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.

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...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative

Jun. 21, 2017

Victor J. Dzau, Mark B. McClellan, J. Michael McGinnis, Sheila P. Burke, Molly J. Coye, Angela Diaz, Thomas A. Daschle, William H. Frist, Martha Gaines, Margaret A. Hamburg, Jane E. Henney, Shiriki Kumanyika, Michael O. Leavitt, Ruth M. Parker, Lewis G. Sandy, Leonard D....

In a JAMA Special Communication message, Victor Dzau and colleagues, including Shiriki Kumanyika, review the most salient health challenges and opportunities facing the United States, and seek to identify practical priorities and policy initiatives essential to health progress. The authors assess 19 National Academy of Medicine-commissioned white papers, and review publicly available data on health care costs and outcomes. They find that, of the $3.2 trillion spent annually on health care, an estimated 30% is related to waste, inefficiencies, and excessive price. Major health...

Identifying Policy Levers And Opportunities for Action Across States To Achieve Health Equity

Jun. 21, 2017

Julia Berenson, Yan Li, Julia Lynch, and José A. Pagán

In Health Affairs, Julia Berenson, Yan Li, Julia Lynch, and José A. Pagán assess state progress on steps to advance health equity. Using publicly available data sources, the authors develop a scorecard for all fifty states and the District of Columbia that measure the use of five evidence-based policies to address health equity domains. The scorecard includes the cigarette excise tax rate, a state’s Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded...

A comparative effectiveness education trial for lifestyle health behavior change in African-Americans

Jun. 20, 2017

Chanita Hughes Halbert, Scarlett Bellamy, Vanessa Briggs, Ernestine Delmoor, Joseph Purnell, Rodney Rogers, Benita Weathers, Jerry C. Johnson

In Health Education Research, Chanita Hughes Halbert and colleagues, including Jerry Johnson, compared the effects of an education trial about risk factors for cancer and cardiovascular disease (CVD) within an African-American community. Participants were randomized to receive either integrated education about shared risk factors between cancer and CVD, or disease-specific education about CVD risk factors only. The authors assessed whether the type of education received affected fruit and vegetable intake or physical activity level. They find that when participants with less than...

Gender Differences in Factors Associated with Unsheltered Status and Increased Risk of Premature Mortality among Individuals Experiencing Homelessness

Jun. 19, 2017

Ann Elizabeth Montgomery, Dorota Szymkowiak, Dennis Culhane

In Women’s Health Issues, Ann Montgomery and colleagues, including Dennis Culhane, explore gender differences in health, access to care, and premature mortality among homeless populations. The researchers used survey data collected during the 100,000 Homes Campaign, and performed statistical analyses to identify differences in the characteristics of women, men, and transgender individuals. While men more frequently experienced unsheltered homelessness, women and transgender individuals more frequently met the criteria for risk of premature mortality. Among women, reports of...

Young Transgender Women’s Attitudes Toward HIV Pre-exposure Prophylaxis

Jun. 12, 2017

Sarah M. Wood, Susan Lee, Frances K. Barg, Marne Castillo, Nadia Dowshen

In Journal of Adolescent Health, Sarah Wood and colleagues, including Nadia Dowshen, seek to understand young transgender women’s (YTW) attitudes toward HIV pre-exposure prophylaxis (PrEP) in order to improve PrEP uptake in this population. Previous studies have shown that, despite a significantly higher risk for HIV amongst YTW, awareness of and access to PrEP remains disproportionately low. The investigators conducted qualitative interviews focusing on participants’ knowledge, attitudes, and experience with PrEP. Sixty-four percent of participants reported knowledge of PrEP....

Pages