Penn LDI Small Grants Program
Annually, Penn LDI provides small grant funding for early-stage investigations that would otherwise not qualify for larger NIH or other institutional grants. In 2024, 12 Fellows have been awarded pilot grants for research projects across a range of topics involving the cost, access, quality, and equity of health care. Below are the researchers and their projects.
Assessing Organizational Capacity for a Suicidal Behavior Intervention in Emergency Department Settings for Victims and Perpetrators of Intimate Partner Violence
Principal Investigator: Millan AbiNader, PhD, MSW | School of Social Policy & Practice
As many as 6-7% of suicides occur in the context of intimate partner violence (IPV). Female emergency department patients with an IPV history report suicidal behaviors at more than six-times the rate of those without a victimization history, and IPV perpetrators account for the majority of IPV-related suicides. Importantly, there is currently no hospital-based intervention to treat suicidal behaviors and IPV as comorbidities in either victims and perpetrators of IPV. To address this gap, we will undertake a pilot project that assesses the capacity of Penn’s health care system to track and address these issues. This research will result in preliminary data to inform the development of an intervention for responding to IPV-SIB cases for practitioner use in hospitals and provide preliminary data for proposals for external funding.
Application of the New Global Definition of ARDS and Assessment of ICU Net Benefit in a Resource-Limited Setting: The South Africa Intensive Care Unit Capacity Strain (SAICU-Strain) Study
Principal Investigator: George Anesi, MD, MSCE | Perelman School of Medicine
The South Africa Intensive Care Unit Capacity Strain (SAICU-Strain) Study is a >8,000-patient two-site cohort study of critical care delivery and outcomes and capacity strain in the South African public health system and a longitudinal collaboration between Penn Medicine and the KwaZulu-Natal Department of Health. We propose two new specific aims. Specific Aim 1 will examine the epidemiology and outcomes of acute respiratory distress syndrome (ARDS) in the South African public health system deploying the 2023 New Global Definition of ARDS. Further validation of the new Global Definition of ARDS will provide growing confidence for adoption of this updated definition and allow for broader application in resource-variable settings. Specific Aim 2 proposes to measure the net benefit of ICU admission among patients referred for critical care in the South African public health system. A finding of ICU net benefit would be a powerful data-driven argument for augmenting critical care capabilities in the South African public health system.
Identifying Meaningful Outcome Metrics in Severe Brain Injury
Principal Investigator: Catherine Auriemma, MD, MSHP | Perelman School of Medicine
Co-Investigator: Christopher Chesley, MD, MSCE | Perelman School of Medicine; David Fischer, MD | Perelman School of Medicine
Neuroprognostication for patients who have experienced a brain injury, such as after cardiac arrest or trauma, is critical. Predictions of an “unfavorable” recovery frequently result in withdrawal of life-sustaining treatment (LST), and therefore death. Most studies equate any degree of functional dependence as “unfavorable”, despite data that many functionally dependent survivors of coma report favorable quality of life, and that acceptability of dependence may differ across racial groups. The potential consequences of this oversimplified, and perhaps biased, interpretation of acceptable outcomes are profound, as they may result in inappropriate continuation or withdrawal of LST and thus avoidable morbidity and mortality. In this project, we will use surveys and semi-structured interviews to investigate the attitudes and preferences of patients and their families around acceptable outcomes after brain injury. We will further explore how these preferences may vary with respect to patient race. These results will inform future prognostication research, clinical practice, and health policy.
Access to Elective Surgery in the United States: Evidence from the Outpatient Surgery Market
Elective surgeries comprise a majority of all surgeries in the United States at substantial cost to the health care system. These surgeries are shifting from inpatient to outpatient settings due to factors such as advancements in surgical techniques, technology, and processes accelerated by the COVID-19 pandemic. The impact of this shift on patient access to care is unclear. This project aims to investigate the underlying mechanisms—such as cost, geographic proximity, and convenience—that affect patient access to elective surgery by leveraging two Centers for Medicare and Medicaid Services (CMS) policies.
Between Value and Recovery in Surgical Critical Care: Charting New Directions for Health System Success
Principal Investigator: Justin Clapp, PhD, MPH | Perelman School of Medicine | School of Arts and Sciences
Co-Investigators: Meghan Lane-Fall, MD, MSHP | Perelman School of Medicine; Ross Perfetti, MSc | School of Arts & Sciences
Calibrating ICU practices to measures of value should, in theory, help critical care achieve patients’ desired outcomes. However, several puzzles remain about what outcomes should be measured and when they should be assessed. The purpose of this project is to evaluate gaps between what patients want for their own recoveries from critical illness and what current value metrics assess, as defined by clinical and operational stakeholders. Patients who survive serious illness and injury are often afflicted by long-term complications of critical care interventions. We use ethnographic methodology to understand how patients and their families experience these impacts of critical illness and define recovery in their own terms. Then, we compare those data to outcome measures, describing differences between what patients desire for their long-term health and what is currently measured. Results from this pilot study will establish new directions for critical illness outcomes research and value-based incentives.
Abortion Access for Active Duty Service Women
Principal Investigator: Caitlin Clason, PhD, MBE | Perelman School of Medicine
Co-Investigators: Marilyn Schapira, MD, MPH | Perelman School of Medicine; Julie Sochalski, PhD, RN | Penn Nursing; Laura Manzo, MAJ, RN
Following Dobbs v. Jackson, nearly 80,000 service women are assigned to states with abortion bans, leaving 40% of active duty women with no or severely restricted access to abortion care. These women are subject to the Hyde Amendment which only pays and permits the use of military medical facilities for abortion in cases of rape, incest, or if the mother’s life is in danger. In October 2022, the Department of Defense passed an unprecedented policy to assist women seeking abortion care. This policy provides mandatory time-off and compensation for travel costs for any elective abortion. The purpose of this study is to assess the barriers and facilitators service women currently experience while trying to obtain abortion care. The findings will inform policy makers as they continue trying to ensure access to safe and timely abortion care for service women.
Developing a Protocol for Postpartum Hypertension Screening in Ambulatory Infant Care Settings
Principal Investigator: Emily Gregory, MD, MHS | Perelman School of Medicine
Co-Investigators: Mario DeMarco, MD, MPH | Perelman School of Medicine; Adi Hirshberg, MD; Rebecca Clark, PhD, RN | Penn Nursing
Blood pressure changes related to pregnancy are a leading cause of maternal morbidity and mortality. These changes can emerge or worsen after pregnancy. Because of this, the American College of Obstetrics and Gynecologists recommends universal blood pressure evaluations at approximately 7 – 10 days postpartum. During this time frame, many postpartum individuals attend infant ambulatory visits. While there has been increased interest in delivering maternal health services through infant visits, existing models do not incorporate blood pressure screening. Barriers include perceived safety and feasibility, which may be addressed by clear protocols and referral pathways. We will (1) develop a protocol for postpartum blood pressure screening in ambulatory infant care settings, drawing on expert input from across the city of Philadelphia, and including interprofessional perspectives from obstetrics, pediatrics, adult care, and (2) test the protocol for feasibility and acceptability.
The Influence of Nursing Resources on Mortality Among Hospitalized Racial and Ethnic Minorities Diagnosed with Chronic Kidney Disease
Chronic Kidney Disease (CKD) is a global public health problem, marked by notable disparities among racial and ethnic minorities. Hispanic and Black patients have a higher likelihood of CKD diagnosis, increased rates of hospitalizations, and suboptimal outcomes during and after hospitalization. These disparities may stem, in part, from differences in hospital quality where they receive care. One important aspect of hospital quality is care received by registered nurses. Existing literature links nurse staffing levels and the hospital work environment to patient mortality outcomes, particularly for racial and ethnic minorities. This study leverages unique survey data from over 16,000 hospital nurses, to identify if this relationship also exists among minority CKD patients. Given the prevalence, high mortality, and significant disparities associated with CKD, understanding how nursing influences outcomes in this population will support efforts to ensure equitable allocation of health care resources and proposed nurse staffing legislation across the United States.
Quality in Vertical Markets: FDA Oversight of Generic Drugs
Principal Investigator: Catherine Ishitani | The Wharton School
Generic pharmaceuticals have brought transformative medicines to millions in the U.S. and globally. Each month, 50% of American adults consume one or more generics, which are typically priced 80-85% lower than branded drugs. The benefits of generics, however, are threatened by the increasing unreliability of their supply. 2023 reported near record drug shortages, including of fourteen critical chemotherapies, proximally caused by low manufacturing quality. Optimal generic regulation trades-off between improving drug quality and reducing patient access to drugs. This project will provide one of the first empirical assessments of generic quality and access, and their effects on patient adherence and health. Is generic reliability too low, and what policies might improve it? Using variation in FDA enforcement timing and novel quality data, I will quantify the effects of different policy mechanisms on generic quality, access, and patient adherence, and simulate patient welfare under counterfactual policies.
Engaging the Other Half of the Equation: Emergency Contraception & Male Adolescents
Principal Investigator: Erin Sieke, MD, MS | Children’s Hospital of Philadelphia
Co-Investigators: Cynthia Mollen, MD, MSCE | Perelman School of Medicine; Sarah Wood, MD, MSHP | Perelman School of Medicine; Melissa Miller, MD
The teen birth rate in the United States is higher than in other industrialized countries, and the vast majority of births in this age group are unplanned. Although most interventions targeting adolescent pregnancy have focused on females, males also have a role in pregnancy prevention. One step that male adolescents can take to prevent unintended pregnancy is to discuss emergency contraception (EC) with their partner(s). However, little is known about adolescent male knowledge, attitudes, and beliefs towards EC. For many adolescents, the emergency department (ED) is their only contact with the health care system, highlighting the possible value of the ED as a venue for EC counseling and prescription. We will use a mixed-methods study assessing male adolescent and pediatric ED provider perspectives on EC counseling and prescription in the ED to inform future interventions that engage adolescent males to reduce unintended adolescent pregnancy.
Optimizing Outcomes for Patients with Pregnancy Loss: A Hybrid Type III Implementation-Effectiveness Study
Principal Investigator: Sarita Sonalkar, MD, MPH | Perelman School of Medicine
Co-Investigators: Rachel McKean, MD, MPH
The provision of equitable, evidence-based health care to women during pregnancy is imperative. This research focuses on the quality of care provided to pregnant women experiencing previable rupture of membranes in the second trimester, a diagnosis that often requires women to make the difficult decision to terminate their pregnancy in order to prevent serious maternal morbidity. The management of this condition varies greatly depending on location of care and services available. My research will further examine the care provided at multiple hospitals across the Penn Medicine network and look for opportunity to improve care through qualitative interviews with key stakeholders. This research will help to elucidate the care being currently provided and to identify the barriers and facilitators that will be important for the implementation of an evidence-based management protocol. We will additionally evaluate clinical outcomes resulting from a revised management protocol.
Scaling Up Low Barrier Wound Care Services for People Who Use Drugs
Principal Investigator: Eleanor Turi, PhD, RN | Perelman School of Medicine
Co-Investigators: Shoshana V. Aronowitz, PhD, MSHP, FNP-BC | Penn Nursing; Amanda Bettencourt, PhD,
APRN, CCRN-K, ACCNS-P | Penn Nursing; Rachel McFadden, MPH, BSN, RN, CEN
There is high demand for wound care among people who use drugs (PWUD). The demand for care has exacerbated recently due to the presence of xylazine in the street opioid supply. Community-based providers have found that wounds among PWUD can be responsive to a few weeks of consistent treatment in low barrier settings, defined as care settings with flexible hours and harm reduction approaches. Yet, the current supply of low barrier care does not meet the demand. There are increasing hospital and emergency department visits among PWUD for unmanaged wounds. The purpose of this study is to explore barriers to, facilitators of, and strategies for scaling up low barrier wound care services. We will conduct qualitative interviews and community advisory board meetings with low barrier wound care providers, administrators, and clinical recovery specialists. The findings will inform implementation strategy testing to improve access to low barrier wound care for PWUD.