Tag: pubmed

Am J Manag Care. 2026 Jul;32(7):406-412. doi: 10.37765/ajmc.2026.89915.

ABSTRACT

OBJECTIVE: To evaluate the impact of an intensive outpatient clinic (IOC) model on health care utilization and costs among medically and behaviorally complex adults enrolled in a Medicaid managed care organization.

STUDY DESIGN: A retrospective cohort study using interrupted time series (ITS) and Bayesian structural time series (BSTS) analysis was conducted to examine changes in health care use and costs before and after IOC enrollment.

METHODS: Observational claims data from 2015 to 2023 were analyzed for 150 adults who enrolled in an IOC between 2017 and 2023. Outcomes included total, medical, and pharmacy costs; hospital admissions; and emergency department (ED) visits, tracked 24 months before and after enrollment.

RESULTS: Mean annual health care spending decreased by 43% 2 years after IOC enrollment. ITS analysis showed significant monthly reductions in total spending (-$142; 95% CI, -$242 to -$42; P < .01) and medical costs (-$129; 95% CI, -$229 to -$29; P = .01). Hospital admissions and ED visits declined by 36 (95% CI, -58 to -13; P < .01) and 25 (95% CI, -35 to -16; P < .01) per 1000 patients per month, respectively. BSTS estimates showed a 6% decrease in total spending, a 10% decrease in medical costs, and a 28% decrease in ED visits.

CONCLUSIONS: The IOC was associated with significant reductions in health care costs and utilization among medically and behaviorally complex adults. Scalable interventions such as an IOC may help improve care coordination and reduce costs for high-risk Medicaid populations.

PMID:42640209 | DOI:10.37765/ajmc.2026.89915

Am J Manag Care. 2026 Jul;32(7):392-395. doi: 10.37765/ajmc.2026.89983.

ABSTRACT

OBJECTIVES: The glucagon-like peptide-1 receptor agonist (GLP-1 RA) semaglutide has several branded versions, including Wegovy, which was initially approved for chronic weight management. In March 2024, the FDA expanded Wegovy’s indications to include reducing cardiovascular events in patients with overweight or obesity and cardiovascular disease. That same month, Medicare Part D expanded coverage for this indication. Evidence is lacking on how these policy changes have affected the utilization of Wegovy and other semaglutide products.

STUDY DESIGN: Retrospective analysis of monthly semaglutide fills in the US before and after expanded FDA indications and Medicare coverage.

METHODS: IQVIA National Prescription Audit PayerTrak data were used to assess temporal trends in semaglutide utilization by brand and payer between September 2023 and September 2024. Additionally, linear segmented regression was used to identify the number of additional fills associated with the FDA and Medicare policy changes.

RESULTS: Total semaglutide utilization increased during the study period, with Wegovy showing the largest relative increase compared with the prepolicy period (136.4%) among all semaglutide products. The greatest increase in relative utilization by payer was for Wegovy purchased through Medicare Part D (598.1%). Policy implementation was associated with an estimated 592,624 additional Wegovy fills by September 2024.

CONCLUSIONS: Expanded FDA indications and Medicare coverage of semaglutide for cardiovascular risk prevention were associated with increased Wegovy utilization, most notably through Medicare Part D. These policies may serve as a template for improving access to semaglutide and other GLP-1 RAs as the clinical indications for these drugs continue to expand.

PMID:42640207 | DOI:10.37765/ajmc.2026.89983

Am J Manag Care. 2026 Jul;32(7):380-382. doi: 10.37765/ajmc.2026.89982.

ABSTRACT

OBJECTIVES: We investigated the timing of supplemental indications and characteristics of those approved after 9 years (small molecules) or 13 years (biologics) post initial approval across all therapeutic areas.

STUDY DESIGN: Using FDA databases, we identified small molecule drugs (n = 97) initially approved between 2004 and 2015 and biologics between 2004 and 2011 (n = 21), allowing for at least 9 and 13 years of follow-up, respectively.

METHODS: We reviewed drug labels as of 2024 to identify supplemental indications. We characterized supplemental indications approved at least 9 or 13 years post approval in several ways: by FDA expedited review pathway, whether they had orphan designation, whether they were approved for pediatric or geriatric populations, and their therapeutic class. We calculated the mean time between consecutive indications for small molecules and biologics.

RESULTS: Overall, 24.0% of small molecule supplemental indications were approved at least 9 years post approval, and 10.0% of biologic supplemental indications were approved at least 13 years post approval. Of the supplemental indications approved (whether for small molecules or biologics) at least 9 or 13 years after initial approval, 56.9% received at least 1 FDA expedited review, 39.2% had orphan status, 49.0% were approved for pediatric use, and 62.7% were approved for older adults. The mean time between consecutive indications was longer for small molecules than for biologics (4.0 vs 3.3 years).

CONCLUSIONS: Additional drug indications approved after 9 years for small molecules and 13 years for large molecules are not uncommon. Many of these later-approved indications receive expedited or orphan designation and target populations with high unmet medical needs.

PMID:42640206 | DOI:10.37765/ajmc.2026.89982

Am J Manag Care. 2026 Jul;32(7):376-379. doi: 10.37765/ajmc.2026.89931.

ABSTRACT

Cancer screening in the US is at a critical juncture, facing an urgent need to shift from a focus on initial test uptake toward a mandate for complete diagnostic resolution. Historically, quality metrics have prioritized the singular event of a recommended test over the necessity of diagnostic resolution. Financial barriers, administrative blind spots in quality metrics, and the “Medicare 5-star paradox” have created a screening purgatory in which patients with abnormal findings are frequently left without a definitive diagnosis. Although the Affordable Care Act successfully increased access to initial screening tests by eliminating cost sharing for insured individuals, it historically left subsequent diagnostic pathways financially unprotected, contributing to late-stage diagnoses despite the availability of effective tools. This commentary explores the systemic failures of current Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare Star Ratings metrics that continue to reward test volume while neglecting the consequences for health equity, cancer prevention, and patient survival. We review key regulatory shifts, including new 2026 federal mandates for first-dollar coverage of diagnostic follow-up for breast and cervical cancers, while noting that significant gaps remain for lung cancer screening and clinical navigation. Additionally, we highlight the potential of the 2025 HEDIS measure for breast cancer follow-up after abnormal mammogram and the proposed 2027 HEDIS measure for colorectal cancer follow-up to serve as a nascent model for aligning quality with timely resolution. Finally, we emphasize the importance of physician leadership, advocacy, and universal diagnostic closure in ensuring that screening fulfills its lifesaving potential. Aligning quality metrics with the entire screening continuum is essential to moving beyond the “easy screen” toward a system that preserves patient-centered outcomes and reduces avoidable cancer mortality.

PMID:42640205 | DOI:10.37765/ajmc.2026.89931

Ir Med J. 2026 Aug 20;119(7):128.

ABSTRACT

AIM: To design, implement, and evaluate a consultant-led Comprehensive Geriatric Assessment (CGA) service within an Irish private acute hospital, where structured geriatric models are not routinely embedded. The study examined the early operational and clinical impact of the service on care delivery for hospitalised adults aged ≥75 years.

METHODS: A retrospective service-improvement audit was conducted involving 50 consecutive inpatients aged ≥75 years admitted to acute medical wards following introduction of a consultant-led geriatric service. Data were extracted from electronic health records using a structured audit tool aligned with the Health Service Executive (HSE) Model of Care for Older People, National Clinical Programme for Older People (NCPOP) quality standards, and the British Geriatrics Society Silver Book II. Primary outcomes were (1) time to first geriatric review and (2) proportion of patients reviewed within 48 hours. Secondary outcomes included multidisciplinary team (MDT) involvement, length of stay (LOS), discharge destination, and 30‑day readmission. Post‑implementation outcomes were descriptively compared with aggregated hospital activity data from the 12 months preceding service introduction.

RESULTS: The mean age of patients was 82.6 years (SD 5.1), and 29 (58%) were female. The median time to first geriatric review was 29 hours, with 42 (84%) patients assessed within 48 hours of admission. MDT involvement was documented in 35 (70%) patients, compared with an estimated pre-implementation baseline of 22 (45%). The mean length of stay was 6.8 days, compared with a historical institutional estimate of 8.7 days derived from pre-service hospital activity data, representing an approximate 22% reduction. Discharge directly home occurred in 33 (66%) patients, while 5 (10%) were readmitted within 30 days. Staff survey responses (50) demonstrated high awareness of the service among 44 (88%) respondents and a perceived improvement in discharge coordination in 41 (82%).

CONCLUSIONS: Introduction of a dedicated geriatric service in a private acute Irish hospital was associated with earlier specialist review, high multidisciplinary engagement, and favourable discharge outcomes. These findings support further development of CGA-aligned services within the private healthcare sector.

PMID:42640196

Radiology. 2026 Aug;320(2):e250278. doi: 10.1148/radiol.250278.

ABSTRACT

Background Differentiating benign from malignant soft tissue tumors (STTs) remains challenging, and conventional US alone is often insufficient. This study evaluated whether elastography and microvascular imaging improve diagnostic accuracy. Purpose To assess the ability of US techniques-B-mode US, shear-wave elastography (SWE), and superb microvascular imaging (SMI)-to discriminate benign from nonbenign STTs. Materials and Methods This tertiary referral center retrospective diagnostic accuracy study included consecutive patients with STTs referred for biopsy between February 2022 and July 2023. B-mode US features were recorded, including largest diameter (LD), deepest diameter (DD), DD-to-LD ratio, and SWE and SMI values. Histologic examination served as the reference standard. Receiver operating characteristic curves were used to evaluate predictions from single-variable and multivariable logistic regression models, including age and imaging-derived variables. The area under the curve (AUC) was used to summarize performance. Results A total of 167 lesions from 167 patients (mean age, 59.3 years ± 13.8 [SD]; 88 women) were included. Mean SWE and SMI values were higher in nonbenign than in benign STTs (SWE value, 4.00 m/sec vs 2.65 m/sec; SMI value, 31.5% vs 6.2%; both P < .001). DD and DD-to-LD ratio also differed between benign and nonbenign lesions (mean DD, 2.55 cm vs 4.57 cm; DD-to-LD ratio, 0.37 vs 0.51; both P < .001). Receiver operating characteristic analysis revealed AUCs of 0.82 (95% CI: 0.73, 0.92) for SMI and 0.75 (95% CI: 0.66, 0.85) for SWE. SMI sensitivity and specificity were 71% (22 of 31; 95% CI: 55, 87) and 87% (94 of 108; 95% CI: 81, 93), respectively; SWE sensitivity and specificity were 75% (24 of 32; 95% CI: 60, 90) and 71% (89 of 126; 95% CI: 63, 79). Combining LDs and DDs with SWE and SMI improved AUC to 0.87. Conclusion SWE and SMI improved diagnostic accuracy in evaluating STTs. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Lee and Stewart in this issue.

PMID:42640188 | DOI:10.1148/radiol.250278

Radiology. 2026 Aug;320(2):e253352. doi: 10.1148/radiol.253352.

ABSTRACT

Background Radiologists face substantial malpractice risk. Prior studies based on surveys or legal databases may not reflect national trends. National-scale analyses using objective data remain limited. Purpose To compare radiology malpractice claims with those from other specialties, identify predictors of higher indemnity payments, and assess temporal and regional litigation trends using the National Practitioner Data Bank. Materials and Methods This retrospective study analyzed all physician malpractice payments in the National Practitioner Data Bank from September 1990 to December 2024. Radiology malpractice cases across the United States were identified on the basis of coded allegations involving imaging errors. Comparative statistical analyses were performed across patient, malpractice case, physician, and U.S. state variables. Temporal and regional payment trends were assessed relative to radiologist employment and compensation. State-level analysis examined reform status at the time of each malpractice event, and multivariable logistic regression identified factors associated with higher payments. Results This study included 399 568 malpractice cases involving 229 276 physicians (mean age ± SD, 44 years ± 10.9, sex not reported). Diagnostic errors accounted for 71.3% of radiology claims versus 27.6% of claims in other specialties (P < .001). Radiology malpractice cases more often involved outpatient care (50.5% vs 20.6%; P < .001) and severe outcomes (64.2% vs 32.3%; P < .001). On multivariate analysis, severe patient outcome (odds ratio, 8.64; P < .001) and malpractice cases after 2010 (odds ratio, 2.23; P < .001) predicted higher indemnity payments. The presence of noneconomic damage reform laws and insurer-paid claims were associated with lower payments (both P < .05). Recent cases (2010-2025) versus earlier cases (1990-2010) had higher payments (mean ± standard error, $344 197 ± 12 802 vs $184 000 ± 9873; P < .001) and fewer filings from states with noneconomic damages reform (P < .001) and joint liability reform (P = .007). Conclusion Radiology malpractice cases, compared with other specialties, more frequently involved diagnostic errors, severe patient outcomes, outpatient settings, and higher indemnity payments, and these trends increased over time and varied by state legal environment. © RSNA, 2026.

PMID:42640185 | DOI:10.1148/radiol.253352

Chaos. 2026 Aug 1;36(8):083149. doi: 10.1063/5.0332883.

ABSTRACT

The dynamic model that couples micro- and macro-level factors holds significant importance for studying diseases with long incubation periods, which also presents a major challenge in multiscale modeling. Based on the nested models, we propose a multiscale model with bidirectional coupling between population-level transmission and within-host viral progression, by including the feedback from the population scale to the individual scale mediated by perceived disease-induced mortality and its effect on treatment adherence. Suppose a saturating incidence and a linear mortality law, we rigorously analyze the dynamics of the proposed system and reveal multiple endemic equilibria and local bifurcations (backward, fold, and Hopf). Numerical continuation further identifies codimension-two organizing centers (Bogdanov-Takens points) and global bifurcations, including homoclinic bifurcations and fold bifurcations of limit cycles. These give rise to parameter regions exhibiting two distinct forms of bistability: the coexistence of two equilibria and the coexistence of an equilibrium with a stable periodic orbit. By contrast, a corresponding unidirectional model exhibits comparatively simple dynamics and predicts that sufficiently high drug efficacy alone will achieve elimination. The bidirectional model, however, yields richer asymptotical and transient behavior and indicates that population-level eradication generally requires simultaneous, substantial improvements in both drug efficacy and medication adherence. These findings show that the multiscale model with bidirectional coupling can change epidemic outcomes and produce more realistic predictions for control of chronic infections.

PMID:42640183 | DOI:10.1063/5.0332883

Chaos. 2026 Aug 1;36(8):083150. doi: 10.1063/5.0340300.

ABSTRACT

We investigate how stochastic Poisson impulsive forcing influences the spatiotemporal dynamics of a two-dimensional network of Hindmarsh-Rose neurons. Unlike continuous noise, impulsive forcing introduces discrete, state-dependent perturbations, making the system response highly sensitive to both the statistics and the spatial structure of the input. In most of the parameter space, stochastic impulses destabilize the initial coherent spiral-wave regime and lead to unstable spiral-wave activity. At the same time, they can also produce constructive effects. Both spatially uniform and spatially non-uniform forcing induce stable target waves that are absent in the autonomous system, suggesting a common mechanism of structure formation driven by discrete excitation events. In addition, spatially uniform forcing suppresses spatial heterogeneity and leads to coherent, nearly synchronous oscillations, demonstrating that even random impulses can promote global synchronization. By contrast, spatially uncorrelated forcing enhances front fragmentation and incoherence, especially at higher amplitudes. To identify and compare the resulting regimes in a highly multistable parameter space, we use a feature-based clustering approach based on statistical descriptors of wave morphology and evolution across multiple time scales. This results in a clear separation of physically distinct regimes. Overall, stochastic Poisson impulses serve not only as a source of disorder but also as an effective control mechanism for destabilizing, reorganizing, and synchronizing collective wave dynamics in networks of coupled neuronal oscillators.

PMID:42640182 | DOI:10.1063/5.0340300

Ir Med J. 2026 Aug 20;119(7):126.

ABSTRACT

AIMS: To evaluate whether school-located influenza vaccination (SLIV) improves uptake and to assess parental attitudes in two primary schools.

METHODS: A post-season questionnaire was distributed to parents following GP-led SLIV clinics in 2024/25 assessing uptake, reasons for non-vaccination and attitudes using 5-point Likert scales and free-text responses. 66 of 67 responses (98.5%) were analysed.

RESULTS: The survey was issued to 201 eligible schoolchildren across two rural primary schools. There were 66 responses (33%). Of respondents, 32 (48.5%) children were vaccinated; 22 (33%) in school and 10 (15%) elsewhere. Parents rated clarity of information regarding vaccination highly, with 52 (80%) reporting information received as clear or very clear. Parents were more likely to vaccinate when SLIV was available, with 34 (52%) reporting that they were likely or very likely to vaccinate, rising to 29 (91%) among those vaccinated this year. The most common reasons for declining were belief the vaccine was unnecessary (21/34, 62%) and safety concerns (9/34, 26%).

DISCUSSION: SLIV improved uptake relative to national and local averages and was generally well received. Attitudinal barriers, especially perceptions of low necessity and safety concerns, remain the primary obstacles. Expanding SLIV alongside stronger public health messaging may offer a scalable strategy to increase uptake.

PMID:42640173