Notice of Retraction and Replacement: Colla et al. Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries. JAMA Internal Medicine. 2016;176(8):1167-1175 To the Editor We write to report and explain errors that occurred in the Original Investigation, titled “Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries,”1 that was published online on June 20, 2016, and in the August 2016 issue of JAMA Internal Medicine. The article reported the results of a cohort study designed to estimate the association between Medicare accountable care organization (ACO) contracts with spending and high-cost institutional use for the overall Medicare population and a clinically vulnerable subgroup of Medicare beneficiaries from January 2009 through December 2013. The main outcome measures of our study were total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care–sensitive admissions, and 30-day readmissions. We determined that the Medicare ACO programs were associated with modest reductions in spending and use of hospitals and emergency departments and that savings were realized through reductions in use of institutional settings in clinically vulnerable patients. After our article was published, the Centers for Medicare & Medicaid Services (CMS) Research Data Assistance Center informed us that there were errors in the Medicare Shared Savings Program provider files, which we had used to determine attribution of Medicare beneficiaries to physician practices. The CMS issued corrected versions of the files, and we used these corrected files to rerun attribution across the 5-year study period and reestimated the main models. This reanalysis results in corrections to the data reported in our article. The corrections have yielded similar overall findings that Medicare ACO programs were associated with modest reductions in spending and use of hospitals and emergency departments. However, there are some important changes to some of the specific results: • There is no reduction in emergency department visits in the clinically vulnerable cohort. • There is no reduction in skilled nursing facility spending in the overall Medicare cohort. • In both cohorts, there is now a small but statistically significant increase in 30-day readmissions. • Spending did not vary monotonically with length of ACO implementation. • The difference between mean spending in the ACO group and the control group is larger. Thus, we have requested that our article be retracted and replaced with the correct data and findings. The replacement article has corrected data and information in the abstract, text, Tables, Figures, and eFigures in the online supplement. We regret any confusion the errors in the CMS data may have caused the readers and editors of JAMA Internal Medicine. The abstract, text, Tables, Figures, and eFigures in the original article have been corrected and replaced online.1 An additional online supplement has been added that includes a version of the original article with the errors highlighted and a version of the replacement article with the corrections highlighted.

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撤回和更换通知：Colla 等人。医疗保险责任医疗组织实施与临床弱势受益人支出之间的关联。JAMA内科。2016;176(8):1167-1175

撤回和更换通知：Colla 等人。医疗保险责任医疗组织实施与临床弱势受益人支出之间的关联。JAMA内科。2016;176(8):1167-1175 致编辑 我们写信报告并解释原始调查中出现的错误，标题为“医疗保险责任医疗组织实施与临床弱势受益人支出之间的关联”1，该调查在线发表于2016 年 6 月 20 日，以及 2016 年 8 月号的 JAMA Internal Medicine。这篇文章报道了一项队列研究的结果，该研究旨在估计 2009 年 1 月至 2013 年 12 月期间医疗保险责任医疗组织 (ACO) 合同与医疗保险总体人口和医疗保险受益人临床弱势亚群的支出和高成本机构使用之间的关系. 我们研究的主要结果指标是每个受益人季度的总支出、支出类别、医院和急诊科的使用、门诊护理敏感入院和 30 天再入院。我们确定，Medicare ACO 计划与医院和急诊科的支出和使用量的适度减少有关，并且通过减少对临床弱势患者的机构设置的使用来实现节省。我们的文章发表后，医疗保险和医疗补助服务中心 (CMS) 研究数据协助中心通知我们，医疗保险共享储蓄计划提供者文件中存在错误，我们曾使用这些文件来确定医疗保险受益人对医生实践的归属。CMS 发布了文件的更正版本，我们使用这些更正的文件在 5 年研究期间重新运行归因并重新估计主要模型。这种重新分析导致对我们文章中报告的数据的更正。这些更正产生了类似的总体调查结果，即医疗保险 ACO 计划与医院和急诊科的支出和使用的适度减少有关。然而，一些具体结果有一些重要变化： • 临床易感人群的急诊就诊次数没有减少。• 在整个医疗保险队列中，熟练护理设施的支出没有减少。• 在这两个队列中，现在 30 天再入院人数略有增加，但具有统计学意义。• 支出不会随着ACO 实施的时间而单调变化。• ACO 组和对照组的平均支出之间的差异更大。因此，我们要求撤回我们的文章，并用正确的数据和调查结果替换。替换文章已更正在线补充中的摘要、文本、表格、图表和电子图表中的数据和信息。对于 CMS 数据中的错误可能给 JAMA Internal Medicine 的读者和编辑造成的任何混淆，我们深表歉意。原文章中的摘要、正文、表格、图表和电子图表已在线更正和替换。