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.

Adverse Childhood Experiences: Expanding the Concept of Adversity

Mar. 14, 2016

Peter Cronholm, Christine Forke, Roy Wade, Megan Bair-Merritt, Martha Davis, Mary Harkins-Schwarz, Lee Pachter, Joel Fein

In the American Journal of Preventive Medicine, Peter Cronholm and colleagues investigate whether Conventional Adverse Childhood Experiences (ACEs) alone can sufficiently measure adversity, particularly among various subgroups. Current knowledge of childhood adversity relies on data predominantly collected from white, middle- /upper-middle-class participants and focuses on experiences within the home. Expanded ACEs were designed to capture unmeasured community-level experiences of socioeconomically and racially urban population. The researchers asked participants from a previous...

The Role of Social Determinants in Explaining Racial/Ethnic Disparities in Perinatal Outcomes

Mar. 14, 2016

Scott Lorch, Elizabeth Enlow

In Pediatric Research, Scott Lorch and Elizabeth Enlow review evidence on the association of social determinants of health on racial/ethnic disparities in preterm birth rates, infant mortality and fetal mortality. The authors find that much of the current literature on racial/ethnic disparities in perinatal outcomes describes the phenomenon without exploring mediating causes of these disparities that may be easily modifiable. Studies that do examine these intermediate steps typically concentrate on only a single mediator, without examining the contribution of other potential...

Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries

Feb. 17, 2016

Justin Bekelman, Scott Halpern, Carl Rudolf Blankart, Julie Bynum, Joachim Cohen, Robert Fowler, Stein Kaasa, Lukas Kwietniewski, Hans Olav Melberg, Bregie Onwuteaka-Philipsen, Mariska Oosterveld-Vulg, Andrew Pring, Joans Schreyogg, Connie Ulrich...

In The Journal of the American Medical Association, Justin Bekelman and colleagues, including Scott Halpern, Connie Ulrich and Ezekiel Emanuel compare site of death, health care utilization and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the United States. Using administrative and registry data, the researchers measured deaths in acute care hospital, along with inpatient and outpatient measures, and hospital expenditures paid by insurers. They find that a smaller proportion of decedents, older than 65, died in acute...

Liver transplant center variability in accepting organ offers and its impact on patient survival

Feb. 17, 2016

David Goldberg, Benjamin French, James Lewis, Frank Scott, Ronac Mamtani, Richard Gilroy, Scott Halpern, Peter Abt

In the Journal of Hepatology, David Goldberg and colleagues, including Benjamin French, James Lewis and Scott Halpern, explore whether transplant centers vary in their propensities to decline organs for the highest priority patients, and how these decisions impact patient outcomes. The authors analyzed Organ Procurement and Transplantation Network (OPTN) data from 2007-2013, and evaluated acceptance rates of liver offers for the highest ranked patients and their subsequent waitlist mortality. Even after adjusting for organ quality and recipient severity of illnesses, the study...

Health Equity Symposium Features Fiery Carmona

Feb. 9, 2016

[content_elements:element:0]Penn’s Second Annual Martin Luther King, Jr. Health Equity Symposium drew attention to the importance of inclusion and diversity in medical education and research on both a national and local level.  A panel of Penn faculty, including several LDI Senior Fellows, directly confronted the barriers to inclusion at Penn, and Dr.

Inpatient Hospital Charge Variability of U.S. Hospitals

Jan. 29, 2016

James Park, Edward Kim, Rachel Werner

In the Journal of General Internal Medicine, James Park and colleagues, including Rachel Werner, describe hospital charge variability in the U.S. and examine its relationship to local health factors. The researchers evaluated 2011 Medicare Inpatient Charge data against 29 county-level measures of health, environmental and socioeconomic status. The authors find no association between any community health measures and hospital charges. However, higher charges were associated with higher rates of uninsured status. The authors conclude that overall, hospital charges lack an...

Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use

Jan. 29, 2016

Junko Takeshita, Joel Gelfand, Penxiang Li, Lionel Pinto, Xinyan Yu, Preethi Rao, Hema Viswanathan, Jalpa Doshi

In the Journal of Investigative Dermatology, Junko Takeshita and colleagues, including Preethi Rao and Jalpa Doshi, look at factors associated with the use of biologics and other treatments for psoriasis. They  analyzed claims from a nationally representative sample of Medicare beneficiaries with Part D drug coverage. The researchers find that Medicare Part D beneficiaries without a low-income subsidy (LIS) had 70% lower odds of having received biologics than those with LIS. Similarly, the odds of having received biologics were 69% lower among black patients compared with white...

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

Jan. 29, 2016

David Lee, Brendan Carr, Tony Smith, Van Tran, Daniel Polsky, Charles Branas

In Population Health Management, David Lee and colleagues, including Brendan Carr, Daniel Polsky and Charles Branas, test the association of hospital and population characteristics and the effect of nearby hospital closures with increases in emergency department volume. The researchers used data from cost reports and administrative databases to analyze emergency department volume at 192 New York State hospitals from 2004 to 2010. They find an overall increase in emergency department visits, but with wide variation. Emergency volume increased nearly twice as fast at tertiary...

Diversity in the Health Professions: a 'Leaky Pipeline'

Jan. 14, 2016

Despite decades of calls for increased representation of minorities in the health professions workforce, we are very far away from a workforce that reflects this nation’s diversity. Underrepresented minorities make up 31% of the general population, but just 15% of medical school students and 13% of dental students. A new study helps us understand the barriers minority college students face in pursuing medical and dental careers.

Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study

Jan. 11, 2016

Meredith Dougherty, Pamela Harris, Joan Teno, Amy Corcoran, Cindy Douglas, Jackie Nelson, Deborah Way, Joan Harrold, David Casarett

In the Journal of the American Geriatrics Society, Meredith Dougherty and colleagues, including David Casarett, compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. The researchers conducted an electronic health record-based retrospective cohort study to compare the difference in the two groups’ length of stay in hospice, use of opioids for pain, and site of death. The authors find the assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%) and enroll in...

The Role of Dementia in Nursing Home Report Cards

Dec. 18, 2015

R. Tamara Konetzka, Daniel Brauner, Marcelo Coca Perraillon, Rachel Werner

In Medical Care Research and Review, R. Tamara Konetzka and colleagues, including Rachel Werner, explore the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents. Selected quality measures are examined using a difference-in-difference design. The authors find that before public reporting, nursing home residents with severe dementia scored worse on most reported quality measures, such as physical restraint use and worsening of activities of daily living. After public reporting was launched (Nursing Home...

The Institutional Effects of Incarceration: Spillovers From Criminal Justice to Health Care

Dec. 18, 2015

Jason Schnittker, Christopher Uggen, Sarah Shannon, Suzy McElrath

In The Milbank Quarterly, Jason Schnittker and colleagues examine the spillover effects of growth in state-level incarceration rates on the US health care system, prior to the Affordable Care Act. The authors merged cross-sectional individual-level data on health care behavior to aggregate state-level data regarding incarceration, and then analyzed trends over time in health care access and utilization. They find that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians,...