Health Behavior & Communication

Incentives and communication strategies that influence behaviors affecting health. LDI Senior Fellows study financial and non-financial incentives that promote healthy behaviors, and how individuals and communities receive and exchange health information.

National Shifts in Outpatient Care for Patients With Cirrhosis

Nov. 24, 2020

As the U.S. enters the tenth month of the COVID-19 pandemic, it is hard to imagine a time when telemedicine was not a mainstay of health care delivery, particularly in the care of vulnerable patients. However, few studies have examined the scale of how outpatient care has changed at the national level, and whether the changes have been sustained beyond the early months of the pandemic.

Assessment Of 135794 Pediatric Patients Tested For Severe Acute Respiratory Syndrome Coronavirus 2 Across The United States

Christopher B. Forrest, MD, PhD
Nov. 23, 2020

L. Charles Bailey, Hanieh Razzaghi, Evanette K. Burrows, H. Timothy Bunnell, Peter E. F. Camacho, Dimitri A. Christakis, Daniel Eckrich, Melody Kitzmiller, Simon M. Lin, Brianna C. Magnusen, Jason Newland, Nathan M. Pajor, Daksha Ranade, Suchitra Rao, Olamiji Sofela, Janet Zahner, Cortney Bruno...

Abstract [from journal]

Importance: There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and infection among pediatric patients across the United States.

Objective: To describe testing for SARS-CoV-2 and the epidemiology of infected patients.

Design, setting, and participants: A retrospective cohort study was conducted using electronic health record data from 135 794 patients younger than 25 years who were tested for SARS-CoV-2 from January 1


Assessing the Role of Gay Community Attachment, Stigma, and PrEP Stereotypes on Young Men Who Have Sex With Men's PrEP Uptake

Nov. 19, 2020

Steven Meanley, Daniel Connochie, Seul Ki Choi, Stephen Bonett, Dalmacio D. FloresJosé A. Bauermeister

Abstract [from journal]

Negative stereotypes about pre-exposure prophylaxis (PrEP) hinder PrEP uptake among young men who have sex with men (YMSM). Prior research suggests community homophobia may be linked to negative PrEP attitudes. Conversely, individuals with high gay community attachments (GCA) may have more access to credible PrEP information/resources. Among 285 YMSM recruited online, we estimated structural equation models to test competing conceptual models that inform pathways from perceived stigmas, GCA, and negative PrEP stereotype endorsements


Socioeconomic Barriers to Prenatal Diagnosis of Critical Congenital Heart Disease

Nov. 10, 2020

Matthew J. CampbellScott Lorch, Jack Rychik, Michael D. Quartermain, Molly Passarella, Peter W. Groeneveld

Abstract [from journal]

Objective: The study was designed to assess the impact of socioeconomic barriers on the rate of prenatal diagnosis of critical congenital heart disease (CCHD).

Methods: This was a retrospective review of the Medicaid analytic extract (MAX) dataset, a national Medicaid administrative claims database with linked maternal-infant claims, from 2007 to 2012. Infants with CCHD were identified by searching for International Classification of Diseases (ICD) 9 codes and Procedural Coding System (PCS)


How Do Claims-Based Measures Of End-Of-Life Care Compare To Family Ratings Of Care Quality?

Nov. 9, 2020

Thomas J. Christian, Andrea Hassol, Gabriel A. Brooks, Qian Gu, Seyoun Kim, Mary Beth Landrum, Nancy L. Keating

Abstract [from journal]

Objectives: Assess whether frequently-used claims-based end-of-life (EOL) measures are associated with higher ratings of care quality.

Design: Retrospective cohort study.

Setting/participants: Deceased fee-for-service Medicare beneficiaries with cancer who underwent chemotherapy during July 2016 to January 2017 and died within 12 months and their caregiver respondents to an after-death survey (n = 2,559).

Measurements: We examined claims-based


A Tertiary Care-based Complex Care Program: Improving Care for Children with Medical Complexity

David M. Rubin, MD, MSCE
Nov. 1, 2020

Annique K. Hogan, Meghan M. Galligan, Noelle J. Stack, Kathryn F. Leach, Brenna L. Aredas, Rachel English, Matthew Dye, David Rubin

Abstract [from journal]

Objective: Children with medical complexity (CMC) have significant health care costs, but they also experience substantial unmet health care needs, hospitalizations, and medical errors. Their parents often report psychosocial stressors and poor care satisfaction. Complex care programs can improve the care for CMC. At our tertiary care institution, we developed a consultative complex care program to improve the quality and cost of care for CMC and to improve the experience of care for patients and families.


Identifying Ethical Considerations For Machine Learning Healthcare Applications

Nov. 1, 2020

Danton S. Char, Michael D Abràmoff, Chris Feudtner

Abstract [from journal]

Along with potential benefits to healthcare delivery, machine learning healthcare applications (ML-HCAs) raise a number of ethical concerns. Ethical evaluations of ML-HCAs will need to structure the overall problem of evaluating these technologies, especially for a diverse group of stakeholders. This paper outlines a systematic approach to identifying ML-HCA ethical concerns, starting with a conceptual model of the pipeline of the conception, development, implementation of ML-HCAs, and the parallel pipeline of evaluation and


Improving Emergency Care for Children with Complex Conditions

Oct. 29, 2020

Only about 1% of children in the U.S. are considered medically complex, but when you work in a busy Children’s Hospital Emergency Department (ED) in a large urban area, the prevalence seems much higher. We see a range of children with complex conditions, such as severe asthma coupled with significant eczema, metabolic disorders, and illnesses requiring a ventilator or other life-sustaining equipment.

Phosphorus Control for Dialysis Patients

Oct. 22, 2020

About one third of chronic dialysis patients have persistently high blood phosphorus levels, which increases risk for vascular damage, cardiovascular disease, and death. Some patients can control phosphorus levels through a healthy diet, although many also require the use of pills that remove dietary phosphorus in the gut. But what about patients with limited access to healthy food outlets?

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


Improving Consumption And Purchases Of Healthier Foods In Retail Environments: A Systematic Review

Oct. 16, 2020

Allison Karpyn, Kathleen McCallops, Henry Wolgast, Karen Glanz

Abstract [from journal]

This review examines current research on manipulations of U.S. food retail environments to promote healthier food purchasing and consumption. Studies reviewed use marketing strategies defined as the 4Ps (product, price, placement, promotion) to examine results based on single- and multi-component interventions by study design, outcome, and which of the "Ps" was targeted. Nine electronic databases were searched for publications from 2010 to 2019, followed by forward and backward searches. Studies were included if the intervention was


Evaluating Spillover Of HIV Knowledge From Study Participants To Their Network Members In A Stepped-wedge Behavioural Intervention In Tanzania

Oct. 7, 2020

Jeffrey Rewley, Mary C. Smith Fawzi, Keith McAdam, Sylvia Kaaya, Yuanyuan Liu, Jim Todd, Irene Andrew, Jukka Pekka Onnela

Abstract [from journal]

Objectives: We aim to describe the social network members of participants of a behavioural intervention, and examine how the effects of the intervention may spillover among network members.

Design: Secondary analysis of a step-wedge randomised controlled trial.

Setting: Change agents (CAs) were recruited from waiting rooms of HIV treatment facilities in Dar es Salaam, Tanzania, and their network members (NMs) were recruited directly by CAs.



An Asthma Population Health Improvement Initiative For Children With Frequent Hospitalizations

Chen Kenyon, MD, MSHP
Oct. 1, 2020

Chén C. KenyonDouglas Strane, G. Chandler Floyd, Ethan G. Jacobi, Tina J. Penrose, Jeffrey M. Ewig, Sigrid Payne DaVeiga, Joseph J. Zorc, David M. Rubin, Tyra C. Bryant-Stephens 

Abstract [from journal]

Objectives: A relatively small proportion of children with asthma account for an outsized proportion of health care use. Our goal was to use quality improvement methodology to reduce repeat emergency department (ED) and inpatient care for patients with frequent asthma-related hospitalization.

Methods: Children ages 2 to 17 with ≥3 asthma-related hospitalizations in the previous year who received primary care at 3 in-network clinics were eligible to receive a bundle of 4 services including (1)


Improving Identification Of Patients At Low Risk For Major Cardiac Events After Noncardiac Surgery Using Intraoperative Data

Amole Navathe19-head
Oct. 1, 2020

Amol S. NavatheVictor J. LeiLee A. Fleisher, ThaiBinh Luong, Xinwei Chen, Edward Kennedy, Kevin G. VolppDaniel E. PolskyPeter W. Groeneveld, Mark Weiner, John H. Holmes...

Abstract [from journal]

Background/objective: Risk-stratification tools for cardiac complications after noncardiac surgery based on preoperative risk factors are used to inform postoperative management. However, there is limited evidence on whether risk stratification can be improved by incorporating data collected intraoperatively, particularly for low-risk patients.

Methods: We conducted a retrospective cohort study of adults who underwent noncardiac surgery between 2014 and 2018 at four