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.

Phosphorus Control for Dialysis Patients

Oct. 22, 2020

About one third of chronic dialysis patients have persistently high blood phosphorus levels, which increases risk for vascular damage, cardiovascular disease, and death. Some patients can control phosphorus levels through a healthy diet, although many also require the use of pills that remove dietary phosphorus in the gut. But what about patients with limited access to healthy food outlets?

Neurodegenerative Disease Is Associated With Increased Incidence Of Epilepsy: A Population Based Study Of Older Adults

Allison Willis, MD
Oct. 7, 2020

Leah J. Blank, Emily K. Acton, Dylan Thibault, Allison W. Willis 

Abstract [from journal]

Objective: To determine the incidence of epilepsy among Medicare beneficiaries with a new diagnosis of Alzheimer dementia (AD) or Parkinson disease (PD).

Methods: Retrospective cohort study of Medicare beneficiaries with an incident diagnosis of AD or PD in the year 2009. The 5-year incidence of epilepsy was examined by sociodemographic characteristics, comorbidities and neurodegenerative disease status. Cox regression models examined the association of neurodegenerative disease with incident


The Impact Of Global Budget Payment Reform On Systemic Overuse In Maryland

Oct. 4, 2020

Allison H. Oakes, Aditi P. Sen, Jodi B. Segal

Abstract [from journal]

Background: Medical overuse is a leading contributor to the high cost of the US health care system and is a definitive misuse of resources. Elimination of overuse could improve health care efficiency. In 2014, the State of Maryland placed the majority of its hospitals under an all-payer, annual, global budget for inpatient and outpatient hospital services. This program aims to control hospital use and spending.

Objective: To assess whether the Maryland global budget program was associated with


Predicting Implementation: Comparing Validated Measures Of Intention And Assessing The Role Of Motivation When Designing Behavioral Interventions

Sep. 28, 2020

Jessica Fishman, Viktor Lushin, David S. Mandell

Abstract [from journal]

Background: Behavioral intention (which captures one's level of motivation to perform a behavior) is considered a causal and proximal mechanism influencing the use of evidence-based practice (EBP). Implementation studies have measured intention differently, and it is unclear which is most predictive. Some use items referring to "evidence-based practice" in general, whereas others refer to a specific EBP. There are also unresolved debates about whether item stems should be worded "I intend to," "I will," or "How


Stories To Communicate Individual Risk For Opioid Prescriptions For Back And Kidney Stone Pain: Protocol For The Life STORRIED Multicenter Randomized Clinical Trial

Zachary Meisel
Sep. 24, 2020

Zachary F. Meisel, Erica B. Goldberg, Abby R. Dolan, Esha Bansal, Karin V. Rhodes, Erik P. Hess, Carolyn C. Cannuscio, Marilyn M. Schapira, Jeanmarie Perrone, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum...

Abstract [from journal]

Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain.

Objective: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported


“Just Because You Have Ears Doesn’t Mean You Can Hear”—Perception of Racial-Ethnic Discrimination During Childbirth

Elizabeth Howell
Sep. 24, 2020

Teresa Janevic, Naissa Piverger, Omara Afzal, Elizabeth A. Howell

Abstract [from journal]

Background: Black and Latina women in New York City are twice as likely to experi­ence a potentially life-threatening morbid­ity during childbirth than White women. Health care quality is thought to play a role in this stark disparity, and patient-provider communication is one aspect of health care quality targeted for improvement. Perceived health care discrimination may influence patient-provider communication but has not been adequately explored during the birth hospitalization.

Purpose: Our objective was to


Patient Frailty Is Independently Associated With The Risk of Acute On Chronic Liver Failure Hospitalization

Sep. 18, 2020

Shivani Shah, David S. Goldberg, David E. Kaplan, Vinay Sundaram, Tamar H. Taddei, Nadim Mahmud

Abstract [from journal]

Background and aims: There is significant interest in identifying risk factors associated with acute on chronic liver failure (ACLF). In transplant candidates, frailty predicts waitlist mortality and post-transplant outcomes. However, the impact of frailty on ACLF development and mortality is unknown.

Methods: This was a retrospective study of U.S. Veterans with cirrhosis identified between 2008 to 2016. First hospitalizations were characterized as ACLF or non-ACLF admissions. Pre-


Prognosticating Outcomes And Nudging Decisions With Electronic Records In The ICU (PONDER-ICU) Trial Protocol

Katherine Courtright, MD, MSHP
Sep. 16, 2020

Katherine R. Courtright, Erich M. Dress, Jaspal Singh, Brian A. Bayes, Marzana Chowdhury, Dylan S. Small, Timothy Hetherington, Lindsay Plickert, Michael E. Detsky, Jason N. Doctor, Michael O. Harhay, Henry L. Burke, Michael B....

Abstract [from journal]

Expert recommendations to discuss prognosis and offer palliative options for critically ill patients at high risk of death are variably heeded by intensive care unit (ICU) clinicians. How to best promote such communication to avoid potentially unwanted aggressive care is unknown. The Prognosticating Outcomes and Nudging Decisions with Electronic Records in the ICU (PONDER-ICU) study is a 33-month pragmatic, stepped-wedge, cluster randomized trial testing the effectiveness of two electronic health record (EHR) interventions designed


Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

Sep. 10, 2020

Adam Dean, Atheendar Venkataramani, and Simeon Kimmel

Abstract [from journal]

More than 40% of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care worker access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known if the presence of health care worker unions in nursing homes is associated with COVID-19 mortality rates. Therefore, we used cross-sectional regression analysis to examine the association between the presence of health care


Association Between 90-Minute Door-To-Balloon Time, Selective Exclusion Of Myocardial Infarction Cases, And Access Site Choice: Insights From The Cardiac Care Outcomes Assessment Program (COAP) In Washington State

Sep. 4, 2020

Ashwin S. Nathan, Swathi Raman, Nancy Yang, Ian Painter, Sameed Ahmed M. Khatana, Elias J. Dayoub, Howard C. Herrmann, Robert W. Yeh, Peter W. Groeneveld, Jacob A. Doll, James M. McCabe, Ravi S. Hira, Jay Giri...

Abstract [from journal]

Background: For patients presenting with ST-segment-elevation myocardial infarction, national quality initiatives monitor hospitals' proportion of cases with door-to-balloon (D2B) time under 90 minutes. Hospitals are allowed to exclude patients from reporting and may modify behavior to improve performance. We sought to identify whether there is a discontinuity in the number of cases included in the D2B time metric at 90 minutes and whether operators were increasingly likely to pursue femoral access in patients with