Tag: pubmed

Health Technol Assess. 2025 Jul;29(33):1-16. doi: 10.3310/GJDM0320.

ABSTRACT

BACKGROUND: In patients who require mechanical ventilation for acute hypoxaemic respiratory failure, further reduction in tidal volumes, compared with conventional low tidal volume ventilation, may improve outcomes.

OBJECTIVE: To determine whether using extracorporeal carbon dioxide removal improves outcomes in patients with acute hypoxaemic respiratory failure and is cost-effective.

DESIGN: A multicentre, randomised, allocation-concealed, open-label, pragmatic clinical trial.

SETTING: Fifty-one intensive care units across the United Kingdom.

PARTICIPANTS: Four hundred and twelve adult patients receiving mechanical ventilation for acute hypoxaemic respiratory failure, of a planned sample size of 1120.

INTERVENTIONS: Lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal for at least 48 hours (n = 202) or standard care with conventional low tidal volume ventilation (n = 210).

MAIN OUTCOME MEASURES: All-cause mortality 90 days. Secondary outcomes included ventilator-free days; adverse events; extracorporeal membrane oxygenation use; long-term mortality; health-related quality of life; health service costs; long-term respiratory morbidity.

RESULTS: The trial was stopped early because of futility and feasibility. The 90-day mortality rate was 41.5% in the extracorporeal carbon dioxide removal group versus 39.5% in the standard care group (risk ratio 1.05, 95% confidence interval 0.83 to 1.33; difference 2.0%, 95% confidence interval – 7.6% to 11.5%; p = 0.68). There were significantly fewer mean ventilator-free days in the extracorporeal carbon dioxide removal group compared with the standard care group (7.1, 95% confidence interval 5.9 to 8.3) versus (9.2, 95% confidence interval 7.9 to 10.4) days; mean difference, -2.1 (95% confidence interval -3.8 to -0.3; p = 0.02). Serious adverse events were reported for 62 patients (31%) in extracorporeal carbon dioxide removal group and 18 (9%) in the standard care group, including intracranial haemorrhage in 9 patients (4.5%) versus 0 (0%) and bleeding at other sites in 6 (3.0%) versus 1 (0.5%) in the extracorporeal carbon dioxide removal group versus the control group. Two-year mortality data were available for 95% of patients. There was no difference in the time to death between groups (hazard ratio 1.08, 95% confidence interval 0.81 to 1.44; log-rank test p = 0.61). There was no difference in long-term outcomes between groups. There was no difference in quality-adjusted life-years at 12 months (mean difference -0.01, 95% confidence interval -0.06 to 0.05). Total 12-month costs were statistically significantly higher in the extracorporeal carbon dioxide removal group (mean difference £7668.76, 95% confidence interval £159.75 to £15,177.77). Secondary analyses indicated there may be heterogeneity of treatment effect based on physiological characteristics of the patients. A systematic review supported these findings.

LIMITATIONS: Only 6% of screened patients were included in the study; most sites were naive to the intervention before the study commenced; other aspects of care were not standardised in each group, because this was a pragmatic trial; the trial may have been underpowered to detect a clinically important difference, because the trial was stopped early; blinding to the clinicians or patients was not possible.

CONCLUSIONS: There were no short- or long-term benefits found, and the device was associated with higher cost and potentially significant complications. We would advise against using this device in addition to standard care for the treatment of patients with hypoxaemic respiratory failure, outside of future clinical trials.

FUTURE WORK: Future studies could further explore whether different patient populations receiving a larger ‘dose’ of from extracorporeal carbon dioxide removal might benefit, use core outcome sets and collect broader long-term outcomes and consider measuring patients’ health-related quality of life at the soonest opportunity after regaining capacity.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 13/143/02.

PMID:40758387 | DOI:10.3310/GJDM0320

Crit Care Med. 2025 Aug 4. doi: 10.1097/CCM.0000000000006809. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether low-density lipoprotein cholesterol (LDL-C) levels, set by the balance of clearance and production, causally contribute to septic shock 28-day mortality.

DESIGN: We measured LDL-C levels and genotypes in patients with septic shock. Using Genotyping and Genome-Wide Association Study summary statistics from over 150,000 Japanese participants, we genetically predicted pre-infection LDL-C levels. Two-sample Mendelian randomization was used to assess the causal relationship between predicted pre-infection LDL-C levels and 28-day mortality. We analyzed PCSK9 and 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) genotypes to determine if LDL-C clearance or production was the underlying mechanism.

SETTING: Multicenter ICUs in Japan.

PATIENTS: Genotyped septic shock patients (n = 614).

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Predicted pre-infection LDL-C levels were much higher than directly measured LDL-C levels at the onset of septic shock (141 mg/dL vs. 40 mg/dL, p < 0.001). Two-sample Mendelian randomization revealed that high predicted pre-infection LDL-C levels were causally associated with increased septic shock 28-day mortality (hazard ratio, 2.78; p = 0.039). PCSK9 genetic variants that increase LDL-C clearance via the LDL receptor (genetically proxied PCSK9 inhibitor treatment) were associated with decreased mortality (p = 0.003) while HMGCR genetic variants that decrease LDL-C production (genetically proxied statin treatment) were not associated with decreased septic shock mortality (indeed the opposite effect was observed, p = 0.039). The two main genetic variants driving the association between high predicted pre-infection LDL-C levels and increased mortality were in apolipoprotein genes (ApoB100-rs13306206 and ApoE-rs7412), apolipoproteins involved in LDL-C binding to the LDL receptor.

CONCLUSIONS: Low LDL-C clearance explains the causal association between high genetically predicted pre-infection LDL-C levels and increased septic shock mortality. PCSK9, ApoB, and ApoE variants were identified as causal, all related to the LDL receptor or its interaction with LDL-C. Enhancing LDL receptor-mediated clearance of pathogen lipid toxins may improve septic shock outcomes.

PMID:40758386 | DOI:10.1097/CCM.0000000000006809

Int Endod J. 2025 Aug 4. doi: 10.1111/iej.70009. Online ahead of print.

ABSTRACT

AIM: To evaluate the effect of electropolishing on the mechanical properties of One RECI and One Curve mini nickel-titanium (NiTi) instruments by comparing electropolished and non-electropolished versions of each instrument type.

METHODOLOGY: Electropolished and non-electropolished One RECI (reciprocating) and One Curve mini (rotary) NiTi instruments, all manufactured with identical geometry and heat treatment, were evaluated. Instrument design was analysed by light microscopy and scanning electron microscopy, while metallurgical characterisation was performed using energy-dispersive X-ray spectroscopy (EDS) and differential scanning calorimetry (DSC). Mechanical performance was assessed through torsional resistance, bending and buckling load, surface microhardness, and cutting efficiency. Statistical comparisons were performed using the independent samples t-test or the Mann-Whitney U-test, with significance set at p < 0.05.

RESULTS: Design and metallurgical analyses confirmed that electropolished and non-electropolished instruments within each group were equivalent in terms of geometry, cross-sectional design, tip configuration, elemental composition, and phase transformation temperatures. Electropolishing significantly enhanced flexibility in both instrument types, as indicated by reduced bending loads and lower buckling resistance (p < 0.05). However, torsional strength was significantly reduced in the electropolished One RECI instruments, reflected by lower maximum torque and angle of rotation prior to fracture (p < 0.05). No significant torsional differences were observed in the One Curve mini group (p > 0.05). Surface microhardness and cutting efficiency remained unaffected by electropolishing in both systems (p > 0.05).

CONCLUSIONS: Electropolishing improved the flexibility of both One RECI and One Curve mini NiTi instruments without compromising their surface microhardness or cutting efficiency. However, its impact on torsional resistance was system-dependent, resulting in reduced strength only in the reciprocating One RECI instruments.

PMID:40758383 | DOI:10.1111/iej.70009

Crit Care Med. 2025 Aug 4. doi: 10.1097/CCM.0000000000006786. Online ahead of print.

ABSTRACT

OBJECTIVES: Delirium is a frequent complication in hospitalized patients, particularly in older adults, and is associated with significant morbidity and mortality. Acetylcholinesterase inhibitors (AChEIs) have been proposed as potential agents to reduce occurrence and severity of delirium. This study aimed to evaluate the efficacy of AChEIs for both prophylaxis and treatment of delirium in hospitalized patients.

DATA SOURCES: We searched PubMed, Embase, and Web of Science. The study was registered on PROSPERO (CRD42024563798).

STUDY SELECTION: Studies comparing AChEIs and placebo for delirium in hospitalized patients.

DATA EXTRACTION: The main outcome of interest was delirium occurrence, while secondary outcomes included duration, severity, and hospital length of stay (LOS).

DATA SYNTHESIS: Subgroup analyses were performed based on prophylaxis or treatment of delirium. Statistical analysis was performed in RStudio 4.4.0 with a random effects model, and heterogeneity was assessed with I2. Risk of Bias 2 was used for bias assessment. We screened 1306 records and included ten studies: eight studies focusing on prophylaxis after surgery and two on treatment of established delirium. A total of 731 patients were analyzed: 365 in the AChEIs group and 366 in the placebo group. AChEIs significantly reduced delirium occurrence (risk ratio = 0.68 [0.47-0.98]; p = 0.039). No significant effects were observed for delirium duration (mean difference [MD] = -0.16 d [-0.9 to 0.62 d]; p = 0.23), delirium severity (standardized mean difference [SMD] = -0.08 [-0.58 to 0.41]; p = 0.74), or LOS (MD = -0.82 d [-2.03 to 0.40 d]; p = 0.19). Subgroup analysis showed a tendency for better outcomes when AChEIs were used as prophylaxis, with a significant reduction in delirium duration in this subgroup (SMD= -0.32 [-0.56 to -0.07]; p < 0.01). No significant differences in adverse events were identified.

CONCLUSIONS: AChEIs are effective in reducing occurrence of delirium when used prophylactically in patients undergoing elective surgery. AChEIs did not significantly impact on delirium duration, severity, or hospital LOS. Further studies are needed to explore the potential benefits or harms of AChEIs in different patient populations and settings.

PMID:40758382 | DOI:10.1097/CCM.0000000000006786

JAMA Intern Med. 2025 Aug 4. doi: 10.1001/jamainternmed.2025.3306. Online ahead of print.

NO ABSTRACT

PMID:40758366 | DOI:10.1001/jamainternmed.2025.3306

JAMA Netw Open. 2025 Aug 1;8(8):e2524773. doi: 10.1001/jamanetworkopen.2025.24773.

ABSTRACT

IMPORTANCE: Restaurants are increasingly interested in capitalizing on consumer interest in environmental sustainability by marketing their products with ecolabels, which signal when foods are more environmentally sustainable. Ecolabels could improve the healthfulness of restaurant meal selections and reduce their carbon footprint, but this potential remains largely untested.

OBJECTIVE: To test whether displaying ecolabels on restaurant menus improves the healthfulness and reduces the carbon footprint of restaurant meal selections.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted online in September to October 2024. A national sample of US adults (aged ≥18 years) was recruited. Participants were randomly assigned to the ecolabel or control arm. Participants viewed a restaurant menu mimicking a popular full-service restaurant and selected items they wanted to order. Statistical analyses were based on the intention-to-treat principle.

INTERVENTIONS: In the ecolabel arm, participants viewed a menu that displayed ecolabels next to entrées and appetizers with a lower carbon footprint (ie, below the median of 1.625 kg of carbon dioxide equivalent [CO2e] emissions per item). In the control arm, participants viewed a menu that did not display ecolabels.

MAIN OUTCOMES AND MEASURES: The outcomes included overall healthfulness (assessed using Ofcom Nutrient Profiling Model scores; range: 0-100, with higher scores indicating healthier items), nutrient content, and total carbon footprint of participants’ entrée and appetizer selections and entire orders (including beverages and desserts).

RESULTS: A total of 3147 participants completed the online trial (1560 men [50%]; mean [SD] age, 34.5 [12.5] years). Participants in the ecolabel arm did not select entrées and appetizers (average differential effect [ADE], 0.45 [95% CI, -0.18 to 1.09]; P = .16; Cohen d = 0.05) or entire orders (ADE, 0.47 [95% CI, -0.09 to 1.03]; P = .10; Cohen d = 0.06) that were statistically significantly healthier compared with the selections of participants in the control arm. Participants in the ecolabel arm selected entrées and appetizers (ADE, 0.87 [95% CI, 0.12-1.62] g; P = .02; Cohen d = 0.08) and entire orders (ADE, 0.82 [95% CI, 0.07-1.56] g; P = .03; Cohen d = 0.08) with more fiber, compared with the selections of participants in the control arm, but did not select entrées and appetizers or entire orders with statistically significantly different amounts of protein, sugar, saturated fat, or calorie content. Participants in the ecolabel arm selected entrées and appetizers (ADE, -0.78 [95% CI, -1.25 to -0.32] kg of CO2e emissions; P < .001; Cohen d = -0.12) and entire orders (ADE, -0.81 [95% CI, -1.27 to -0.34] kg of CO2e emissions; P < .001; Cohen d = -0.12) with lower carbon footprints than the selections of participants in the control arm.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, menu ecolabels reduced the carbon footprint of restaurant meal selections without worsening nutritional quality. Ecolabels could be a scalable, low-cost strategy to reduce the carbon emissions of restaurant food choices.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06584539.

PMID:40758354 | DOI:10.1001/jamanetworkopen.2025.24773

JAMA Netw Open. 2025 Aug 1;8(8):e2525057. doi: 10.1001/jamanetworkopen.2025.25057.

ABSTRACT

IMPORTANCE: Alzheimer disease special care units (ASCUs) are associated with improved outcomes for residents with dementia, yet they are unavailable in most nursing homes.

OBJECTIVES: To examine racial and ethnic disparities in the availability of ASCUs and whether more generous Medicaid payments are associated with reduced disparities.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 2009-2019 Certification and Survey Provider Enhanced Reporting data and resident assessments from Medicare- and Medicaid-certified nursing homes in the US, as well as state Medicaid payment-to-cost ratios for 2019. Statistical analysis was performed from September to December 2024.

EXPOSURE: The percentages of Black residents and Hispanic residents in a facility and the state mean nursing homes’ ratio of Medicaid payment to estimated Medicaid cost of care.

MAIN OUTCOMES AND MEASURES: The main outcome was whether a nursing home had an ASCU. Multivariable logistic regression was conducted on ASCUs, and then separate logistic regressions were performed for states with different quartiles of Medicaid payment-to-cost ratios.

RESULTS: Most of the 13 229 nursing homes in the study were for profit (9561 [72.3%]) and were part of a chain (7775 [58.8%]). The overall mean (SD) Medicaid payment-to-cost ratio among all states was 0.87 (0.13) (range, 0.58-1.29). Each 1% increase in the percentage of Black residents was associated with a 0.1% decrease in the probability of having an ASCU. Compared with facilities with 0% to 0.8% of Black residents, the odds of having an ASCU were 37% lower in nursing homes with 4.3% to 15.2% Black residents (odds ratio [OR], 0.63; 95% CI, 0.53-0.74), and 45% lower in nursing homes with 15.2% or more of Black residents (OR, 0.55; 95% CI, 0.46-0.65). Compared with facilities with no Hispanic residents, the odds of having an ASCU were 27% lower in those with 3.7% or more of Hispanic residents (OR, 0.73; 95% CI, 0.62-0.86). In states with Medicaid payment-to-cost ratios between 0.58 and 0.81, nursing homes with 15.2% or more of Black residents were 68% less likely to have an ASCU (OR, 0.32; 95% CI, 0.21-0.50). This difference decreased to 45% in states with Medicaid payment-to-cost ratios between 0.82 and 0.94 (OR, 0.55; 95% CI, 0.44-0.69) and almost disappeared in states with Medicaid payment-to-cost ratios greater than 0.94 (OR, 0.86; 95% CI, 0.53-1.40). Higher Medicaid payment-to-cost ratios were not associated with reduced disparities among Hispanic residents.

CONCLUSIONS AND RELEVANCE: This cohort study of nursing homes suggests that racial and ethnic disparities in ASCU availability narrowed in states where Medicaid payment rates cover a greater share of costs. Racial disparities in specialized dementia care may be mitigated and even eliminated by more generous Medicaid payments.

PMID:40758352 | DOI:10.1001/jamanetworkopen.2025.25057

JAMA Netw Open. 2025 Aug 1;8(8):e2525064. doi: 10.1001/jamanetworkopen.2025.25064.

ABSTRACT

IMPORTANCE: Cognitive behavioral therapy (CBT) has the most empirical support for treatment of binge eating. Appetitive traits, including food responsiveness and satiety responsiveness, impact how individuals interact with the current obesogenic environment. The regulation of cues (ROC) plus behavioral weight loss (BWL) intervention was specifically developed to target food responsiveness, satiety responsiveness, and energy reduction.

OBJECTIVE: To evaluate the feasibility and efficacy of ROC+BWL and CBT over 5 months of treatment and 6 months of follow-up and to explore whether clinical binge eating was a moderator of outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from March 2019 to April 2023 among veterans at a university clinic. Eligible participants were veterans who met criteria for Binge Eating Disorder (BED) or subthreshold BED, had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45, were aged 18 to 65 years, and were free of other exclusionary criteria. Data were analyzed from January 2024 to June 2025.

INTERVENTION: The ROC+BWL intervention uniquely targets food responsiveness, satiety responsiveness, and energy reduction. CBT focuses on disrupting the dietary restraint/binge eating cycle by changing maladaptive thoughts and behaviors. Participants were randomized to receive either ROC+BWL or CBT for 5 months.

MAIN OUTCOMES AND MEASURES: The main outcomes were feasibility and change in binge eating (measured as loss of control) and body weight, assessed at midtreatment (2.5 months), posttreatment (5 months), and a 6-month follow-up (11 months).

RESULTS: A total of 1853 veterans inquired about participation and 1724 were excluded or declined to participate. The final sample included 129 veterans (mean [SD] age, 47.1 [11.3] years; 76 [59%] male; mean [SD] BMI, 34.8 [4.7]), with 63 randomized to ROC+BWL and 66 to CBT. A total of 123 veterans (95%) provided data posttreatment, and 115 veterans (89%) provided data at the 6-month follow-up. Attendance and acceptability ratings did not differ between treatments. ROC+BWL resulted in a greater reduction in risk of binge eating than CBT at midtreatment (difference in probability, -0.20; 95% credible interval [CrI], -0.30 to -0.11), posttreatment (difference in probability, -0.23; 95% CrI, -0.22 to -0.19), and at the 6-month follow-up (difference in probability, -0.21; 95% CrI, -0.21 to -0.18). ROC+BWL also resulted in greater weight loss at midtreatment (difference in BMI change, -0.68; 95% CrI, -1.23 to -0.12) and posttreatment (difference in BMI change, -0.71; 95% CrI, -1.40 to -0.01) assessments than CBT, but significant differences were no longer observed at the 6-month follow-up (difference in BMI change, -0.22; 95% CrI, -0.98 to 0.54). Results were more pronounced among veterans with BED.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial among veterans with binge eating and obesity, ROC+BWL resulted in greater decreases in binge eating compared with CBT. Although ROC+BWL resulted in greater weight loss compared with CBT during treatment, these differences were not maintained. Thus, ROC+BWL could be an alternate model to treat BED among veterans, but effects on weight need further research.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03678766.

PMID:40758351 | DOI:10.1001/jamanetworkopen.2025.25064

JAMA Netw Open. 2025 Aug 1;8(8):e2525147. doi: 10.1001/jamanetworkopen.2025.25147.

ABSTRACT

IMPORTANCE: The limited success of major depressive disorder (MDD) treatments is largely due to the disorder’s etiological and pathophysiological heterogeneity. Addressing this heterogeneity is essential for developing accurate prognostic models and personalized treatment strategies.

OBJECTIVE: To characterize MDD heterogeneity using a mechanism-first latent profile analysis based on environmental, neurostructural, and neurofunctional indicators, and to validate profiles via associations with MDD course, severity, and antidepressant treatment remission.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from 2 Canadian Biomarker Integration Network in Depression (CAN-BIND) studies: CAN-BIND-1 (2014-2017), a multicenter outpatient antidepressant trial, and CAN-BIND-4 (2015-2018), a single-site study. Data analyses were completed from February to September 2024. Participants meeting Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria for unipolar depression were included. Individuals with lifetime bipolar, psychotic, substance use disorder, acute suicidality, and neurological disorders were excluded.

EXPOSURE: In CAN-BIND-1, patients received 10 to 20 mg of escitalopram daily; nonresponders at 8 weeks received aripiprazole augmentation for 8 additional weeks. CAN-BIND-4 was observational.

MAIN OUTCOMES AND MEASURES: Primary outcomes were latent profiles derived from childhood maltreatment (CM; semistructured interview); hippocampal, amygdala, thalamus structural volume (SV); anterior cingulate thickness (image segmentation); and DMN functional connectivity (average time series of the blood oxygen level-dependent signal). Secondary outcomes included associations with MDD course, symptom severity (including anhedonia, measured using Montgomery-Åsberg Depression Rating Scale), and remission rates.

RESULTS: In a sample of 309 adults with clinical depression (mean [SD] age, 33.81 [13.17] years; 206 female [66.67%]), 4 profiles emerged: (1) low CM and high SV, (2) low CM and low SV, (3) high CM and high SV, and (4) high CM and low SV with default mode network hypoconnectivity. Profile 4 was associated with the worst course, with the highest morbidity (mean number of years of morbidity, 19.91 years; 95% CI, 12.45-20.69 years), anhedonia (mean, 10.72; 95% CI, 9.74-11.70), and lowest remission rate (mean, 21.5%; 95% CI, 17.6%-23.5%) at week 16. Profile 3 had the highest remission rates (mean, 90.9%; 95% CI, 63.4%-118.0%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 309 adults with depression, 4 latent profiles were identified. Default mode network hypoconnectivity defined profile 4, supporting its role as a key neural indicator of antidepressant response. CM was associated with both the highest and lowest remission rates, indicating it does not uniformly project negative outcomes and suggesting that neurobiological resilience in the context of childhood trauma may have contributed to more favorable clinical outcomes; further research is needed to refine clinical applications.

PMID:40758349 | DOI:10.1001/jamanetworkopen.2025.25147

JAMA Netw Open. 2025 Aug 1;8(8):e2525336. doi: 10.1001/jamanetworkopen.2025.25336.

ABSTRACT

IMPORTANCE: Enrollment in Medicare Advantage (MA) is expected to continue growing. Previous studies have examined differences in the use and quality of home health care between MA and traditional Medicare, but less is known about outcomes among patients receiving care from agencies with greater exposure to MA patients.

OBJECTIVE: To examine the association between home health agency (HHA) experience with caring for MA patients and quality of care delivered.

DESIGN, SETTING, PARTICIPANTS: This cohort study included patients continuously enrolled in MA and who received HHA care in 2019. The data analysis was performed between July 16, 2024, and January 16, 2025.

EXPOSURE: Medicare beneficiaries who received home health care from agencies with differing levels of MA specialization.

MAIN OUTCOMES AND MEASURES: Primary outcomes included hospitalizations during the HHA episode and after HHA discharge (at 30 and 90 days), length of stay, and total number of visits. Secondary outcomes included postdischarge mortality and nursing home admission. The outcomes were measured using instrumental variable analysis. The treatment variable was a continuous measure of the HHA-level share of MA patients. The instrumental variable was the differential distance from the nearest MA-specialized HHA to nearest non-MA-specialized HHA (based on the 75th percentile of the HHA-level share of MA patients from January 1 to December 31, 2019 [ie, ≥36.4%]).

RESULTS: The study included 749 719 MA patients who received HHA care in 2019 (mean [SD] age, 76.2 [10.4] years; 61.6% female; 26.3% with dual eligibility), of whom 65.4% received care from an MA-specialized HHA and 34.6% received care from a non-MA-specialized HHA. A 1-mile increase in differential distance was associated with a lower likelihood of admission to more MA-specialized HHAs (0.3 percentage points; SE, 0.015 percentage points; F statistic, 450.73). In the instrumental variable analysis, receiving care from more specialized HHAs was associated with a shorter length of stay (coefficient [SE], -15.14 [2.84] days) and fewer total HHA visits (coefficient [SE], -9.40 [1.15] visits) alongside more hospitalizations and nursing home admissions after discharge from the HHA.

CONCLUSION AND RELEVANCE: In this cohort study of MA patients who received HHA care, those receiving care from more MA-specialized HHAs had lower service use during the HHA episode, but no clear differences compared with non-MA-specialized HHAs were observed in care use after discharge. These findings are important given the costs associated with delivering HHA care and the expected growth in MA enrollment.

PMID:40758348 | DOI:10.1001/jamanetworkopen.2025.25336