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.

Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center

Sep. 19, 2016

Anna U. Morgan, David T. Grande, Tamala Carter, Judith A. Long, Shreya Kangovi

In the American Journal of Public Health, Anna Morgan and colleagues, including Dave Grande, Judith Long, and Shreya Kangovi, describe the process by which Penn’s Center for Community Health Workers grew from a small grant-funded research project into a robust program serving 2,000 patients annually and funded through the health system’s operational budget. The authors describe an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. The case illustrates a path toward sustainability for other community-based...

Acute Health Care Utilization among Food-Insecure Children in Primary Care Practices

Sep. 13, 2016

Deepak Palakshappa, Saba Khan, Chris Feudtner, and Alexander G. Fiks

In the Journal of Health Care for the Poor and Underserved, Deepak Palakshappa and colleagues, including Chris Feudtner and Alexander Fiks, investigate the relationship between food insecurity and child health care utilization. They test whether differences in child health care utilization can predict household food insecurity and whether food insecurity is associated with subsequent acute health care use. This prospective cohort study involved 3,335 children screened for food insecurity at three-year well-child visits in three urban practices. The authors evaluated acute care use...

Using Video from Mobile Phones to Improve Pediatric Phone Triage in an Underserved Population

Aug. 19, 2016

Brandi Freeman, Stephanie Mayne, A. Russell Localio, Anthony Luberti, Joseph J. Zorc, and Alexander G. Fiks

In Telemedicine and Health, Brandi Freeman and colleagues, including LDI Senior Fellow Alexander Fiks, assess the feasibility, acceptability, and utility of videos sent via mobile phones to enhance pediatric telephone triage for an underserved population with asthma. Asthma is a leading cause of childhood hospitalization, disability and healthcare-related cost. Asthma disproportionately affects Black and Hispanic children, and these populations have been shown to be more likely to use the emergency department as a routine source of sick care. Moreover, telephone triage systems...

Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities

Research Brief
Aug. 8, 2016

Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?

Racial Disparities in Geographic Access to Primary Care in Philadelphia

Research Brief
Aug. 8, 2016

Geographic access to primary care providers is usually considered a problem of rural areas, rather than of more densely populated urban ones. But the supply of primary care providers may be inadequate in certain neighborhoods even if the number of providers for the population is adequate for the city as a whole.The authors conducted a spatial analysis of census tracts in Philadelphia to assess the supply of primary care providers, quantify differences in supply that might contribute to disparities, and determine population characteristics associated with variations in geographic access. They calculated the ratio of adults-per-primary-care-provider in each tract using a five-minute travel time from the center of each census tract. They wanted to know if the overall number of providers in a city obscures significant differences across neighborhoods, and if so, whether low-access neighborhoods are more likely to be found in areas with large concentrations of racial and ethnic minorities.  

Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions

Aug. 5, 2016

Jeffrey H. SilberPaul R. Rosenbaum, Wei Wang, Shawna Calhoun, James P. Guevara, Joseph J. Zorc, Orit Even-Shoshan

In Pediatrics, Jeffrey Silber and colleagues investigate whether Medicaid and non-Medicaid patients admitted to the hospital for asthma are treated differently in major children’s hospitals. Medicaid provider reimbursement levels can be significantly lower than private insurance reimbursements, making it important to analyze whether this impacts the health care received by Medicaid beneficiaries. The authors used data from 40 children’s hospitals to analyze more than 17,000 matched pairs of Medicaid to non-Medicaid children admitted for asthma in the same hospital over three years...

Accounting for Social Risk Factors in Medicare Payment: Third National Report

Jul. 19, 2016

How should social risk factors enter into Medicare’s value-based payments to hospitals? The answer goes beyond an arcane discussion of payment policy; it has a direct impact on hospital bottom lines and the quality of care provided to underserved communities.  A new report from the National Academies of Sciences, Engineering, and Medicine—the third in a series of five—lays out criteria and methods to account for social risk factors in Medicare payment.  

Non-surgical management of ovarian cancer: Prevalence and implications

Jun. 9, 2016

David I. Shalowitz, Andrew J. Epstein, Emily M. Ko, Robert L. Giuntoli

In Gynecologic Oncology, David Shalowitz and colleagues, including Andrew Epstein, analyze the prevalence of non-surgical treatment for ovarian cancer, the reasons behind this in cases where surgery would have been clinically appropriate, and implications for survival rates. The authors find that one in five patients with ovarian cancer do not undergo surgery, which goes against best-practice guidelines. Surgery has been shown to significantly improve survival rates for ovarian cancer compared with non-surgical treatment. The largest determinant of whether a patient had surgical...

Gender of the Clinician, Child, and Guardian and the Association With Receipt of Routine Adolescent Vaccines

May. 17, 2016

Laura Johnson Faherty, Benjamin French, Alexander Fiks

In the Journal of Adolescent Health, Laura Johnson Faherty and colleagues, including Benjamin French and Alexander Fiks, investigate the relationship of the gender of the clinician, child and guardian to the child’s receipt of human papilloma virus (HPV) vaccine compared to tetanus, diphtheria, acellular pertussis (Tdap) and meningococcal dose 1 (MCV4) vaccines. Faherty and colleagues used electronic health record data from visits by adolescents to 27 primary care practices from 2009 to 2014 and stratified visits by type (preventive/acute). Adolescents were more likely to be...

The Health Status and Well-Being of Low-Resource, Housing-Unstable, Single-Parent Families Living in Violent Neighborhoods in Philadelphia, Pennsylvania

May. 11, 2016

Sara Jacoby, Laura Tach, Terry Guerra, Douglas Wiebe, Therese Richmond

In Health and Social Care, Sara Jacoby and colleagues, including Terry Guerra, Douglas Wiebe, and Therese Richmond, investigate the health and well-being of single-parent families in public housing, and living in violent neighborhoods. The authors designed a two-phase, mixed methods study: in phase 1, data collected using standardized health status instruments were used to describe the health of the participating families in comparison to population norms; in phase 2, daily activity mapping, surveys and interviews of parents and children were collected to assess how these family...