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.

Pathways To Help-Seeking Among Black Male Trauma Survivors: A Fuzzy Set Qualitative Comparative Analysis

Jun. 9, 2020

John A. Rich, Theodore J. Corbin, Sara F. Jacoby, Jessica L. Webster, Therese S. Richmond

Abstract [from journal]

Many Black men suffer symptoms of traumatic stress in the aftermath of traumatic injury, and they also often carry social concerns, including experiences of discrimination and stigma, and a lack of financial resources. The objective of the present study was to understand how traumatic symptoms and social factors combine in complex ways toward the outcome of psychological help-seeking. We analyzed qualitative and quantitative data from 32 injured Black men admitted to a Level 1 trauma center. Qualitative interviews explored their

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Models For Acute On Chronic Liver Failure Development And Mortality In A Veterans Affairs Cohort

Jun. 9, 2020

Karen Y. Xiao, Rebecca A. Hubbard, David E. Kaplan, Tamar H. Taddei, David S. Goldberg, Nadim Mahmud

Abstract [from journal]

Background and purpose: The diagnosis of acute on chronic liver failure (ACLF) carries a high short-term mortality, making early identification of at-risk patients crucial. To date, there are no models that predict which patients with compensated cirrhosis will develop ACLF, and limited models exist to predict ACLF mortality. We sought to create novel risk prediction models using a large North American cohort.

Methods: We performed a retrospective study of 75,922 patients with compensated

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Reported Needs And Depressive Symptoms Among Older Adults Entering Long-Term Services And Supports

Jun. 9, 2020

Eleanor Rivera, Karen B. Hirschman, Mary D. Naylor

Abstract [from journal]

Background and objectives: Long-term services and supports (LTSS) are vital for older adults with physical and cognitive disabilities. LTSS can be provided in settings such as nursing homes, assisted living, or via community-based services. During the transition to LTSS, older adults are at risk of increased depressive symptoms. In addition, older adults may identify unmet needs despite having access to new LTSS resources. The goal of this study was to examine the factors associated with increased depressive symptoms

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A Standardized Labor Induction Protocol: Impact on Racial Disparities in Obstetrical Outcomes

Jun. 5, 2020

Rebecca F. Hamm, Sindhu K. Srinivas, Lisa D.Levine

Abstract [from journal]

Background: There are marked disparities between black and nonblack women in the United States in birth outcomes. Yet, there are little data on methods to reduce these disparities. Although the cause of racial disparities in health is multifactorial, implicit bias is thought to play a contributing role. To target differential management, studies in nonobstetrical populations have demonstrated disparity reduction through care standardization. With wide variation by site and provider, labor management

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Breastfeeding Education In Family Medicine Residencies: A 2019 CERA Program Directors Survey

Peter Cronholm, MD, MSCE
Jun. 1, 2020

Zeynep Uzumcu, Mary Beth Sutter, Peter F. Cronholm

Abstract [from journal]

Background and objectives: Breastfeeding counseling is an integral skill for all family physicians, regardless of whether they ultimately practice maternal child health (MCH). Evidence on time spent in breastfeeding education and resident competence is lacking. This study aimed to identify program characteristics associated with an increase the amount of breastfeeding education and program directors' (PDs) perceived competence of residents' breastfeeding counseling skills.

Methods: A national

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Physicians And Students Take To The Streets To Ask: What Do People Want From Their Health Care?

Jun. 1, 2020

Kimberly DiGioia, Mohit Nair, Morgan Shields, Vikas Saini

Abstract [from journal]

With the aim of better understanding what the public (as opposed to "patients") wants from health care, this study asked people on the street, "What does the right health care mean to you?" Responses ranged from "Caring about me more than just in the appointment" to "That everyone should see exactly what medical treatment costs." A qualitative analysis revealed that all responses fell into 2 overarching categories: health care at the interpersonal level and health care at the system level. Approximately 66.7% of responses included

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Racial/Ethnic Disparities Among Extremely Preterm Infants In The United States From 2002 To 2016

Jun. 1, 2020

Colm P. Travers, Waldemar A. Carlo, Scott A. McDonald, Abhik Das , Namasivayam Ambalavanan, Edward F. Bell, Pablo J. Sánchez, Barbara J. Stoll, Myra H. Wyckoff, Abbot R. Laptook, Krisa P. Van Meurs, Ronald N. Goldberg, Carl T. D'Angio, Seetha Shankaran, Sara B. DeMauro, Michele C. Walsh, Myriam...

Abstract [from journal]

Importance: Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes.

Objective: To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants.

Design, setting, and participants: This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks'

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Kidney Transplantation and Donation in the Transgender Population: A Single‐Institution Case Series

Omar Ramadan, MD
Apr. 30, 2020

Omar I. Ramadan, Ali Naji, Matthew H. Levine, Paige M. Porrett, Ty B. Dunn, Susanna M. Nazarian, Robert M. Weinrieb, Mary Kaminski, David Johnson, Jennifer Trofe‐Clark, Ilona S. Lorincz, Emily A. Blumberg, Blair C. Weikert, Melissa Bleicher, Peter L. Abt

Abstract [from journal]

The medical needs of the transgender population are increasingly recognized within the US health care system. Hormone therapy and gender‐affirming surgery present distinct anatomic, hormonal, infectious, and psychosocial issues among transgender kidney transplant donors and recipients. We present the first reported experience with kidney transplantation and donation in transgender patients. A single‐center case series (January 2014‐December 2018) comprising 4 transgender kidney transplant recipients and 2 transgender living donors was

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Effect Of Patient Education On Palliative Care Knowledge And Acceptability Of Outpatient Palliative Care Services Among Gynecologic Oncology Patients: A Randomized Controlled Trial

Feb. 1, 2020

Ashley Graul, Ashley Haggerty, Carolyn Stickley, Knashawn Morales, Hillary Bogner, Robert Burger, Mark Morgan, Emily Ko

Abstract [from journal]

Objectives: A randomized control trial (RCT) to estimate the effect of an interventional video on improving palliative care knowledge, acceptability and attendance to outpatient services in gynecologic oncology patients.

Methods: Women receiving treatment for gynecologic malignancy recruited at an academic tertiary care center were randomized to: palliative care educational video or non-directive cancer center video. The primary outcome was referral to

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