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.

Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania

Jan. 4, 2021

Eric Winter, Allyson M. Hynes, Kaitlyn Shultz, Daniel N. Holena, Neil R. Malhotra, Jeremy W. Cannon

Abstract [from journal]

Importance: Police in Philadelphia, Pennsylvania, routinely transport patients with penetrating trauma to nearby trauma centers. During the past decade, this practice has gained increased acceptance, but outcomes resulting from police transport of these patients have not been recently evaluated.

Objective: To assess mortality among patients with penetrating trauma who are transported to trauma centers by police vs by emergency medical services (EMS).

Design,

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Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy: A Randomized Clinical Trial

Jan. 4, 2021

Nadim MahmudDavid A. Asch, Jessica Sung, Catherine Reitz, Mary S. Coniglio, Caitlin McDonald, Donna Bernard, Shivan J. Mehta

Abstract [from journal]

Importance: Outpatient colonoscopy is important for colorectal cancer screening. However, nonadherence and poor bowel preparation are common.

Objective: To determine if an automated text messaging intervention with a focus on informational and reminder functions could improve attendance rates and bowel preparation quality for outpatient colonoscopy.

Design, setting, and participants: This randomized clinical trial was conducted in an endoscopy center at an urban

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Implementing Resident Team Assistant Programs at Academic Medical Centers: Lessons Learned

Dec. 20, 2020

Ryosuke Takei, George Dalembert, Jeanine Ronan, Nicole Washington, Stuti Tank, Michael Perry, John D. Mahan, David A. Stewart, Heather L. Burrows

Abstract [from journal]

Background: Excessive inpatient administrative tasks can lead to adverse consequences for residents and their patients. Furthermore, this burden has been linked to depersonalization, a major component of physician burnout.

Objective: To describe the development, implementation, feasibility, acceptability, and early outcomes of Resident Team Assistant (RTA) programs.

Methods: Three large academic medical centers created RTA programs in which

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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

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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

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“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-

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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

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Pediatric Healthcare Needs and Barriers Self-Reported by a Rural Hispanic Community

Diana Montoya-Williams, MD
Dec. 9, 2020

Juan J. Leon, Kourtney K. Guthrie, Carolina Rueda, Diomel De la Cruz, Diana Montoya-Williams

Abstract [from journal]

Purpose Hispanic immigrants in rural communities can be a hard-to-reach population with many unmet medical needs that have yet to be properly identified. This is particularly true for rural immigrant children. This study focused on documenting self-reported healthcare barriers among this isolated population to identify methods for reducing health disparities among this vulnerable population. Methods Participants at recurrent mobile health fairs were anonymously surveyed from June 2016 to January 2018. Differences between the US and

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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

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Expanding Therapeutic Jurisprudence Across the Federal Judiciary

Nov. 24, 2020

Benjamin A. Barsky, Heather Ellis Cucolo, Dominic A. Sisti

Abstract [from journal]

A patchwork of drug courts and other problem-solving courts currently exists to divert individuals with mental illness and substance use disorders away from the criminal justice system. We call for a broader implementation of problem-solving courts, particularly at the federal level, that would operate according to the principles of therapeutic jurisprudence (i.e., a framework that aims to maximize the health benefits of judicial and legislative policies and practices). Expanding federal problem-solving courts will better serve

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National Shifts in Outpatient Care for Patients With Cirrhosis

Nov. 24, 2020

As the U.S. enters the tenth month of the COVID-19 pandemic, it is hard to imagine a time when telemedicine was not a mainstay of health care delivery, particularly in the care of vulnerable patients. However, few studies have examined the scale of how outpatient care has changed at the national level, and whether the changes have been sustained beyond the early months of the pandemic.

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