Access to Care

The extent to which someone can gain access to the health care system, and the financial, social, and organizational factors that affect a person’s ability to get needed care in a timely way.

ACA Dependent Coverage & Young Adults with Cancer

Dec. 2, 2020

As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.

Surviving COVID-19 After Hospital Discharge: Symptom, Functional, And Adverse Outcomes Of Home Health Recipients

Nov. 24, 2020

Kathryn H. Bowles, Margaret McDonald, Yolanda Barrón, Erin Kennedy, Melissa O'Connor, Mark Mikkelsen

Abstract [from journal]

Background: Little is known about recovery from coronavirus disease 2019 (COVID-19) after hospital discharge.

Objective: To describe the home health recovery of patients with COVID-19 and risk factors associated with rehospitalization or death.

Design: Retrospective observational cohort.

Setting: New York City.

Participants: 1409 patients with COVID-19 admitted to home health care (HHC) between 1 April and 15 June 2020


Assessment Of 135794 Pediatric Patients Tested For Severe Acute Respiratory Syndrome Coronavirus 2 Across The United States

Christopher B. Forrest, MD, PhD
Nov. 23, 2020

L. Charles Bailey, Hanieh Razzaghi, Evanette K. Burrows, H. Timothy Bunnell, Peter E. F. Camacho, Dimitri A. Christakis, Daniel Eckrich, Melody Kitzmiller, Simon M. Lin, Brianna C. Magnusen, Jason Newland, Nathan M. Pajor, Daksha Ranade, Suchitra Rao, Olamiji Sofela, Janet Zahner, Cortney Bruno...

Abstract [from journal]

Importance: There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and infection among pediatric patients across the United States.

Objective: To describe testing for SARS-CoV-2 and the epidemiology of infected patients.

Design, setting, and participants: A retrospective cohort study was conducted using electronic health record data from 135 794 patients younger than 25 years who were tested for SARS-CoV-2 from January 1


Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?

Research Brief
Kira Rysinka, MD
Nov. 16, 2020

In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.

Acute Kidney Injury In Deceased Organ Donors And Kidney Transplant Outcomes: A National Cohort Study Using A Novel Data Source

Nov. 13, 2020

Elizabeth M. SonnenbergJesse Y. Hsu, Jordana B. Cohen, Vishnu S. Potluri, Zhi Geng, Matthew H. Levine, Peter L. Abt, Peter P. Reese

Abstract [from journal]

Objective: To determine graft function and survival for kidney transplants from deceased donors with acute kidney injury (AKI) that persists at the time of organ procurement.

Background: Kidneys from donors with AKI are often discarded and may provide an opportunity to selectively expand the donor pool.

Methods: Using OPTN and DonorNet data, we studied adult kidney-only recipients between 5/1/2007-12/31/2016. DonorNet was used to characterize


Analysis Of Multicenter Clinical Trials With Very Low Event Rates

Nov. 9, 2020

Jiyu Kim, Andrea B. TroxelScott D. HalpernKevin G. Volpp, Brennan C. Kahan, Tim P. Morris, Michael O. Harhay

Abstract [from journal]

Introduction: In a five-arm randomized clinical trial (RCT) with stratified randomization across 54 sites, we encountered low primary outcome event proportions, resulting in multiple sites with zero events either overall or in one or more study arms. In this paper, we systematically evaluated different statistical methods of accounting for center in settings with low outcome event proportions.

Methods: We conducted a simulation study and a reanalysis of a completed RCT to compare five popular


Association of Adverse Neighborhood Exposures with HIV Viral Load in Pregnant Women at Delivery

Florence Momplaisir, MD, MSHP, University of Pennsylvania
Nov. 2, 2020

Florence M. Momplaisir, Tanner Nassau, Kari Moore, Clara Grayhack, Wanjiku F. M. Njoroge, Ana V. Diez Roux, Kathleen A. Brady

Abstract [from journal]

Importance: Racial disparities in maternal morbidity and mortality are in large part driven by poor control of chronic diseases. The association between adverse neighborhood exposures and HIV virologic control has not been well described for women with HIV during pregnancy.

Objective: To evaluate the association between adverse neighborhood exposures and HIV viral load at delivery.

Design, setting, and participants: This population-based cohort study assessed HIV


Improving The Resident Educational Experience In A Level IV Neonatal/Infant Intensive Care Unit

Oct. 26, 2020

Sara C. Handley, Nicole Pouppirt, Eric Zucker, Katherine A. Coughlin, Anne Ades

Abstract [from journal]

The neonatal/infant intensive care unit (N/IICU) at the Children's Hospital of Philadelphia is a 98-bed, level IV unit through which second-year pediatric residents rotate monthly. We developed a quality improvement project to improve the resident educational experience using goal setting. Primary objectives were to increase resident educational goal identification to 65% and goal achievement to 85% by June 2017. Secondary objectives were to (1) increase in-person feedback from fellows and/or attendings to 90% by June 2017 and (2)


Benchmarking Critical Care Well-Being: Before And After The Coronavirus Disease 2019 Pandemic

Oct. 21, 2020

Sofia Gomez, Brian J. Anderson, Hyunmin Yu, Jacob Gutsche, Juliane Jablonski, Niels Martin, Meeta Prasad KerlinMark E. Mikkelsen

Abstract [from journal]

Objectives: Examine well-being, measured as burnout and professional fulfillment, across critical care healthcare professionals, ICUs, and hospitals within a health system; examine the impact of the coronavirus disease 2019 pandemic.

Design: To complement a longitudinal survey administered to medical critical care physicians at the end of an ICU rotation, which began in May 2018, we conducted a cross-sectional survey among critical care professionals across four hospitals in December 2018 to


Prediction Models For Physical, Cognitive, And Mental Health Impairments After Critical Illness: A Systematic Review And Critical Appraisal

Oct. 15, 2020

Kimberley J. Haines, Elizabeth Hibbert, Joanne McPeake, Brian J. Anderson, Oscar Joseph Bienvenu, Adair Andrews, Nathan E. Brummel, Lauren E. Ferrante, Ramona O. Hopkins, Catherine L. Hough, James Jackson, Mark E. Mikkelsen, Nina Leggett, Ashley Montgomery-Yates, Dale M. Needham, Carla M. Sevin...

Abstract [from journal]

Objectives: Improved ability to predict impairments after critical illness could guide clinical decision-making, inform trial enrollment, and facilitate comprehensive patient recovery. A systematic review of the literature was conducted to investigate whether physical, cognitive, and mental health impairments could be predicted in adult survivors of critical illness.

Data sources: A systematic search of PubMed and the Cochrane Library (Prospective Register of Systematic Reviews ID:


Association Between Intensive Care Unit Utilization For Patients With Non-ST Segment Elevation Myocardial Infarction And Patient Experience

Oct. 9, 2020

Alexander C. Fanaroff, Anita Y. Chen, Sean van Diepen, Deirdre Mylod, Eric D. Peterson, Tracy Y. Wang

Abstract [from journal]

Routine intensive care unit (ICU) utilization for patients with initially stable non-ST segment elevation myocardial infarction is not associated with improved short- or long-term patient outcomes; however, the association with patient experience has not been reported. Using Hospital Consumer Assessment of Healthcare Providers and Systems patient survey data linked to ICU use data from the National Cardiovascular Data Registry, we found no association between hospital-level ICU utilization and metrics of patient experience, including


Racial Disparities in Treatment and Outcomes of Children With Type 1 Diabetes

Oct. 8, 2020

Terri H. Lipman, Jennifer A. Smith, Oona Patil, Steven M. Willi, Colin P. Hawkes

Abstract [from journal]

Objective: The aim of this study was to assess racial disparities in treatments and outcomes between Non‐Hispanic black (NHB), Hispanic and Non‐Hispanic white (NHW) children with type 1 diabetes (T1D).

Methods: We reviewed electronic health records of children (<18 years) attending a large, pediatric tertiary care diabetes center in the United States between October 1, 2018,


Real-World Experiences With Generating Real-World Evidence: Case Studies From Pcori's Pragmatic Clinical Studies Program

Oct. 7, 2020

Mark D. Neuman, Michael D. Kappelman, Elliot Israel, Susan S. Ellenberg, Cindy Girman, Jess Robb, Allie Rabinowitz, Anne Trontell

Abstract [from journal]

Background: Over the last decade, randomized studies evaluating outcomes of health care interventions conducted in real-world settings-often termed "pragmatic trials"-have come to be seen as an important means of obtaining relevant, actionable evidence to guide health care decisions. Despite extensive writing on methodological considerations in pragmatic trial design, limited information exists regarding the practical and logistical challenges encountered in carrying out rigorous randomized evaluations in highly