detailing downstream health care utilization after telemedicine visits is needed.Objective: To compare pediatric primary care conducted via telemedicine (video or telephone) with in-person office visits with regard to physician medication prescribing and imaging and laboratory ordering and downstream follow-up office visits, emergency department (ED) visits, and hospitalizations.Design, setting, and participants: This cohort study included all patients younger than 18 years who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the Kaiser Permanente Northern California health system, a large integrated health care delivery system offering in-person office visits, video visits, or telephone visits for pediatric primary care.Exposure: Pediatric primary care in-person visit, telephone visit, or video visit.Main outcome and measures: Rates of physician medication prescribing and imaging and laboratory ordering during an index telemedicine or office visit and rates of in-person office visits, ED visits, and hospitalizations within 7 days after the visit, adjusted for patient and clinical characteristics.Results: Of 782 596 total appointments (51.1% male) among 438 638 patients, telemedicine was used for 332 153 visits (42.4%). After adjustment, there was more medication prescribing for in-person visits (39.8%) compared with video visits (29.5%; adjusted difference, -10.3%; 95% CI, -10.6% to -10.0%) or telephone visits (27.3%; adjusted difference, -12.5%; 95% CI, -12.5% to -12.7%). There was also more laboratory ordering for in-person visits (24.6%) compared with video visits (7.8%; adjusted difference, -16.8%; 95% CI, -17.0% to -16.6%) or telephone visits (8.5%; adjusted difference, -16.2%; 95% CI, -16.3% to -16.0%). There was more imaging ordering for in-person visits (8.5%) compared with video visits (4.0%; adjusted difference, -4.5%; 95% CI, -4.6% to -4.4%) and telephone visits (3.5%; adjusted difference, -5.0%; 95% CI, -5.1% to -4.9%). After adjustment, fewer in-person follow up visits occurred for index visits that were in-person (4.3%) compared with video (14.4%; adjusted difference, 10.1%; 95% CI, 9.9%-10.3%) or telephone (15.1%; adjusted difference, 10.8%; 95% CI, 10.7%-11.0%) visits. The rate of ED visits following an in-person visit was slightly lower (1.75%) compared with after video visits (2.04%; adjusted difference, 0.29%; 95% CI, 0.21%-0.38%) or telephone visits (2.00%; adjusted difference, 0.25%; 95% CI, 0.18%-0.33%). There was no statistically significant difference in the 7-day rate of hospitalizations.Conclusions and relevance: In this cohort study, telephone and video visits for pediatric primary care were

重要性：远程医疗在提供儿科初级保健服务方面的应用日益广泛，但研究不足。需要有证据详细说明远程医疗访问后下游医疗保健的利用情况：目的：比较通过远程医疗（视频或电话）进行的儿科初级保健与亲自到诊所就诊在医生开药、影像和实验室检查以及下游后续诊所就诊、急诊室就诊和住院方面的情况：这项队列研究包括 2022 年 1 月 1 日至 12 月 31 日期间在北加州凯撒医疗系统（Kaiser Permanente Northern California health system）中与儿科医生预约初级保健的所有 18 岁以下患者，该医疗系统是一个大型综合医疗服务系统，提供儿科初级保健的面对面门诊、视频门诊或电话门诊：主要结果和测量指标：主要结果和测量指标：根据患者和临床特征进行调整后，远程医疗或诊室就诊期间医生开药、影像和实验室检查的比例，以及就诊后 7 天内的亲自诊室就诊率、急诊室就诊率和住院率：在 438 638 名患者的 782 596 次预约中（51.1% 为男性），332 153 次就诊使用了远程医疗（42.4%）。经调整后，与视频就诊（29.5%；调整后差异为-10.3%；95% CI，-10.6%至-10.0%）或电话就诊（27.3%；调整后差异为-12.5%；95% CI，-12.5%至-12.7%）相比，亲自就诊（39.8%）的处方用药量更大。与视频就诊（7.8%；调整后差异为-16.8%；95% CI，-17.0%至-16.6%）或电话就诊（8.5%；调整后差异为-16.2%；95% CI，-16.3%至-16.0%）相比，亲自就诊（24.6%）的化验订单也更多。与视频就诊（4.0%；调整后差异为-4.5%；95% CI，-4.6%至-4.4%）和电话就诊（3.5%；调整后差异为-5.0%；95% CI，-5.1%至-4.9%）相比，亲自就诊（8.5%）的影像学检查订单更多。经调整后，与视频（14.4%；调整后差异为 10.1%；95% CI，9.9%-10.3%）或电话（15.1%；调整后差异为 10.8%；95% CI，10.7%-11.0%）就诊相比，当面就诊的指数随访率（4.3%）更低。与视频就诊（2.04%；调整后差异为 0.29%；95% CI 为 0.21%-0.38%）或电话就诊（2.00%；调整后差异为 0.25%；95% CI 为 0.18%-0.33%）相比，面对面就诊后的急诊就诊率略低（1.75%）。在 7 天住院率方面没有统计学意义上的显著差异：在这项队列研究中，儿科初级保健的电话和视频就诊与亲自就诊相比，开处方和下订单的情况较少。远程医疗就诊与随后的亲自就诊率略高和急诊室就诊率略高有关，但住院率没有差异。远程医疗似乎是为儿科人群提供医疗服务的有用工具，尽管它并不能完全替代面对面就诊。

{"title":"Health Care Utilization With Telemedicine and In-Person Visits in Pediatric Primary Care.","authors":"Scott D Casey, Jie Huang, Daniel D Parry, Tracy A Lieu, Mary E Reed","doi":"10.1001/jamahealthforum.2024.4156","DOIUrl":"10.1001/jamahealthforum.2024.4156","url":null,"abstract":"Importance: Telemedicine is an increasingly used yet understudied vehicle to deliver pediatric primary care. Evidence detailing downstream health care utilization after telemedicine visits is needed.Objective: To compare pediatric primary care conducted via telemedicine (video or telephone) with in-person office visits with regard to physician medication prescribing and imaging and laboratory ordering and downstream follow-up office visits, emergency department (ED) visits, and hospitalizations.Design, setting, and participants: This cohort study included all patients younger than 18 years who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the Kaiser Permanente Northern California health system, a large integrated health care delivery system offering in-person office visits, video visits, or telephone visits for pediatric primary care.Exposure: Pediatric primary care in-person visit, telephone visit, or video visit.Main outcome and measures: Rates of physician medication prescribing and imaging and laboratory ordering during an index telemedicine or office visit and rates of in-person office visits, ED visits, and hospitalizations within 7 days after the visit, adjusted for patient and clinical characteristics.Results: Of 782 596 total appointments (51.1% male) among 438 638 patients, telemedicine was used for 332 153 visits (42.4%). After adjustment, there was more medication prescribing for in-person visits (39.8%) compared with video visits (29.5%; adjusted difference, -10.3%; 95% CI, -10.6% to -10.0%) or telephone visits (27.3%; adjusted difference, -12.5%; 95% CI, -12.5% to -12.7%). There was also more laboratory ordering for in-person visits (24.6%) compared with video visits (7.8%; adjusted difference, -16.8%; 95% CI, -17.0% to -16.6%) or telephone visits (8.5%; adjusted difference, -16.2%; 95% CI, -16.3% to -16.0%). There was more imaging ordering for in-person visits (8.5%) compared with video visits (4.0%; adjusted difference, -4.5%; 95% CI, -4.6% to -4.4%) and telephone visits (3.5%; adjusted difference, -5.0%; 95% CI, -5.1% to -4.9%). After adjustment, fewer in-person follow up visits occurred for index visits that were in-person (4.3%) compared with video (14.4%; adjusted difference, 10.1%; 95% CI, 9.9%-10.3%) or telephone (15.1%; adjusted difference, 10.8%; 95% CI, 10.7%-11.0%) visits. The rate of ED visits following an in-person visit was slightly lower (1.75%) compared with after video visits (2.04%; adjusted difference, 0.29%; 95% CI, 0.21%-0.38%) or telephone visits (2.00%; adjusted difference, 0.25%; 95% CI, 0.18%-0.33%). There was no statistically significant difference in the 7-day rate of hospitalizations.Conclusions and relevance: In this cohort study, telephone and video visits for pediatric primary care were ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 11","pages":"e244156"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

JAMA Health Forum. 美国医学会杂志健康论坛。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-10-04 DOI: 10.1001/jamahealthforum.2024.0535

引用次数: 0

Unwinding Medicaid Eligibility: Lessons for Health Policy. 取消医疗补助资格：对医疗政策的启示。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-10-04 DOI: 10.1001/jamahealthforum.2024.4487

Michelle Bedoya, Joshua M Sharfstein

引用次数: 0

Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits. 医生利他主义与支出、入院率和急诊就诊率。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-10-04 DOI: 10.1001/jamahealthforum.2024.3383

Lawrence P Casalino, Shachar Kariv, Daniel Markovits, Raymond Fisman, Jing Li

Importance: Altruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.

Objective: To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.

Design, setting, and participants: This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.

Exposure: Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.

Main measures: Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.

Results: In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01).

Conclusions and relevance: This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.

重要性：利他主义--把病人放在第一位--是医生职业精神的基本组成部分。有关医生利他主义、医疗质量和支出之间关系的证据尚缺：目的：确定医生利他主义、医疗质量和支出之间是否存在关系，假设利他主义医生的医疗效果更好：这项横断面研究使用一个经过验证的经济实验来衡量利他主义，研究于 2018 年 10 月至 2019 年 11 月期间进行，使用的是美国全国范围内的初级保健医生和心脏病专家样本。利他主义数据与 2019 年医疗保险理赔相关联，并使用多变量回归来检验利他主义与质量和支出指标之间的关系。研究共纳入了 43 家医疗机构的 250 名医生（这些医疗机构的规模、地点和所有权各不相同）和 7626 名医疗保险付费服务受益人。分析时间为 2022 年 4 月至 2024 年 8 月：医生们完成了一项广泛使用的改良独裁者游戏式网络实验；根据他们的回答，他们被分为利他主义较强或较弱的类型：主要衡量指标：潜在可预防的入院率、潜在可预防的急诊就诊率和医疗保险支出：共有 1599 名受益人（21%）归属于 45 名被归类为利他主义的医生（18%），6027 名患者归属于 205 名未被归类为利他主义的医生。在对患者、医生和诊所特征进行调整后，利他主义医生的患者接受任何潜在可预防入院治疗（几率比 [OR]，0.60；95% CI，0.38-0.97；P = .03）和任何潜在可预防急诊就诊（OR，0.64；CI，0.43-0.94；P = .02）的可能性较低。调整后的支出降低了 9.26% (95% CI, -16.24% to -2.27%; P = .01)：这项横断面研究发现，接受利他主义医生治疗的医疗保险患者的潜在可预防住院和急诊就诊次数较少，花费也较低。医院、医疗机构和医学院校的决策者和领导者可能需要考虑建立激励机制、组织结构和文化，以提高或至少不降低医生的利他主义。进一步的研究应设法确定这些因素和其他可改变的因素，如医生的选择和培训，这些因素可能会影响医生的利他主义。研究还可以分析利他主义与其他医疗实践、专科和国家的质量和支出之间的关系，并使用更多的质量和患者体验衡量标准。

{"title":"Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits.","authors":"Lawrence P Casalino, Shachar Kariv, Daniel Markovits, Raymond Fisman, Jing Li","doi":"10.1001/jamahealthforum.2024.3383","DOIUrl":"10.1001/jamahealthforum.2024.3383","url":null,"abstract":"Importance: Altruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.Objective: To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.Design, setting, and participants: This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.Exposure: Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.Main measures: Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.Results: In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01).Conclusions and relevance: This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 10","pages":"e243383"},"PeriodicalIF":9.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Errors in Table 2 and eTables 1 and 3. 表 2 及电子表格 1 和 3 中的误差。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-10-04 DOI: 10.1001/jamahealthforum.2024.3865

引用次数: 0

The Unintended Consequences of Individual Market Reinsurance. 个人市场再保险的意外后果》。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES

JAMA Health Forum

Pub Date : 2024-10-04 DOI: 10.1001/jamahealthforum.2024.3188

Coleman Drake, David M Anderson

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

JAMA Health Forum

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀