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.

Community Concerns about the COVID-19 Vaccine

Jul. 7, 2021

More than one-third of all Americans age 12 and over remain unvaccinated for COVID-19. The latest Kaiser Family Foundation poll indicates that hesitancy and acceptance of these vaccines varies by geographic, sociodemographic, and cultural factors. While we often think about vaccine hesitancy on an individual level, these individuals belong to communities that respond to the COVID-19 vaccine in very different ways.

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


The Relationship Between Surgeon Gender and Stress During the COVID-19 Pandemic

Jan. 22, 2021

Catherine L. Mavroudis, Sarah Landau, Ezra Brooks, Regan Bergmark, Nicholas L. Berlin, Blanche Blumenthal, Zara Cooper, Eun Kyeong Hwang, Elizabeth Lancaster, Jennifer Waljee, Elizabeth Wick, Heather Yeo, Christopher Wirtalla, Rachel R. Kelz

Abstract [from journal]

Objective: To investigate the relationship between surgeon gender and stress during the Covid-19 pandemic.

Background: While female surgeons face difficulties integrating work and home in the best of times, the Coronavirus Disease 2019 (Covid-19) pandemic has presented new challenges. The implications for the female surgical workforce are unknown.

Methods: This cross-sectional, multi-center telephone survey study of surgeons was conducted across five


Delayed Emergencies: The Composition and Magnitude of Non-Respiratory Emergency Department Visits During the COVID-19 Pandemic

Jan. 14, 2021

Ari B. Friedman, Deidre Barfield, Guy David, Thomas Diller, Candace Gunnarson, Miao Liu, Benjamin V. Vicidomina, Ruthann Zhang, Yuan Zhang, Somesh C. Nigam

Abstract [from journal]

Importance: COVID-19 has been associated with excess mortality among patients not diagnosed with COVID-19, suggesting disruption of acute health care provision may play a role.

Objective: To determine the degree of declines in emergency department (ED) visits attributable to COVID-19 and determine whether these declines were concentrated among patients with fewer comorbidities and lower severity visits.

Design: We conducted a differences-in-differences analysis of all


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


Patients’ and Caregivers’ Perspectives in Determining Discharge Readiness From Home Health

Jan. 11, 2021

Melissa O'Connor, Helene Moriarty, Anne Schneider, Elizabeth B. Dowdell, Kathryn H. Bowles

Abstract [from journal]

There are no national, empirically derived clinical decision support tools to assist the interprofessional home health team in determining readiness for discharge from skilled home health. Eliciting patient and family caregiver perspectives around readiness for home health discharge is integral to developing tools that address their needs in this decision-making process. The purpose of this study was to describe the factors home health patients and their family caregivers perceive as critical when determining readiness for discharge


How Health Care Workers Wield Influence Through Twitter Hashtags: Retrospective Cross-Sectional Study of the Gun Violence and COVID-19 Public Health Crises

Sharath Chandra Guntuku, PhD
Jan. 6, 2021

Ayotomiwa Ojo, Sharath Chandra Guntuku, Margaret Zheng, Rinad S. Beidas, Megan L. Ranney

Abstract [from journal]

Background: Twitter has emerged as a novel way for physicians to share ideas and advocate for policy change. #ThisIsOurLane (firearm injury) and #GetUsPPE (COVID-19) are examples of nationwide health care-led Twitter campaigns that went viral. Health care-initiated Twitter hashtags regarding major public health topics have gained national attention, but their content has not been systematically examined.

Objective: We hypothesized that Twitter discourse on two epidemics (firearm injury and


The Healthy Food Marketing Strategies Study: Design, Baseline Characteristics, and Supermarket Compliance

Karen Glanz
Dec. 31, 2020

Karen Glanz, Annie Chung, Knashawn H. Morales, Pui L. Kwong, Douglas Wiebe, Donna Paulhamus Giordano, Colleen M. Brensinger, Allison Karpyn

Abstract [from journal]

Identifying effective strategies to promote healthy eating and reduce obesity is a priority in the USA, especially among low-income and minority groups, who often have less access to healthy food and higher rates of obesity. Efforts to improve food access have led to more supermarkets in low-income, ethnically diverse neighborhoods. However, this alone may not be enough to reduce food insecurity and improve residents' diet quality and health. This paper summarizes the design, methods, baseline findings, and supermarket in-store


Supported Decision Making With People at the Margins of Autonomy

Dec. 29, 2020

Andrew Peterson, Jason KarlawishEmily Largent

Abstract [from journal]

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step


Identifying Adolescent Suicide Risk via Depression Screening in Pediatric Primary Care: An Electronic Health Record Review

Dec. 18, 2020

Molly Davis, Victoria Rio, Alyssa M. Farley, Morgan L. Bush, Rinad S. Beidas, Jami F. Young

Abstract [from journal]

Objective: The authors evaluated suicide risk rates detected via a depression screener administered within a large pediatric primary care system and examined 1-year follow-up care after adolescents' endorsement of suicide risk.

Methods: Retrospective electronic health record data were extracted to examine both suicide risk rates from items endorsed on the Patient Health Questionnaire-Modified for Teens (PHQ-9-M) and primary care providers' (PCPs') follow-up suicide risk assessments on the day


Time To Address Disparities in Care by Appointment Time

Dec. 15, 2020

Allison H. Oakes, Mitesh S. Patel

Abstract [from journal]

Quality of care systematically decreases over the course of the day. Ensuring that patients seen later in the day receive the same care as patients seen first thing in the morning has broad clinical and economic implications for our health care system. In this article, we outline feasible near-term solutions to direct clinicians and patients toward consistently better primary care decisions, throughout the day. These insights could be adapted to address similar challenges in other health care settings.


“Why Couldn’t I Go in to See Him?” Bereaved Families’ Perceptions of End-of-Life Communication During COVID-19

Mary Ersek
Dec. 15, 2020

Shelli Feder, Dawn Smith, Hilary Griffin, Scott T. Shreve, Daniel Kinder, Ann Kutney-Lee, Mary Ersek

Abstract [from journal]

Background/objective: The COVID-19 pandemic has resulted in rapid changes to end-of-life care for hospitalized older adults and their families, including visitation restrictions. We examined bereaved families' perceptions of the quality of end-of-life communication among Veterans, families and staff in Veterans Affairs (VA) medical centers during the COVID-19 pandemic.

Design: Qualitative descriptive study using data from a survey of bereaved family members of Veterans administered from March-


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.