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.

Assessing the Role of Gay Community Attachment, Stigma, and PrEP Stereotypes on Young Men Who Have Sex With Men's PrEP Uptake

Nov. 19, 2020

Steven Meanley, Daniel Connochie, Seul Ki Choi, Stephen Bonett, Dalmacio D. FloresJosé A. Bauermeister

Abstract [from journal]

Negative stereotypes about pre-exposure prophylaxis (PrEP) hinder PrEP uptake among young men who have sex with men (YMSM). Prior research suggests community homophobia may be linked to negative PrEP attitudes. Conversely, individuals with high gay community attachments (GCA) may have more access to credible PrEP information/resources. Among 285 YMSM recruited online, we estimated structural equation models to test competing conceptual models that inform pathways from perceived stigmas, GCA, and negative PrEP stereotype endorsements


Socioeconomic Barriers to Prenatal Diagnosis of Critical Congenital Heart Disease

Nov. 10, 2020

Matthew J. CampbellScott Lorch, Jack Rychik, Michael D. Quartermain, Molly Passarella, Peter W. Groeneveld

Abstract [from journal]

Objective: The study was designed to assess the impact of socioeconomic barriers on the rate of prenatal diagnosis of critical congenital heart disease (CCHD).

Methods: This was a retrospective review of the Medicaid analytic extract (MAX) dataset, a national Medicaid administrative claims database with linked maternal-infant claims, from 2007 to 2012. Infants with CCHD were identified by searching for International Classification of Diseases (ICD) 9 codes and Procedural Coding System (PCS)


Developing the TIC Grade: A Youth Self-Report Measure of Perceptions of Trauma-Informed Care

Laura Sinko
Nov. 9, 2020

Laura Sinko, Dana Beck, Julia Seng

Abstract [from journal]

Background: Service delivery organizations are advancing the provision of trauma-informed care (TIC) for youth to improve outcomes. However, currently there are no validated, reliable evaluation measures to capture the voices of adolescent clients and how well they perceive TIC implementation.

Aims: The purpose of this project was to create an evaluation measure with strong content validity for adolescent health and service users to give feedback to organizations about their implementation of


When A Family Seeks To Exclude Residents From Their Child's Care

Nov. 5, 2020

Emily A. Largent, Ross Newman, Christopher E. Gaw, John D. Lantos

Abstract [from journal]

A primary goal of our medical education system is to produce physicians qualified to promote health, prevent and treat disease, and relieve suffering. Although some aspects of the practice of medicine can be learned in classrooms, from textbooks, or with simulators, other aspects can only be learned through the direct provision of patient care. Residency programs therefore offer essential educational experiences that support residents' acquisition of knowledge, skills, and professional judgment through the assumption of progressive


A Tertiary Care-based Complex Care Program: Improving Care for Children with Medical Complexity

David M. Rubin, MD, MSCE
Nov. 1, 2020

Annique K. Hogan, Meghan M. Galligan, Noelle J. Stack, Kathryn F. Leach, Brenna L. Aredas, Rachel English, Matthew Dye, David Rubin

Abstract [from journal]

Objective: Children with medical complexity (CMC) have significant health care costs, but they also experience substantial unmet health care needs, hospitalizations, and medical errors. Their parents often report psychosocial stressors and poor care satisfaction. Complex care programs can improve the care for CMC. At our tertiary care institution, we developed a consultative complex care program to improve the quality and cost of care for CMC and to improve the experience of care for patients and families.


Identifying Ethical Considerations For Machine Learning Healthcare Applications

Nov. 1, 2020

Danton S. Char, Michael D Abràmoff, Chris Feudtner

Abstract [from journal]

Along with potential benefits to healthcare delivery, machine learning healthcare applications (ML-HCAs) raise a number of ethical concerns. Ethical evaluations of ML-HCAs will need to structure the overall problem of evaluating these technologies, especially for a diverse group of stakeholders. This paper outlines a systematic approach to identifying ML-HCA ethical concerns, starting with a conceptual model of the pipeline of the conception, development, implementation of ML-HCAs, and the parallel pipeline of evaluation and


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?

Improving Consumption And Purchases Of Healthier Foods In Retail Environments: A Systematic Review

Oct. 16, 2020

Allison Karpyn, Kathleen McCallops, Henry Wolgast, Karen Glanz

Abstract [from journal]

This review examines current research on manipulations of U.S. food retail environments to promote healthier food purchasing and consumption. Studies reviewed use marketing strategies defined as the 4Ps (product, price, placement, promotion) to examine results based on single- and multi-component interventions by study design, outcome, and which of the "Ps" was targeted. Nine electronic databases were searched for publications from 2010 to 2019, followed by forward and backward searches. Studies were included if the intervention was


Racial Disparities in Treatment and Outcomes of Children With Type 1 Diabetes

Oct. 8, 2020

Terri H. Lipman, Jennifer A. Smith, Oona Patil, Steven M. Willi, Colin P. Hawkes

Abstract [from journal]

Objective: The aim of this study was to assess racial disparities in treatments and outcomes between Non‐Hispanic black (NHB), Hispanic and Non‐Hispanic white (NHW) children with type 1 diabetes (T1D).

Methods: We reviewed electronic health records of children (<18 years) attending a large, pediatric tertiary care diabetes center in the United States between October 1, 2018,


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


“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