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End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations
Zhang JJ, Reuben DB, Walling AM, Zingmond DS, Damberg CL, Wenger NS, Xu H, Ikesu R, Kaneshiro GS, Klomhaus A, et al.. JAMA Health Forum, 2025-05-02
Topic: Risk, prevention and care in population studies
Results Of 162 034 eligible Medicare beneficiaries (mean [SD] age, 85.0 [7.9] years; 94 304 female [58.2%]), 51 191 (31.6%) were attributed to MSSP ACO. Sensitivity analyses using inverse probability weighting yielded similar results.
Key findings
- Results Of 162 034 eligible Medicare beneficiaries (mean [SD] age, 85.0 [7.9] years; 94 304 female [58.2%]), 51 191 (31.6%) were attributed to MSSP ACO.
- Sensitivity analyses using inverse probability weighting yielded similar results.
Why it matters
This study looked at Medicare beneficiaries with dementia in accountable care organizations, including 51,191 attributed to the MSSP ACO out of 162,034 eligible beneficiaries. The available summary does not report findings on end-of-life care or health care spending outcomes.
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Study details
- Study designcohort
- Participants162,034
- Effect sizeHospice use difference -0.4 percentage points (95% CI -1.4 to 0.5); last-6-months spending -$632 (95% CI -$1,377 to $113)
- Evidence strengthModerate
Limitations
Quasi-experimental rather than randomised; ACO attribution can change year to year; claims capture billed advance care planning, not conversations that were not billed; fee-for-service only.
How this study scored 54/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 53 of the 98 points we could judge it on, which is 54 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JAMA Health Forum) |
| Journal's citation record | 0 / 4 | JAMA Health Forum: journal h-index 60 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 162,034 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Yusuke Tsugawa: h-index 47 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, Los Angeles: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40343716) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 53 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 53 of the 98 points we could judge it on is 54 out of 100. |
| Total | 54 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1001/jamahealthforum.2025.0731
- PubMed: 40343716
- Original source →
- Free full text: PubMed Central →
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Zhang, J. J., Reuben, D. B., Walling, A. M., Zingmond, D. S., Damberg, C. L., Wenger, N. S., et al. (2025). End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations. JAMA Health Forum. https://doi.org/10.1001/jamahealthforum.2025.0731
Vancouver
Zhang JJ, Reuben DB, Walling AM, Zingmond DS, Damberg CL, Wenger NS, et al. End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations. JAMA Health Forum. 2025. doi:10.1001/jamahealthforum.2025.0731. PMID: 40343716.
BibTeX
@article{zhang2025-40343716,
author = {Zhang, J. J. and Reuben, D. B. and Walling, A. M. and Zingmond, D. S. and Damberg, C. L. and Wenger, N. S. and Xu, H. and Ikesu, R. and Kaneshiro, G. S. and Klomhaus, A. and others},
title = {{End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations}},
journal = {JAMA Health Forum},
year = {2025},
doi = {10.1001/jamahealthforum.2025.0731},
pmid = {40343716},
url = {https://doi.org/10.1001/jamahealthforum.2025.0731}
}
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