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.

Exploring The Gap: Food Insecurity And Resource Engagement

Aug. 11, 2020

Danielle Cullen, Dori Abel, Megan Attridge, Joel A. Fein

Abstract [from journal]

Background: Pediatric healthcare institutions are increasingly implementing food insecurity (FI) screens, but there is limited information about participant interest in referral and engagement with resources provided.

Methods: In this descriptive cross-sectional study, we recruited participants from a consecutive sample of adult caregivers arriving with pediatric patients in the ED at an urban, freestanding children's hospital. Caregivers completed a validated, two-question screen for FI. All


Intersectionality and Health Inequities For Gender Minority Blacks In The U.S.

Aug. 10, 2020

Elle Lett, Nadia L. Dowshen, Kellan E. Baker

Abstract [from journal]

Introduction: Gender minority blacks represent the intersection of multiply marginalized populations that experience severe health inequities in the U.S. However, few studies focus on the unique health experiences of this multiply disadvantaged population. This study quantifies the health inequities experienced by gender minority blacks in the U.S. using an intersectional framework.

Methods: This cross-sectional study analyzed data in 2018/2019 from the Behavioral Risk Factor Surveillance System, including all...

Short-Term Psychological Outcomes Of Disclosing Amyloid Imaging Results To Research Participants Who Do Not Have Cognitive Impairment

Jason Karlawish, MD of Penn Medicine
Aug. 10, 2020

Joshua D. Grill, Rema Raman, Karin Ernstrom, David L. Sultzer, Jeffrey M. Burns, Michael C. Donohue, Keith A. Johnson, Paul S. Aisen, Reisa A. Sperling, Jason Karlawish, A4 Study Team

Abstract [from journal]

Importance: The goal of preclinical Alzheimer disease (AD) clinical trials is to move diagnosis and treatment to presymptomatic stages, which will require biomarker testing and disclosure.

Objective: To assess the short-term psychological outcomes of disclosing amyloid positron emission tomography results to older adults who did not have cognitive impairment.

Design, setting, and participants: This observational study included participants who were screening for a


"The More They Know, The Better Care They Can Give": Patient Perspectives On Measuring Functional Status In Primary Care

Rebecca Brown, MD, MPH
Aug. 4, 2020

Francesca M. Nicosia, Malena J. Spar, Alicia Neumann, Molly C. Silvestrini, Maureen Barrientos, Rebecca T. Brown

Abstract [from journal]

Background: Despite its importance to care and outcomes for older adults, functional status is seldom routinely measured in primary care. Understanding patient perspectives is necessary to develop effective, patient-centered approaches for measuring function, yet we know little about patient views on this topic.

Objective: To examine patient and caregiver perspectives on measuring activities of daily living (ADLs) and instrumental ADLs (IADLs).

Design: Qualitative study


Suicide Risk Among Persons Living With HIV

Aug. 3, 2020

Lily A. Brown, Ifrah Majeed, Wenting Mu, Jesse McCann, Stephen Durborow, Song Chen, Michael B. Blank

Abstract [from journal]

Persons living with HIV (PLWH) are significantly more likely to die by suicide compared to the general population. This is the first study to examine the impact of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), insomnia, and substance use disorders on suicidal ideation/behavior among PLWH using electronic medical record (EMR) data. We also evaluated the mutual influence of interactions between PTSD and substance use disorders on suicide risk, consistent with the substance abuse, violence exposure, and HIV/AIDS


Clinical Research In Hepatology In The COVID-19 Pandemic And Post-Pandemic Era: Challenges And The Need For Innovation

Aug. 2, 2020

Elizabeth C. Verna,  Marina Serper,  Jaime Chu,  Kathleen Corey,  Oren K. Fix,  Karen Hoyt,  Kimberly A. Page,  Rohit Loomba,  Ming Li,  Gregory T. Everson,  Michael W. Fried,  Guadalupe Garcia‐Tsao,  Norah Terrault,  Anna S. Lok,  Raymond T. Chung,  K. Rajender Reddy

Abstract [from journal]

The SARS-CoV-2 pandemic has drastically altered all facets of clinical care and research. Clinical research in hepatology has had a rich tradition in several domains, including the discovery and therapeutic development for diseases such as hepatitis B and C, and studying the natural history of many forms of chronic liver disease. NIH, foundation and industry funding has provided important opportunities to advance the academic careers of young investigators while they strived to make contributions to the field. Instantaneously,


Wide Variation in The Percentage of Donation After Circulatory Death Donors Across Donor Service Areas: A Potential Target for Improvement

Aug. 1, 2020

Elizabeth M. SonnenbergJesse Y. HsuPeter P. ReeseDavid S. Goldberg, Peter L. Abt

Abstract [from journal]

Background: Substantial differences exist in the clinical characteristics of donors across the 58 donor service areas (DSAs). Organ procurement organization (OPO) performance metrics incorporate organs donated after circulatory determination of death (DCDD) donors but do not measure potential DCDD donors.

Methods: Using 2011-2016 United Network for Organ Sharing data, we examined the variability in DCDD donors/all deceased donors (%DCDD) across DSAs. We supplemented United Network for Organ


Unemployment Insurance And Food Insecurity Among People Who Lost Employment In The Wake Of COVID-19

Jul. 30, 2020

Julia Raifman, Jacob Bor, Atheendar Venkataramani

Abstract [from journal]

Forty million U.S. residents lost their jobs in the first two months of the coronavirus disease 2019 (COVID-19) pandemic. In response, the Federal Government expanded unemployment insurance benefits in both size ($600/week supplement) and scope (to include caregivers and self-employed workers). We assessed the relationship between unemployment insurance and food insecurity among people who lost their jobs during the COVID-19 pandemic in the period when the federal unemployment insurance supplement was in place. We analyzed data from


Hepatitis C and The Layering of Disease-Related Stigma

Jul. 28, 2020
“That's exactly how I feel like they look at you. Like, ‘You on drugs, you dirty, you homeless, you don't got nowhere to take yourself, staying yourself and take yourself.’ Why should they try to help you and give you the best care possible? For what? They could save it for somebody else that's doing all the right things versus give it to the people that's doing all the wrong things.” – HIV/HCV-coinfected study participant

Getting To Complete And Accurate Medication Lists During The Transition To Home Health Care

Jul. 25, 2020

Claire Champion, Paulina S. Sockolow, Kathryn H. Bowles, Sheryl Potashnik, Yushi Yang, Carl Pankok Jr, Natasha Le, Elease McLaurin, Ellen J. Bass

Abstract [from journal]

Objectives: Characterize the work that home health care (HHC) admission nurses complete as part of the medication reconciliation tasks, explore the impact of shared electronic medication data (interoperability) from the referral source on medication reconciliation, and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies.

Design: Observational field study.

Settings and participants: Three diverse Pennsylvania


Observational Study Assessing Changes In Timing Of Readmissions Around Postdischarge Day 30 Associated With The Introduction Of The Hospital Readmissions Reduction Program

Jul. 21, 2020

Ashwin S. Nathan, Joseph R. Martinez, Jay Giri, Amol S. Navathe

Abstract [from journal]

Background: The Hospital Readmissions Reduction Program (HRRP) initially penalised hospitals for excess readmission within 30 days of discharge for acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA) and was expanded in subsequent years to include readmissions for chronic obstructive pulmonary disease, elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass graft surgery. We assessed whether HRRP was associated with delays in readmissions from immediately


Overdose Awareness And Reversal Trainings At Philadelphia Public Libraries

Jul. 14, 2020

Margaret Lowenstein, Rachel Feuerstein-Simon, Roxanne Dupuis, Allison Herens, Jeffrey Hom, Meghana Sharma, Risha Sheni, Lonard Encarnacion, Carina Flaherty, Maria Cueller, Carolyn Cannuscio

Abstract [from journal]

Purpose: To evaluate an overdose response training program in public libraries.

Design: Mixed methods evaluation including pre- and post-intervention questionnaires and debriefing interviews.

Setting: Ten Philadelphia public libraries.

Sample: Overdose response training participants (library staff and community members).

Intervention: Public, hour-long overdose response trainings run by the Philadelphia Department of