Category: Statistics

J Am Assoc Nurse Pract. 2025 Jun 1;37(6):323-326. doi: 10.1097/JXX.0000000000001119.

ABSTRACT

Candello, the national medical professional liability (MPL) data collaborative of CRICO, the medical malpractice insurer for all Harvard medical institutions and their affiliates undertook a comprehensive retrospective analysis to evaluate malpractice risk associated with the increasing number of nurse practitioners (NPs) and physician associates (PAs) in the health care workforce. The report analyzed 65,754 asserted MPL cases and 69,782 closed MPL cases between 2012 and 2021 to compare those involving NPs and PAs to those involving medical doctors (MDs). Despite increasing use of NPs and PAs, there was no observed increase in the proportion of MPL claims involving these practitioners. The analysis also includes the differences in case characteristics by provider type, including contributing factors, clinical severity, and location. The data showed no significant differences in medical malpractice risk between NPs, PAs, and MDs based on the analysis of these characteristics. However, these data show the likelihood of indemnity, and the average paid is higher in cases involving multiple providers.

PMID:40456051 | DOI:10.1097/JXX.0000000000001119

Health Aff (Millwood). 2025 Jun;44(6):707-715. doi: 10.1377/hlthaff.2024.01277.

ABSTRACT

Insurance claim denials are a common source of administrative burden, especially for patients with private health insurance. Contesting denied claims requires considerable investment from physicians and patients or caregivers, including both institutional knowledge of health policies and billing practices and the means to engage in reconciliation. We used a novel national data set comprising remittance data and patient demographics to describe disparities in the rates of seeking and receiving claim denial corrections across demographic and socioeconomic dimensions. We found that patients from historically disadvantaged racial and ethnic groups or with low household incomes experienced the largest burdens from claim denials. Patients with household incomes less than $50,000 annually were least likely to have denied claims contested and, conditionally, have cost-sharing obligations reduced. Racial minority patients were more likely than non-Hispanic White patients to have cost-sharing obligations reduced but achieved lower mean savings per successfully contested denial. Policy makers working to promote equitable health care access should make available more resources for contesting and rectifying administrative errors and enact policies to prevent billing errors and consequent claim denials.

PMID:40456042 | DOI:10.1377/hlthaff.2024.01277

Health Aff (Millwood). 2025 Jun;44(6):731-738. doi: 10.1377/hlthaff.2024.01287.

ABSTRACT

Since 2013, Medicare has reimbursed clinicians for delivering transitional care management (TCM) services after patients’ discharge from eligible medical facilities. Concurrently, Medicare has implemented population-based Alternative Payment Models (APMs) to encourage patient-centered care, care coordination, and clinician accountability. In this analysis, we used 2017-20 Medicare data to evaluate the effect of TCM on four quality and cost outcomes and the effect of population-based APM participation on the association between TCM and the four outcomes. TCM was associated with more healthy days at home and lower total spending after hospital discharge, with more pronounced differences among patients aligned with population-based APMs compared to nonaligned patients. TCM was also associated with lower readmissions but not differences in mortality; neither finding varied between patients who were versus were not aligned with population-based APMs. These findings suggest that the benefits of TCM may be even greater when patients are aligned with population-based APMs, highlighting potentially complementary effects.

PMID:40456041 | DOI:10.1377/hlthaff.2024.01287

Health Aff (Millwood). 2025 Jun;44(6):702-706. doi: 10.1377/hlthaff.2024.01485.

ABSTRACT

This article quantifies the prevalence of claim denials in Medicare Advantage (MA), along with their direct impact on provider revenue. Employing medical claims data from multiple MA plans, covering 30 percent of the entire MA market in 2019, our study found claim denial rates of 17 percent as a share of initial claim submissions. We also found that 57 percent of all claim denials were ultimately overturned. We calculated that denials resulted in a 7 percent net reduction in provider MA revenue, based on the dollar-weighted share of claim denials that were not overturned. However, the indirect impact of denials could be even greater than this direct effect that we measured. This article points to the important role that claim denials play in reducing MA spending and in driving outcome differences between MA and traditional Medicare. However, our analysis did not weigh the cost-saving benefits of claim denials against potential downsides.

PMID:40456040 | DOI:10.1377/hlthaff.2024.01485

Health Aff (Millwood). 2025 Jun;44(6):754-760. doi: 10.1377/hlthaff.2024.01220.

ABSTRACT

In lieu of hiring physicians, hospitals often contract with medical groups and pay stipends to clinicians to supplement professional services reimbursements from insurers and patients. We measured the prevalence and magnitude of stipends from California hospitals to emergency medicine and anesthesiology clinicians in Hospital Annual Financial Disclosure Reports from the period 2002-21. The prevalence and average magnitudes of stipends, even standardizing for service volume, have risen in both specialties. In 2021, stipends to emergency medicine and anesthesiology clinicians were paid by 81 percent and 57 percent of hospitals in California, respectively. The mean amount hospitals spent on stipends were $4.1 million for emergency medicine and $2.9 million for anesthesiology annually in 2021, among hospitals with any stipend. Standardizing for service volume, the mean amount across all hospitals was $91.42 per emergency visit and $40.11 per fifteen minutes of anesthesiology services in 2021. These findings inform policy discussions on hospital labor costs and professional reimbursement.

PMID:40456039 | DOI:10.1377/hlthaff.2024.01220

Health Aff (Millwood). 2025 Jun;44(6):650-658. doi: 10.1377/hlthaff.2024.01527.

ABSTRACT

The Medicare prescription drug plan redesign under the Inflation Reduction Act of 2022 aims to simplify the Part D benefit while capping out-of-pocket spending for Part D-covered drugs. Whether and which Medicare beneficiaries will see savings from the redesigned benefit is unclear. We evaluated plan coverage and cost sharing for commonly used brand-name and generic drugs to estimate potential out-of-pocket spending changes for beneficiaries using the same drug and plan in both 2024 and 2025. We found that beneficiaries filling prescriptions for high-cost drugs would have expected mean savings of approximately $1,400 between 2024 and 2005. Beneficiaries who had spending lower than the out-of-pocket cap of $2,000 would have less consistent savings as a result of plans increasing the use of coinsurance versus copayments for preferred brands and increases in premiums among some stand-alone Part D plans. The variability across plans in expected out-of-pocket spending and premiums under the redesigned drug benefit reinforces the need for Medicare beneficiaries to shop for plans that best match their expected medication use.

PMID:40456037 | DOI:10.1377/hlthaff.2024.01527

Health Aff (Millwood). 2025 Jun;44(6):684-692. doi: 10.1377/hlthaff.2024.01536.

ABSTRACT

Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA. Using data from the 2015-20 restricted Medicare Current Beneficiary Survey with information on beneficiaries’ perceptions of access, cost, and quality, plus MA contract star ratings and plan generosity data, we assessed factors associated with disenrolling from an MA plan. Enrollees’ self-reported inability to access and receive high-quality care, more than perceived burdens of out-of-pocket costs, was associated with MA plan disenrollment, as was an objective measure of plan generosity. Difficulty accessing needed medical care was more strongly associated with MA-to-traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

PMID:40456034 | DOI:10.1377/hlthaff.2024.01536

J Med Internet Res. 2025 Jun 2;27:e65868. doi: 10.2196/65868.

ABSTRACT

BACKGROUND: Lifestyle interventions are a critical component of weight loss programs, yet digital, personalized, and theory- and evidence-based lifestyle interventions remain limited.

OBJECTIVE: This study aimed to investigate the effects of a combination of various dietary approaches and digital technology-based exercise on the body composition of college students with obesity.

METHODS: A total of 129 college students with obesity (mean age 18.3, SD 0.7 years; mean weight 89.9, SD 13.6 kg; mean BMI 30.6, SD 3.3 kg/m²) were initially recruited for this study. After excluding 2 participants, 127 students with obesity were ultimately included in the statistical analysis. An 8-week weight loss intervention was conducted with the students, combining exercise and various digitally supported dietary approaches. Body composition indicators (muscle mass and fat mass) were assessed before and after the intervention. Participants were divided into 3 experimental groups (twice-weekly fasting [TWF], low-calorie diet [LCD], and time-restricted feeding [TRF]). Between-group comparisons were made using a 1-way ANOVA, while within-group comparisons used a repeated-measures ANOVA. Linear mixed-effects models were used to examine the interaction effects between sex and time, as well as between sex and group.

RESULTS: All groups showed significant decreases in weight and BMI, and the TRF group also showed a significant decrease in BMI (P=.002), but there were significant sex differences. The male TWF group showed the largest decrease in weight (mean difference [MD] -4.86 kg; P<.001), BMI (MD -1.1 kg/m²; P<.001), visceral fat mass (MD -0.607 kg; P=.003) and subcutaneous fat mass (MD -1.987 kg; P<.001) at 8 weeks. Improvements in weight (MD -5.662 kg; P<.001) and BMI (MD -1.587 kg/m²; P<.001) were more pronounced in the LCD group of female participants (P<.001). Muscle mass declined significantly in male participants in the TRF group at 4 weeks (P<.001) but stabilized at 8 weeks (P=.87). Linear mixed effects models showed that the sex and diet interaction significantly affected subcutaneous fat mass (P=.02). The effect of TRF on muscle mass in male participants peaked at 4 weeks (P<.001), with no significant difference from the control group at 8 weeks (P=.91).

CONCLUSIONS: This study demonstrated that 3 diet-combined exercise regimens produced sex-specific improvements in body composition in college students with obesity. Male participants achieved maximum visceral fat mass loss after 8 weeks with TWF combined with exercise, whereas female participants achieved greater total body fat loss with LCD combined with exercise. The effectiveness of the closed-loop monitoring-feedback behavior modification was verified by digital technology through intelligent monitoring to improve dietary compliance and a real-time feedback mechanism to enhance the effect of the intervention. The sex and diet interaction significantly affected subcutaneous fat mass; women who used LCD and TRF needed additional protein supplementation. Digital technology shows great potential in obesity management and is worth promoting.

PMID:40455565 | DOI:10.2196/65868

Kardiologiia. 2025 Jun 2;65(5):70-74. doi: 10.18087/cardio.2025.5.n2827.

ABSTRACT

AIM: To study the prevalence of cardiovascular risk factors (RFs) associated with obesity in young people studying at a multidisciplinary university, as well as to analyze the awareness of students about the potential relationship between these RFs and cardiovascular diseases.

MATERIAL AND METHODS: This cross-sectional study included in the final analysis 1158 students of the Moscow State University without known chronic non-communicable diseases (CNCDs). Participants filled out a standard “Questionnaire for persons under 65 years of age to identify CNCDs, their RFs, and the use of non-prescribed narcotic drugs and psychotropic substances”, which included a question to identify individuals with a high level of physical activity (PA), as well as an additional questionnaire with open-ended questions on RFs for cardiovascular diseases (CVDs).

RESULTS: The prevalence of obesity in young people studying at the multidisciplinary university was 5.0%, overweight 13.6%, and abdominal obesity (AO) 12.7%. Correlation analysis showed that the body mass index (BMI) had weak but significant relationships with systolic blood pressure (r = 0.434; p &lt; 0.001), total cholesterol (r = 0.170; p &lt; 0.001), and blood glucose (r = 0.185; p &lt; 0.001). Young people with obesity consumed significantly less vegetables and fruits than those with normal BMI (p=0.032). There were more smokers among overweight and obese patients (p=0.019), probably due to an unhealthy behavior pattern in general. Unhealthy diet was named as a RF for CVD by ⅔ of the surveyed young people; more than ¾ were aware of the negative impact of low PA on the cardiovascular system. Obesity was named as a RF by less than 20% of the respondents regardless of gender. The awareness of students with obesity or overweight about obesity as a RF for CVD was generally higher than in the general group (p&lt;0.001). However, only 41.3% of those with a BMI of 30 kg/m2 or more named obesity as a RF for CVD.

CONCLUSION: Understanding the prevalence of behavioral RFs for CVD, awareness of the related risks, and the need to maintain health among young people is critical for prevention of CVD. Interventions targeting university students should promote healthy eating behavior, increased PA, and weight control.

PMID:40455557 | DOI:10.18087/cardio.2025.5.n2827

Kardiologiia. 2025 Jun 2;65(5):28-34. doi: 10.18087/cardio.2025.5.n2719.

ABSTRACT

OBJECTIVE: Analyze the clinical characteristics and resuscitation outcomes of patients with in-hospital cardiac arrest (IHCA) and explore the factors affecting the success rate of cardiopulmonary resuscitation in IHCA patients.

MATERIAL AND METHODS: A retrospective observational study was conducted. Patients who received resuscitative treatment for IHCA between September 2022 and December 2023 were evaluated. Clinical data and prognostic information were collected and analyzed, including age, gender, underlying diseases, time of cardiac arrest, cause of cardiac arrest, presence of shockable rhythm, application of defibrillation, duration of CPR (&gt;30 min), presence of endotracheal intubation, cumulative dose of adrenaline, and resuscitation outcomes (return of spontaneous circulation, survival to discharge).

RESULTS: A total of 323 IHCA patients were included in this study. After CPR treatment, 246 had return of spontaneous circulation (ROSC), with 90 surviving to discharge. Coronary artery disease, shockable initial rhythm, presence of a shockable rhythm during resuscitation, defibrillation, and absence of emergency endotracheal intubation differed statistically between the ROSC and non-ROSC groups (univariate analysis, p &lt; 0.001) Age was a statistically significant determinant of whether patients survived to discharge (p &lt; 0.05). Multivariate logistic regression analysis showed that CPR duration ≥ 30 min was an independent risk factor for ROSC, while younger age, application of emergency endotracheal intubation, and lower cumulative dose of adrenaline were independent protective factors for ROSC (p &lt; 0.05).

CONCLUSION: Age lower than 60 years old, application of defibrillation, and emergency endotracheal intubation are positively associated with increased likelihood of ROSC. Age is an independent risk factor negatively related to survival after discharge. Clinicians should pay close attention to these factors to improve the outcomes of cardiopulmonary resuscitation patients.

PMID:40455552 | DOI:10.18087/cardio.2025.5.n2719