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.

Stories To Communicate Individual Risk For Opioid Prescriptions For Back And Kidney Stone Pain: Protocol For The Life STORRIED Multicenter Randomized Clinical Trial

Zachary Meisel
Sep. 24, 2020

Zachary F. Meisel, Erica B. Goldberg, Abby R. Dolan, Esha Bansal, Karin V. Rhodes, Erik P. Hess, Carolyn C. Cannuscio, Marilyn M. Schapira, Jeanmarie Perrone, Melissa A. Rodgers, Michael M. Zyla, Jeffrey J. Bell, Sharon McCollum...

Abstract [from journal]

Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain.

Objective: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported


Patient Frailty Is Independently Associated With The Risk of Acute On Chronic Liver Failure Hospitalization

Sep. 18, 2020

Shivani Shah, David S. Goldberg, David E. Kaplan, Vinay Sundaram, Tamar H. Taddei, Nadim Mahmud

Abstract [from journal]

Background and aims: There is significant interest in identifying risk factors associated with acute on chronic liver failure (ACLF). In transplant candidates, frailty predicts waitlist mortality and post-transplant outcomes. However, the impact of frailty on ACLF development and mortality is unknown.

Methods: This was a retrospective study of U.S. Veterans with cirrhosis identified between 2008 to 2016. First hospitalizations were characterized as ACLF or non-ACLF admissions. Pre-


Prognosticating Outcomes And Nudging Decisions With Electronic Records In The ICU (PONDER-ICU) Trial Protocol

Katherine Courtright, MD, MSHP
Sep. 16, 2020

Katherine R. Courtright, Erich M. Dress, Jaspal Singh, Brian A. Bayes, Marzana Chowdhury, Dylan S. Small, Timothy Hetherington, Lindsay Plickert, Michael E. Detsky, Jason N. Doctor, Michael O. Harhay, Henry L. Burke, Michael B....

Abstract [from journal]

Expert recommendations to discuss prognosis and offer palliative options for critically ill patients at high risk of death are variably heeded by intensive care unit (ICU) clinicians. How to best promote such communication to avoid potentially unwanted aggressive care is unknown. The Prognosticating Outcomes and Nudging Decisions with Electronic Records in the ICU (PONDER-ICU) study is a 33-month pragmatic, stepped-wedge, cluster randomized trial testing the effectiveness of two electronic health record (EHR) interventions designed


Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

Sep. 10, 2020

Adam Dean, Atheendar Venkataramani, and Simeon Kimmel

Abstract [from journal]

More than 40% of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care worker access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known if the presence of health care worker unions in nursing homes is associated with COVID-19 mortality rates. Therefore, we used cross-sectional regression analysis to examine the association between the presence of health care


Association Between 90-Minute Door-To-Balloon Time, Selective Exclusion Of Myocardial Infarction Cases, And Access Site Choice: Insights From The Cardiac Care Outcomes Assessment Program (COAP) In Washington State

Sep. 4, 2020

Ashwin S. Nathan, Swathi Raman, Nancy Yang, Ian Painter, Sameed Ahmed M. Khatana, Elias J. Dayoub, Howard C. Herrmann, Robert W. Yeh, Peter W. Groeneveld, Jacob A. Doll, James M. McCabe, Ravi S. Hira, Jay Giri...

Abstract [from journal]

Background: For patients presenting with ST-segment-elevation myocardial infarction, national quality initiatives monitor hospitals' proportion of cases with door-to-balloon (D2B) time under 90 minutes. Hospitals are allowed to exclude patients from reporting and may modify behavior to improve performance. We sought to identify whether there is a discontinuity in the number of cases included in the D2B time metric at 90 minutes and whether operators were increasingly likely to pursue femoral access in patients with


Long-Term Care, Residential Facilities, And COVID-19: An Overview Of Federal And State Policy Responses

Angela Chen, MA
Sep. 1, 2020

Angela T. ChenKira L. Ryskina, Hye-Young Jung

Abstract [from journal]

The COVID-19 pandemic has disproportionately affected residents and staff at long-term care (LTC) and other residential facilities in the United States. The high morbidity and mortality at these facilities has been attributed to a combination of a particularly vulnerable population and a lack of resources to mitigate the risk. During the first wave of the pandemic, the federal and state governments received urgent calls for help from LTC and residential care facilities; between March and early June of 2020, policymakers responded


Effects Of Leader Tactics On The Creativity, Implementation, And Evolution Of Ideas To Improve Healthcare Delivery

Ingrid Nembhard, PhD
Aug. 31, 2020

Yuna S. H. Lee, Paul D. Cleary, Ingrid M. Nembhard

Abstract [from journal]

Background: Slow progress in quality improvement (QI) has prompted calls to identify new QI ideas. Leaders guiding these efforts are advised to use evidence-based tactics, or specific approaches to address a goal, to promote clinician and staff engagement in the generation and implementation of QI ideas, but little evidence about effective tactics exists.

Objective: Examine the association between leader tactics and the creativity, implementation outcome, and evolution of


Mental Health, Social Influences, And HIV Pre-Exposure Prophylaxis (PrEP) Utilization Among Men And Transgender Individuals Screening For HIV Prevention Trials

Aug. 28, 2020

Sarah M. Wood, Knashawn H. Morales, David Metzger, Annet Davis, Danielle Fiore, Danielle Petsis, Kezia Barnett, Helen C. Koenig, Nadia DowshenRobert Gross, Ian Frank

Abstract [from journal]

The effects of mental health comorbidities and social support on the HIV pre-exposure prophylaxis (PrEP) care continuum are unknown. We conducted a cross-sectional study of men and transgender individuals, ≥ 18 years-old, with ≥ 2 male or transgender partners, or recent condomless anal intercourse. Surveys assessed demographics, mental health treatment, depressive symptomatology, social support, and PrEP-related social contacts. Logistic regression assessed associations between these factors and PrEP uptake and persistence.


Patterns Of Postpartum Ambulatory Care Follow-Up Care Among Women With Hypertensive Disorders Of Pregnancy

Aug. 27, 2020

Jennifer Lewey, Lisa D. Levine, Lin Yang, Jourdan E. Triebwasser, Peter W. Groeneveld 

Abstract [from journal]

Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow-up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially


Utilization And Survival Outcomes Of Sequential, Concurrent And Sandwich Therapies For Advanced Stage Endometrial Cancers By Histology

Aug. 13, 2020

Emily M. Ko, Colleen M. Brensinger, Lori Cory, Robert L. Giuntoli 2nd, Ashley F. Haggerty, Nawar A. Latif, Diego Aviles, Lainie Martin, Mark A. Morgan, Lilie L. Lin

Abstract [from journal]

Objective: To determine the impact on overall survival (OS) of different modalities of adjuvant therapy for the treatment of stage III endometrial cancer (EC), by histology.

Methods: Stage 3 endometrioid (EAC), serous (SER), clear cell (CC), and carcinosarcoma (CS) patients who underwent primary surgical staging from 2000 to 2013 were identified in SEER-Medicare. Adjuvant therapy was defined by a 4-arm comparator grouping (none; RT only; CT only; combination RT), as well as by an 8-arm