The digital determinants of liver disease

Wadhwani, Sharad I.; Lai, Jennifer C.

doi:10.1002/hep.32639

Cited by 1 publication

(2 citation statements)

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“…Telehealth is another tool to address the lack of transportation and has been associated with decreased time from referral to evaluation and waitlisting. [123] To achieve its full potential, telehealth must first overcome the "digital divide" [124] that exists, with patients living in low SES communities being less likely to access high-quality internet, which is a necessary tool for telehealth. [125] Studies showing that patients from more deprived communities are less likely to receive LT, [83] with only a quarter getting waitlisted for LT, [67] suggest that neighborhood deprivation could be used as a measure of SES to identify patients at increased risk of dropping out during LT evaluation.…”

Section: What Can Be Done To Address Existing Geographic Disparities?mentioning

confidence: 99%

“…Telehealth is another tool to address the lack of transportation and has been associated with decreased time from referral to evaluation and waitlisting 123 . To achieve its full potential, telehealth must first overcome the “digital divide” 124 that exists, with patients living in low SES communities being less likely to access high-quality internet, which is a necessary tool for telehealth 125 …”

Section: What Can Be Done To Address Existing Geographic Disparities?mentioning

confidence: 99%

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Geographic disparities in access to liver transplantation

Yilma

Dalal

Wadhwani

et al. 2023

Liver Transplantation

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Since the Final Rule regarding transplantation was published in 1999, organ distribution policies have been implemented to reduce geographic disparity. While a recent change in liver allocation, termed acuity circles, eliminated the donor service area as a unit of distribution to decrease the geographic disparity of waitlisted patients to liver transplantation, recently published results highlight the complexity of addressing geographic disparity. From geographic variation in donor supply, as well as liver disease burden and differing model for end-stage liver disease (MELD) scores of candidates and MELD scores necessary to receive liver transplantation, to the urban-rural disparity in specialty care access, and to neighborhood deprivation (community measure of socioeconomic status) in liver transplant access, addressing disparities of access will require a multipronged approach at the patient, transplant center, and national level. Herein, we review the current knowledge of these disparities—from variation in larger (regional) to smaller (census tract or zip code) levels to the common etiologies of liver disease, which are particularly affected by these geographic boundaries. The geographic disparity in liver transplant access must balance the limited organ supply with the growing demand. We must identify patient-level factors that contribute to their geographic disparity and incorporate these findings at the transplant center level to develop targeted interventions. We must simultaneously work at the national level to standardize and share patient data (including socioeconomic status and geographic social deprivation indices) to better understand the factors that contribute to the geographic disparity. The complex interplay between organ distribution policy, referral patterns, and variable waitlisting practices with the proportion of high MELD patients and differences in potential donor supply must all be considered to create a national policy strategy to address the inequities in the system.

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