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.

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....

A safe haven for the injured? Urban trauma care at the intersection of healthcare, law enforcement, and race

Jun. 8, 2017

Sara F. Jacoby, Therese S. Richmond, Daniel N. Holena, Elinore J. Kaufman

In Social Sciences & Medicine, Sara Jacoby and colleagues describe how injured, Black trauma patients perceived their interactions with police before and during hospitalization, and what these perceptions reveal about police involvement within trauma care systems. The authors used combined data from two qualitative studies. The first was ethnographic fieldwork that followed Black trauma patients in the hospital through the physical and emotional aftermath of their injuries. The second was a qualitative, descriptive study of how patients

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The Role of Community Health Centers in Reducing Racial Disparities in Spatial Access to Primary Care

Apr. 20, 2017

Jane W. Seymour, Daniel E. Polsky, Elizabeth J. Brown, Corentin M. Barbu, David Grande

In the Journal of Primary Care & Community Health, Jane Seymour and colleagues, including LDI senior fellows Daniel Polsky and David Grande, investigate the role of community health centers in reducing racial disparities in access to care. Racial minorities are more likely to live in primary care shortage areas, which is of particular concern given the role of primary care in prevention, chronic disease management, and as an overall entry point to the health care system. The authors surveyed primary care practices in Philadelphia County and neighboring zip codes, identified...

Novello Inspires Action at 2017 Penn Health Equity Symposium

Mar. 21, 2017

Penn’s third annual Martin Luther King Jr. Health Equity Symposium featured a keynote address by Antonia Novello, 14th Surgeon General of the United States, who had a hopeful, yet challenging message: “Had Martin Luther King been here today, he would see that we are doing much better, but he would he would still be fighting. He would feel pride, disappointment, sadness, and he would be appalled that blacks and whites are still segregated.”[content_elements:element:0]

Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans

Research Brief
Mar. 16, 2017

In a review of ACA plans, the authors find that the proportion of narrow networks were greater for pediatric specialties than for adult specialties, highlighting the need to monitor access to specialty care for children and families.

Insurance Coverage and Access to Care Under the Affordable Care Act

Issue Brief
Dec. 8, 2016

This brief details changes in insurance coverage and access to care under the Affordable Care Act. About 20 million individuals gained coverage under the law and access to care improved.  Despite these gains, more than 27 million individuals are still uninsured, and many others face barriers in accessing care.  As a result of the 2016 elections, the future of the ACA is uncertain.  As the next Administration and policymakers debate further health system reforms, they should consider the scope of the ACA’s effects on their constituents. 

Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial

Research Brief
Dec. 8, 2016

An educational video on the risks and benefits of total knee replacement increased the rate of surgery among black patients, in a clinical trial of an intervention that could reduce known racial disparities in treatment of osteoarthritis.

Health Systems and Social Determinants

Dec. 1, 2016

The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.

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