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.

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

Research Brief
Sep. 5, 2017

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.

Progressive rural-urban disparity in acute stroke care

Aug. 29, 2017

Sergio Gonzales, Michael T. Mullen, Leslie Skolarus, Dylan P. Thibault, Uduak Udoeyo, and Allison W. WIllis

In Neurology, Sergio Gonzales and colleagues, including Michael Mullen and Allison Willis, examine differences in tissue plasminogen activator (tPA) utilization between rural and urban stroke patients. As with many health services, disparities in care based on geographic location or income exist, and rural populations often have little access to medical care. The authors used ten years of hospital discharge data from the National Inpatient Sample and indicators of tPA utilization for acute strokes. They find that, of 914,500 cases, tPA use in urban hospitals was quadruple that of...

Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Research Brief
Aug. 21, 2017

Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.

Continuity of Care in Infancy and Early Childhood Health Outcomes

Jul. 14, 2017

Elizabeth Enlow, Molly Passarella, Scott A. Lorch

In Pediatrics, Elizabeth Enlow and colleagues, including Scott Lorch, assess the relationship between provider continuity in infancy, and use of both urgent and preventative health services. Continuity of care is a key aspect of the patient-centered medical home and has been shown to improve pediatric outcomes. The authors hypothesize that increased provider continuity in infancy decreases urgent health care use and increases preventative services use in early childhood. They measured continuity across all primary care encounters during the first year of life for 17,773 infants...

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

Jul. 14, 2017

Pooja K. Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, Sindhu K. Srinivas

In Women’s Health Issues, Pooja Mehta and colleagues, including Shreya Kangovi and Sindhu Srinivas, seek to understand maternal preference for unscheduled hospital-based obstetric care, in order to inform interventions and improve value of publicly funded care during pregnancy. Previous research has shown that pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes; however drivers of this association are unknown. The authors conducted a comparative qualitative analysis of in-depth semi structured interviews. Low-income pregnant women...

An Assessment of Global Oral Health Education in U.S Dental Schools

Jul. 5, 2017

Janet Sung and Joan I. Gluch

In Journal of Dental Education, Janet Sung and Joan Gluch assess how global health education is currently incorporated into pre-doctoral dental training in the U.S.  In 2015-2016, the authors surveyed 64 accredited U.S dental schools regarding their global health education and competencies, and received responses from 52 of those schools. Most dental school curricula covered social determinants of oral diseases and conditions, how to identify barriers to use of oral health services, and how to work with patients who have limited dental health literacy. But other key areas of...

Coercion or Caring: The Fundamental Paradox for Adherence Interventions for HIV+ People With Mental Illness

Jul. 3, 2017

Marlene M. Eisenberg, Michael Hennessy, Donna Coviello, Nancy Hanrahan, Michael B. Blank

In AIDS and Behavior, Marlene Eisenberg and colleagues, including Nancy Hanrahan and Michael Blank, examine if a high-intensity HIV-treatment intervention would be perceived as coercive by HIV-positive individuals with serious mental illness. Previous research has shown that potentially coercive mandates during the earliest stages of mental health treatment are associated with later treatment benefits. Furthermore, the prevalence of HIV is significantly higher among populations with mental illness. The authors developed an HIV management regimen that utilized advance practice...

Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study

Jun. 29, 2017

Atheendar S. Venkataramani, Sachin J. Shah, Rourke O’Brien, Ichiro Kawachi, Alexander C. Tsai

In The Lancet Public Health, Atheendar Venkataramani and colleagues investigate the physical and mental health effects of the Deferred Action for Childhood Arrivals (DACA) program. DACA, a 2012 U.S immigration policy, provided renewable work permits and freedom from deportation for a large number of undocumented immigrants. The researchers conducted a retrospective, quasi-experimental study using data from non-citizen Hispanic adults. They examined changes in health outcomes among individuals meeting DACA eligibility criteria before and after program implementation, and compared...

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