Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

Racial, Gender, and Socioeconomic Disparities in Liver Transplantation

Jan. 25, 2021

Lauren D. Nephew, Marina Serper

Abstract [from journal]

Liver transplantation (LT) is a life-saving therapy; therefore, equitable distribution of this scarce resource is of paramount importance. We searched contemporary literature on racial, gender, and socioeconomic disparities across the LT care cascade in referral, waitlisting practices, allocation, and post-LT care. We subsequently identified gaps in the literature and future research priorities. Studies found that racial and ethnic minorities (Black and Hispanic patients) have lower rates of LT referral, more advanced liver disease


Implementation of a Calculator To Predict Cesarean During Labor Induction: A Qualitative Evaluation of the Clinician Perspective

Jan. 22, 2021

Rebecca F. Hamm, Lisa D. Levine, Maria N. Nelson, Rinad Beidas

Abstract [from journal]

Background: We previously conducted a prospective cohort study (n=1610) demonstrating that implementation of a validated calculator to predict likelihood of cesarean delivery during labor induction was associated with reduced maternal morbidity, reduced cesarean delivery rate, and improved birth satisfaction.

Objective: To optimize future implementation, we used qualitative interviews to understand the clinician perspective on: (1) the cesarean risk calculator implementation, and (2) the


Timing and Efficacy of Mifepristone Pretreatment for Medical Management of Early Pregnancy Loss

Jan. 18, 2021

Anne N. Flynn, Andrea H. Roe, Nathanael Koelper, Arden McAllister, Mary D. Sammel, Courtney A. Schreiber

Abstract [from journal]

Objectives: To determine the time interval between mifepristone and misoprostol administration associated with the most efficacious early pregnancy loss (EPL) management.

Study design: We performed a secondary analysis of a randomized trial. Participants with EPL were instructed to take 200 mg oral mifepristone followed by 800 mcg vaginal misoprostol 24 hours later. The primary outcome was gestational sac expulsion at the first follow-up visit (1-4 days after misoprostol use) after a single


Leveraging the Work Environment To Minimize the Negative Impact of Nurse Burnout on Patient Outcomes

Jan. 12, 2021

Amelia E. SchlakLinda H. Aiken, Jesse Chittams, Lusine Poghosyan, Matthew McHugh

Abstract [from journal]

Background: Burnout remains a persistent issue affecting nurses across the US health system. Limited evidence exists about the direct impact of nurse burnout on patient outcomes. This study explores the relationship between nurse burnout and mortality, failure to rescue, and length of stay, while also considering the effect of a good work environment.

Methods: Cross sectional data from nurses and hospitals were used in conjunction with patient claims data. Multivariate logistic regression was


Lessons Learned From the Implementation of a Video Health Coaching Technology Intervention to Improve Self-Care of Family Caregivers of Adults With Heart Failure

Dec. 20, 2020

Karen B. Hirschman, Kathryn H. Bowles, Lydia Garcia-Gonzalez, Brooke Shepard, Tracie J. Walser, Gladys L. Thomas, Michael A. StawnychyBarbara Riegel

Abstract [from journal]

Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients ("Virtual Caregiver Coach for You"-ViCCY). A randomized controlled trial is currently in progress


The Changing Landscape of Community Mental Health Care: Availability of Treatment Services in National Data, 2010-2017

Dec. 18, 2020

Janet R. Cummings, Joseph L. Smith, Sara W. Cullen, Steven C. Marcus

Abstract [from journal]

Objective: The authors sought to describe changes in availability of crisis and substance use treatment services in U.S. mental health facilities (including outpatient and inpatient facilities) from 2010 to 2017.

Methods: Using National Mental Health Services Survey data, the authors of this descriptive study examined changes in the proportion of facilities providing crisis and substance use treatment services during the 2010-2017 period.



Patient and Staff Perceptions of Universal Severe Acute Respiratory Syndrome Coronavirus 2 Screening Prior to Cardiac Catheterization and Electrophysiology Laboratory Procedures

Dec. 4, 2020

Naga Venkata K. Pothineni, Samantha Starkey, Kristine Conn, Christina Evans, Ronak Shah, Matthew C. Hyman, David S. Frankel, Rim Halaby, Hillary A. Johnston-Cox, Katherine Kunkel, Ashwin S. Nathan, Matthew E. Seigerman, Howard C. Herrmann, Jay Giri, Francis E....

Abstract [from journal]

In response to the coronavirus disease 2019 (COVID-19) pandemic many cardiac catheterization and electrophysiology laboratories canceled elective procedures to limit the burden on hospital resources. A major challenge in resuming elective procedures is the risk of exposing patients and health care personnel (HCP) to carriers of the virus. To facilitate procedure resumption, the Hospital of the University of Pennsylvania began testing all patients scheduled for elective and urgent catheterization and electrophysiology procedures for severe acute...

Mobile Health (mHealth) Technology: Assessment of Availability, Acceptability, and Use in CKD

Dec. 3, 2020

Sarah J. Schrauben, Lawrence Appel, Eleanor Rivera, Claudia M. Lora, James P. Lash, Jing Chen, L. Lee Hamm, Jeffrey C. Fink, Alan S. Go, Raymond R. Townsend, Rajat Deo, Laura M. Dember, Harold I. Feldman, Clarissa J. Diamantidis, CRIC Study...

Abstract [from journal]

Rationale & objective: Digital and mobile health (mHealth) technologies improve patient-provider communication and increase information accessibility. We assessed technology use, attitudes toward using mHealth technologies, and the proficiency in using mHealth technologies among individuals with chronic kidney disease (CKD).

Study design: Cross-sectional survey with open text responses SETTING & PARTICIPANTS: Chronic Renal Insufficiency Cohort Study participants who completed current


Trends in Oral Anticoagulant Co-Prescription With Antiepileptic Drugs Among Adults With Epilepsy, 2010–2018

Allison Willis, MD
Dec. 1, 2020

Emily K. Acton, Michael A. Gelfand, Sean Hennessy, Sharon X. Xie, John R. Pollard, Scott E. Kasner, Allison W. Willis

Abstract [from journal]

Treatment considerations for epilepsy patients requiring anticoagulation are changing, and actual prescribing practices have not been characterized. We used the 2010-2018 Optum Clinformatics® Data Mart Database to estimate the annual prevalence and distinguish the patterns of oral anticoagulants (OACs) co-dispensed with antiepileptic drugs (AEDs) among adults with epilepsy. Monotonic trends were assessed using the Spearman rank correlation coefficient (ρ). Multivariable logistic regression models were built to evaluate the


Greater Self-Reported Preference for Fat Taste and Lower Fat Restraint Are Associated With More Frequent Intake of High-Fat Food

Douglas Wiebe, PhD, University of Pennsylvania
Nov. 25, 2020

Agata Chmurzynska, Monika A. Mlodzik-Czyzewska, Anna M. Malinowska, Anna Radziejewska, Joanna Mikołajczyk-Stecyna, Ewa Bulczak, Douglas J. Wiebe

Abstract [from journal]

The determinants of the intake of high-fat products are not well recognized, but fat preference may be one of them. The aim of this study was thus to determine whether intake of different types of high-fat food is associated with fat preference in people with normal and increased body weight. Participants aged 20-40 years [n = 421] were enrolled in Poznań, Poland in 2016-2018. Fat preference was measured using the Fat Preference Questionnaire. Self-reported preference for fat taste (TASTE) and fat restraint (DIFF) scores were


Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study

George Demiris, Penn Nursing School
Nov. 10, 2020

Yong K. Choi, Hilaire J. Thompson, George Demiris

Abstract [from journal]

Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents' safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined.

Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart


Developing the TIC Grade: A Youth Self-Report Measure of Perceptions of Trauma-Informed Care

Laura Sinko
Nov. 9, 2020

Laura Sinko, Dana Beck, Julia Seng

Abstract [from journal]

Background: Service delivery organizations are advancing the provision of trauma-informed care (TIC) for youth to improve outcomes. However, currently there are no validated, reliable evaluation measures to capture the voices of adolescent clients and how well they perceive TIC implementation.

Aims: The purpose of this project was to create an evaluation measure with strong content validity for adolescent health and service users to give feedback to organizations about their implementation of


Predictors Of Mortality In Older Adults With Epilepsy: Implications For Learning Health Systems

Allison Willis, MD
Oct. 21, 2020

Leah J. Blank, Emily K. Acton, Allison W. Willis

Abstract [from journal]

Objective: To determine the incidence of epilepsy and subsequent 5-year mortality among older adults, as well as characteristics associated with mortality.

Methods: Retrospective cohort study of Medicare beneficiaries age 65 or above with at least 2 years enrollment before January 2009. Incident epilepsy cases were identified in 2009 using ICD-9-CM code-based algorithms; death was assessed through 2014. Cox regression models examined the association between 5-year mortality