Access & Equity

How health care resources are distributed across the population and how access and health outcomes vary across different groups. LDI Senior Fellows focus on how to achieve greater access for vulnerable populations and how to reduce disparities in health outcomes.

Bringing Gynecologic Cancer Care Closer to Patients

Jan. 13, 2021

For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.

Rationing, Racism and Justice: Advancing the Debate Around ‘Colourblind’ COVID-19 Ventilator Allocation

Nwamaka Eneanya, MD
Jan. 6, 2021

Harald Schmidt, Dorothy E. Roberts, Nwamaka D. Eneanya

Abstract [from journal]

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance


Implementation Science is Imperative to the Optimization of Obstetric Care

Dec. 15, 2020

Rebecca F. Hamm, Brian K. Iriye, Sindhu K. Srinivas

Abstract [from journal]

In an effort aimed at improving outcomes, obstetric teams have enacted comprehensive care bundles and other clinical tools. Yet, these practices have had limited degrees of success on a national scale. Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization. This emerging field takes into account key stakeholders at the clinician, institution, and health policy levels. Implementation science evaluates how well an intervention is or can be delivered, to


The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation

Dec. 15, 2020

Sasha Deutsch-Link, Ethan M. Weinberg, Therese Bitterman, Mackenzie McDougal, Aniket Dhariwal, Lauren S. Jones, Robert M. Weinrieb, Arpita G. Banerjee, Senayish Addis, Marina Serper

Abstract [from journal]

Background: The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized psychosocial evaluation tool used in liver transplant (LT) evaluation. Study aims were to assess the impact of the SIPAT score and sub-score domains on transplant waitlisting decisions and post-LT outcomes including immunosuppression (IS) non-adherence, biopsy-proven rejection, and mortality/graft failure.

Methods: We conducted a single center observational cohort study of 1430 patients


“Why Couldn’t I Go in to See Him?” Bereaved Families’ Perceptions of End-of-Life Communication During COVID-19

Mary Ersek
Dec. 15, 2020

Shelli Feder, Dawn Smith, Hilary Griffin, Scott T. Shreve, Daniel Kinder, Ann Kutney-Lee, Mary Ersek

Abstract [from journal]

Background/objective: The COVID-19 pandemic has resulted in rapid changes to end-of-life care for hospitalized older adults and their families, including visitation restrictions. We examined bereaved families' perceptions of the quality of end-of-life communication among Veterans, families and staff in Veterans Affairs (VA) medical centers during the COVID-19 pandemic.

Design: Qualitative descriptive study using data from a survey of bereaved family members of Veterans administered from March-


Hospital Outcomes for Children With Severe Sepsis in the USA by Race or Ethnicity and Insurance Status: A Population-Based, Retrospective Cohort Study

Anireddy Reddy
Dec. 14, 2020

Hannah K. Mitchell, Anireddy ReddyDiana Montoya-WilliamsMichael Harhay, Jessica C. Fowler, Nadir Yehya

Abstract [from journal]

Background: Disparities in outcomes of adult sepsis are well described by insurance status and race and ethnicity. There is a paucity of data looking at disparities in sepsis outcomes in children. We aimed to determine whether hospital outcomes in childhood severe sepsis were influenced by race or ethnicity and insurance status, a proxy for socioeconomic position.

Methods: This population-based, retrospective cohort study used data from the 2016 database release from the Healthcare Cost and


Patient and Staff Perceptions of Universal Severe Acute Respiratory Syndrome Coronavirus 2 Screening Prior to Cardiac Catheterization and Electrophysiology Laboratory Procedures

Dec. 4, 2020

Naga Venkata K. Pothineni, Samantha Starkey, Kristine Conn, Christina Evans, Ronak Shah, Matthew C. Hyman, David S. Frankel, Rim Halaby, Hillary A. Johnston-Cox, Katherine Kunkel, Ashwin S. Nathan, Matthew E. Seigerman, Howard C. Herrmann, Jay Giri, Francis E....

Abstract [from journal]

In response to the coronavirus disease 2019 (COVID-19) pandemic many cardiac catheterization and electrophysiology laboratories canceled elective procedures to limit the burden on hospital resources. A major challenge in resuming elective procedures is the risk of exposing patients and health care personnel (HCP) to carriers of the virus. To facilitate procedure resumption, the Hospital of the University of Pennsylvania began testing all patients scheduled for elective and urgent catheterization and electrophysiology procedures for severe acute...

Insulin Pump Use in Children With Type 1 Diabetes: Over a Decade of Disparities

Nov. 25, 2020

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

Abstract [from journal]

Purpose: Racial disparities have been shown in outcomes and treatment of children with type 1 diabetes (T1D). The purpose of this study was to examine temporal trends in insulin pump use among non-Hispanic white (NHW), non-Hispanic black (NHB) and Hispanic children attending a large urban diabetes center.

This study was a retrospective chart review of insulin pump usage by race (NHW/ NHB) in 2005, and race/ethnicity (NHW/NHB/Hispanic) in 2011–2019. Demographic data (age, sex, diabetes duration, SES) and most recent