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.

Neighborhood Socioeconomic Status And Risk Of Hospitalization In Patients With Chronic Kidney Disease: A Chronic Renal Insufficiency Cohort Study

Jesse Yechih Hsu, PhD
Jul. 10, 2020

Milda R. Saunders, Ana C. Ricardo, Jinsong Chen, Amanda H. Anderson, Esteban A. Cedillo-Couvert, Michael J. Fischer, Jesus Hernandez-Rivera, Margaret T. Hicken, Jesse Y. Hsu, Xiaoming Zhang, Denise Hynes, Bernard Jaar, John W. Kusek, Panduranga Rao, Harold I. Feldman, Alan S. Go...

Abstract [from journal]

Patients with chronic kidney disease (CKD) experience significantly greater morbidity than the general population. The hospitalization rate for patients with CKD is significantly higher than the general population. The extent to which neighborhood-level socioeconomic status (SES) is associated with hospitalization has been less explored, both in the general population and among those with CKD.We evaluated the relationship between neighborhood SES and hospitalizations for adults with CKD participating in the Chronic Renal

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Multiple Complications In Emergency Surgery: Identifying Risk Factors For Failure-to-Rescue

Jul. 10, 2020

Justin S. Hatchimonji, Robert A. Swendiman, Elinore J. Kaufman, Dane Scantling, Jesse E. Passman, Wei Yang, M. Kit Delgado, Daniel N. Holena

Abstract [from journal]

Background: While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death.

Methods: We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac,

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Effects Of A Standardized Community Health Worker Intervention On Hospitalization Among Disadvantaged Patients With Multiple Chronic Conditions: A Pooled Analysis Of Three Clinical Trials

Jul. 8, 2020

Aditi Vasan, John W. Morgan, Nandita Mitra, Chang Xu, Judith A. Long, David A. Asch, Shreya Kangovi

Abstract [from journal]

Objective: To analyze the effects of a standardized community health worker (CHW) intervention on hospitalization.

Data sources/study setting: Pooled data from three randomized clinical trials (n = 1340) conducted between 2011 and 2016.

Study design: The trials in this pooled analysis were conducted across diseases and settings, with a common study design, intervention, and outcome measures. Participants were patients living in high-poverty regions of Philadelphia and

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Unsupervised Modeling And Genome-Wide Association Identify Novel Features Of Allergic March Trajectories

John Holmes, PhD
Jul. 7, 2020

Stanislaw J. Gabryszewski, Xiao Chang, Jesse W. Dudley, Frank Mentch, Michael March, John H. Holmes, Jason Moore, Robert W. Grundmeier, Hakon Hakonarson, David A. Hill

Abstract [from journal]

Background: The allergic march refers to the natural history of allergic conditions during infancy and childhood. However, population-level disease incidence patterns do not necessarily reflect the development of allergic disease in individuals. A better understanding of the factors that predispose to different allergic trajectories is needed.

Objective: Determine the demographic and genetic features that associate with the major allergic march trajectories.

Methods: 

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Benchmarking Accomplishments of Leaders In American Surgery And Justification For Enhancing Diversity And Inclusion

Jul. 7, 2020

Paris Butler, Carla Pugh, Elana Meer, Lanair Lett, Estifanos Tilahun, Hilary A. Sanfey, Cherisse Berry, Steven Stain, Ronald DeMatteo, Selwyn Vickers, L. D. Britt, Colin Martin

Abstract

Objective: To comprehensively assess the level of achievement and demographics of national surgical society presidents.

Background: Data on the accomplishments needed to rise to positions of national surgical leadership is scarce and merit alone does not always yield such opportunities. Recognizing the shortcomings of sex and ethnic diversity within academic surgical leadership, the American College of Surgeon (ACS), American Surgical Association (ASA), Association of Women Surgeons (AWS), and the Society of Black Academic Surgeons...

Responding to the Trauma of COVID-19

Jul. 2, 2020

As the country looks to reopen and epidemiologists anticipate future waves of coronavirus (COVID-19) cases, we must address an equally important “pandemic:” the virus’ far-reaching mental health and trauma-related consequences. Whether balancing activities of essential work with exposure risk, bearing witness to suffering or loss, or feeling anguish or guilt for not “doing more” during this time, our society is facing great adversity with potentially devastating consequences.

Healthier Food And Beverage Interventions In Schools: Four Community Guide Systematic Reviews

Jul. 1, 2020

Holly R. Wethington, Ramona K. C. Finnie, Leigh Ramsey Buchanan, Devon L. Okasako-Schmucker, Shawna L. Mercer, Caitlin Merlo, Youfa Wang, Charlotte A. Pratt, Emmeline Ochiai, Karen Glanz, Community Preventive Services Task Force

Abstract [from journal]

Context: Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight.

Evidence acquisition: School obesity prevention programs aiming to improve diet were

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The Income-Based Mortality Gradient Among US Health Care Workers: Cohort Study

Jun. 30, 2020

Sasmira Matta, Paula Chatterjee, Atheendar S. Venkataramani 

Abstract [from journal]

The health care industry is the largest employer in the USA. The health care workforce encompasses a range of occupations that vary widely by income, including home health aides, food service workers, clerical workers, nurses, physicians, and executives....

Practice Gap In Atrial Fibrillation Oral Anticoagulation Prescribing At Emergency Department Home Discharge

Jun. 29, 2020

Bory Kea, Bethany T. Waites, Amber Lin, Merritt Raitt, David R. Vinson, Niroj Ari, Luke Welle, Andrew Sill, Dana Button, Benjamin C. Sun

Abstract [from journal]

Introduction: Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.

Methods: This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from

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Male Partner Testing And Sexual Behaviour Following Provision Of Multiple HIV Self-Tests To Kenyan Women At Higher Risk Of HIV Infection In A Cluster Randomized Trial

Jun. 26, 2020

Sue Napierala, Elizabeth F. Bair, Noora Marcus, Perez Ochwal, Suzanne Maman, Kawango Agot, Harsha Thirumurthy

Abstract [from journal]

Introduction: Without significant increases in uptake of HIV testing among men, it will be difficult to reduce HIV incidence to disease elimination levels. Secondary distribution of HIV self-tests by women to their male partners is a promising approach for increasing male testing that is being implemented in several countries. Here, we examine male partner and couples testing outcomes and sexual decision making associated with this approach in a cluster randomized trial.

Methods: We examined

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Ethical And Regulatory Issues For Embedded Pragmatic Trials Involving People Living With Dementia

Jun. 26, 2020

Emily A. Largent, Spencer Phillips Hey, Kristin Harkins, Allison K. HoffmanSteven Joffe, Julie C. Lima, Alex John London, Jason Karlawish

Abstract [from journal]

Embedded pragmatic clinical trials (ePCTs) present an opportunity to improve care for people living with dementia (PLWD) and their care partners, but they also generate a complex constellation of ethical and regulatory challenges. These challenges begin with participant identification. Interventions may be delivered in ways that make it difficult to identify who is a human subject and therefore who needs ethical and regulatory protections. The need for informed consent, a core human subjects protection, must be considered but can be

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Practices And Perspectives Of Traditional Bone Setters In Northern Tanzania

Neil Sheth, MD
Jun. 16, 2020

Elizabeth B. Card, Joy E. Obayemi, Octavian Shirima, Matayo Lazaro, Honest Massawe, John W. Stanifer, Ajay Premkumar, Neil P. Sheth

Abstract [from journal]

Background: Traditional health practitioners remain a critical source of care in Tanzania, more than 50% of Tanzanians frequently using their services. With a severe shortage of orthopaedic surgeons (1:3.3 million Tanzanians) traditional bone setters (TBSs) could potentially expand access to musculoskeletal care and improve outcomes for morbidity as a result of trauma.

Objective: We sought to identify the advantages and disadvantages of traditional bone setting in Tanzania and to assess

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Comparison of Medical Comorbidities in Medicare Patients Treated by Orthopaedic Surgeons and Neurosurgeons Throughout the USA

Jun. 12, 2020

Alexander Beschloss, John Mueller, Jon-Michael E. Caldwell, Alex Ha, Joseph M. Lombardi, Ali Ozturk, Ronald Lehman, Comron Saifi

Abstract [from journal]

Aims: Medical comorbidities are a critical factor in the decision-making process for operative management and risk-stratification. The Hierarchical Condition Categories (HCC) risk adjustment model is a powerful measure of illness severity for patients treated by surgeons. The HCC is utilized by Medicare to predict medical expenditure risk and to reimburse physicians accordingly. HCC weighs comorbidities differently to calculate risk. This study determines the prevalence of medical comorbidities and the average HCC

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