ArticleJAMA health forum2026
Institutional Special Needs Plans and End-of-Life Outcomes for Nursing Home Residents With Dementia.
Article in JAMA health forum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Error in Table 3.JAMA health forum · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
10 authors.
Funding
Abstract
Importance: Nursing home residents with dementia are often unnecessarily hospitalized at the end of life. Institutional Special Needs Plans (I-SNPs) are a type of Medicare Advantage plan for long-term nursing home residents that use advanced practice clinicians to manage care. Studies have demonstrated the effectiveness of the original and largest I-SNP operated by UnitedHealthcare (UHC), but there has been minimal evaluation of non-UHC I-SNPs, which have driven recent growth, nor specific focus on end-of-life outcomes. Objective: To examine the association of I-SNP enrollment with end-of-life outcomes for nursing home residents with dementia, separately for UHC and non-UHC I-SNPs. Design, Setting, and Participants: This retrospective cohort study used 2010 to 2022 Medicare data on 1.4 million long-stay nursing home residents with dementia who died between 2013 and 2022. Facility-level and patient-level selection bias were addressed with cross-temporal propensity score matching and difference-in-differences models. Both the direct effects of I-SNP enrollment, as well as the indirect (ie, spillover) effects on nonenrollees residing in nursing homes offering I-SNPs were assessed. Variation in these relationships by I-SNP maturity was also examined. Data were analyzed from November 2024 to April 2026. Exposure: Four I-SNP exposure categories: UHC I-SNP enrollment and spillover; non-UHC I-SNP enrollment and spillover. Main Outcomes and Measures: Hospitalization and hospice use in the last month of life. Results: The study cohort included 1 415 265 long-stay nursing home residents with dementia who died between 2013 and 2022. The unadjusted hospitalization rate in the last 30 days of life was 27.7%. UHC I-SNP enrollment was associated with a 9.0-percentage point (pp) reduction in hospitalization (95% CI, -10.3 pp to -7.7 pp) while non-UHC I-SNP enrollment was associated with a 5.9-pp reduction (95% CI, -8.4 pp to -3.5 pp). The spillover effect on nonenrollees in nursing homes offering a UHC I-SNP was a 1.7-pp (95% CI, -2.4 pp to -1.1 pp) decline in hospitalizations; the spillover effect in non-UHC nursing homes was not statistically significant. Similar trends appeared with hospitalization in the last 3 days of life, intensive care unit admission, and mechanical ventilation, but there was no association with hospice use. The reduction in hospitalizations increased in the 3 years after nursing home I-SNP adoption, then plateaued. Conclusions and Relevance: In this retrospective cohort study, I-SNP enrollment was associated with significantly fewer hospitalizations for nursing home residents with dementia at the end of life, with effect sizes larger for UHC vs non-UHC I-SNPs. Plan maturity and volume are likely important factors impacting success.
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