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.

Unmet Nursing Care Linked to Rehospitalizations Among Older Black AMI Patients: A Cross-Sectional Study of US Hospitals

Apr. 22, 2016

Margo Brooks-Carthon, Karen Lasater, Jessica Rearden, Sara Holland, Douglas Sloane 

In Medical Care, Margo Brooks-Carthon and colleagues, including Karen Lasater, investigate the differences in the relationship between nursing care left undone and acute myocardial infarction readmissions among older black patients compared with older white patients. Brooks-Carthon and colleagues used multiple datasets, including 2006 to 2007 administrative discharge data, a survey of registered nurses, and the American Hospital Association Annual Survey to estimate the association between care left undone, 30-day readmission, and the impact of race on this interaction. The sample...

"Look Like You Belong"

Apr. 18, 2016

[Editor's note: Penn Medicine recently sponsored a week-long series of events challenging all of us to address health equity in our work. One of these events was a 'story slam' in which a series of speakers told stories that testified to the impact of health inequities, here and abroad. This is one of those stories, by a former LDI SUMR Scholar.]

Educating Health Professionals on Social Determinants of Health

Apr. 6, 2016

Health professionals are ill-prepared to address social factors that contribute to poor health, because these factors often lie beyond the scope of medical education. But just as addressing social determinants of health (SDH) involves stretching beyond traditional medical practices, educating health professionals involves stretching beyond traditional medical education.

The Digital Hood: Social Media Use Among Youth In Disadvantaged Neighborhoods

Mar. 29, 2016

Robin Stevens, Stacia Gilliard-Matthews, Jamie Dunaev, Marcus Woods, Bridgette Brawner

In New Media & Society, Robin Stevens and colleagues examine the role of social media in the lives of youth living in disadvantaged neighborhoods. Stevens conducted semi-structured interviews with 30 female and 30 male youths about their social worlds and neighborhoods, both online and offline. The study took place in predominantly African American and Hispanic neighborhoods. The researchers discovered a dynamic and concerning interplay between the geographic neighborhood and digital neighborhood, whereby negative social interactions in the geographic neighborhood are...

Adverse Childhood Experiences: Expanding the Concept of Adversity

Mar. 14, 2016

Peter Cronholm, Christine Forke, Roy Wade, Megan Bair-Merritt, Martha Davis, Mary Harkins-Schwarz, Lee Pachter, Joel Fein

In the American Journal of Preventive Medicine, Peter Cronholm and colleagues investigate whether Conventional Adverse Childhood Experiences (ACEs) alone can sufficiently measure adversity, particularly among various subgroups. Current knowledge of childhood adversity relies on data predominantly collected from white, middle- /upper-middle-class participants and focuses on experiences within the home. Expanded ACEs were designed to capture unmeasured community-level experiences of socioeconomically and racially urban population. The researchers asked participants from a previous...

The Role of Social Determinants in Explaining Racial/Ethnic Disparities in Perinatal Outcomes

Mar. 14, 2016

Scott Lorch, Elizabeth Enlow

In Pediatric Research, Scott Lorch and Elizabeth Enlow review evidence on the association of social determinants of health on racial/ethnic disparities in preterm birth rates, infant mortality and fetal mortality. The authors find that much of the current literature on racial/ethnic disparities in perinatal outcomes describes the phenomenon without exploring mediating causes of these disparities that may be easily modifiable. Studies that do examine these intermediate steps typically concentrate on only a single mediator, without examining the contribution of other potential...

Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries

Feb. 17, 2016

Justin Bekelman, Scott Halpern, Carl Rudolf Blankart, Julie Bynum, Joachim Cohen, Robert Fowler, Stein Kaasa, Lukas Kwietniewski, Hans Olav Melberg, Bregie Onwuteaka-Philipsen, Mariska Oosterveld-Vulg, Andrew Pring, Joans Schreyogg, Connie Ulrich...

In The Journal of the American Medical Association, Justin Bekelman and colleagues, including Scott Halpern, Connie Ulrich and Ezekiel Emanuel compare site of death, health care utilization and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the United States. Using administrative and registry data, the researchers measured deaths in acute care hospital, along with inpatient and outpatient measures, and hospital expenditures paid by insurers. They find that a smaller proportion of decedents, older than 65, died in acute...

Liver transplant center variability in accepting organ offers and its impact on patient survival

Feb. 17, 2016

David Goldberg, Benjamin French, James Lewis, Frank Scott, Ronac Mamtani, Richard Gilroy, Scott Halpern, Peter Abt

In the Journal of Hepatology, David Goldberg and colleagues, including Benjamin French, James Lewis and Scott Halpern, explore whether transplant centers vary in their propensities to decline organs for the highest priority patients, and how these decisions impact patient outcomes. The authors analyzed Organ Procurement and Transplantation Network (OPTN) data from 2007-2013, and evaluated acceptance rates of liver offers for the highest ranked patients and their subsequent waitlist mortality. Even after adjusting for organ quality and recipient severity of illnesses, the study...