Disparities and Health Equity

The differences in ability to access health care and in health outcomes across the population.

Dissatisfaction with Medical and Surgical Residency Training Is Consistently Higher for Women than for Men

Nov. 11, 2019

C. Jessica Dine, Manqing Liu, David A. Asch, Lisa M. Bellini, Karl Y. Bilimoria, Sanjay V. Desai, Judy A. Shea

Abstract [from journal]

In an attempt to balance service and education, there is a renewed focus on trainee work experiences and job satisfaction. Overall measures of dissatisfaction likely disguise differences across defined subgroups, particularly men and women, known to experience job satisfaction and burnout differently across professions. A previous study showed gender differences in satisfaction during surgical residency training. The objective of this study was to determine gender differences in dissatisfaction with specific aspects of the institutional environment and with...

Comparing Rates of Adverse Events and Medical Errors on Inpatient Psychiatric Units at Veterans Health Administration and Community-Based General Hospitals

Nov. 1, 2019

Sara W. Cullen, Ming Xie, Jentien M. Vermeulen, Steven C. Marcus

Abstract [from journal]

Objective: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes. This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals.

Method: Retrospective medical record reviews assessed the prevalence of


Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients

Marilyn M. Schapira, MD, MPH
Oct. 28, 2019

Marilyn Schapira, Arshia Faghri, Elizabeth Jacobs, Kathlyn Fletcher, Pamela Ganschow, Denise Gil, Alicia Smallwood, Cindy Walker, Joan Neuner

Abstract [from journal]

Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and


Healthcare Utilization for Children in Foster Care

Oct. 14, 2019

Colleen E.Bennett, Joanne N.Wood, Philip V.Scribano

Abstract [from journal]

Objective: To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) healthcare utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and, 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.

Methods: Children ≤18 years old with a designation of FC placement and controls matched on age, race/


Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review

Oct. 9, 2019

Stacey Bevan, Jianghong Liu, Kate Wallis, Jennifer Pinto-Martin

Abstract [from journal]

Background: Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the...

Complete Eats: Summer Meals Offered by the Emergency Department for Food Insecurity

Oct. 1, 2019

Danielle Cullen, Abigail Blauch, Morgan Mirth, Joel Fein

Abstract [from journal]

More than 21 million low-income children rely on free or reduced-price meals during the school year. The US Department of Agriculture Summer Food Service Program (SFSP) provides meals to children during the summer months, but these programs are underused. The emergency department (ED) of urban medical centers is 1 of the few establishments that children access during the summer months, and as such, it may be a prime point of entry for such programs. This advocacy case study describes the implementation and evaluation of situating an SFSP in the


Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Mixed Studies Review of Factors Influencing Receipt of Pain Treatment by Injured Black Patients

Sep. 30, 2019

Shoshana V. Aronowitz, Catherine C. McDonald, Robin C. Stevens, Therese S. Richmond

Abstract [from journal]

Aim: To explore the factors that influence provider pain treatment decision making and the receipt of pain management by injured Black patients in the United States.

Design: We completed a systematic mixed studies review using a results-based convergent synthesis design.

Data source: PubMed, SCOPUS, and CINAHL were searched for articles published between 2007-2017 using the search terms "African American", "Black American", "race", "pain treatment", "pain management", and "analgesia".


Nonadherence Labeling in Primary Care: Bias by Race and Insurance Type for Adults With Type 2 Diabetes

Peter Cronholm, MD, MSCE
Sep. 24, 2019

Sourik Beltrán, Lanair A.Lett, Peter F.Cronholm

Abstract [from journal] 

Introduction: Little is known about how provider bias can influence nonadherence labeling. Therefore, a retrospective cohort analysis was conducted to assess the risk of patients with Type 2 diabetes being labeled nonadherent by sociodemographic factors.

Methods: Patients with Type 2 diabetes were identified from 4 primary care sites of the University of Pennsylvania Health System. Demographics, HbA1c, and ICD-10 codes for Type 2 diabetes and nonadherence were extracted from the electronic health


Fast-tracking Behavioral Health Care

Sep. 17, 2019

Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.