About

David Grande, MD, MPA, is an Associate Professor of Medicine at the University of Pennsylvania School of Medicine and an Associate Professor of Health Care Management at The Wharton School. His research focuses on health care for vulnerable populations, with an emphasis on identifying and overcoming barriers to care. He also studies ethical issues related to marketing in health care and digital health information privacy. Dr. Grande received his MD from Ohio State University and trained in internal medicine at the Hospital of the University of Pennsylvania. He completed a Masters in Public Affairs (MPA) at the Woodrow Wilson School at Princeton University and was a Robert Wood Johnson Health & Society Scholar at the University of Pennsylvania.

Research topics

• Political Science
• Computer Science
• Medicine
• Internet privacy
• Mathematics
• Statistics
• Actuarial science
• Data science
• Finance
• Economics
• Economic growth
• Business
• Nursing
• Environmental health
• Public economics

Selected publications

• Consumer Confidence in the Responsible Use of Digital Health Data After the COVID-19 Pandemic

  JAMA Network Open · 2025-02-26 · 2 citations

  articleOpen accessSenior author

  This study compares 2020 and 2022 surveys to identify changes in how respondents view use of their health information by public and private organizations, including by political leaning.

  PublisherOA PDFDOI

• P60. Presentation And Management of Ballistic Mandibular Fractures

  Plastic & Reconstructive Surgery Global Open · 2025-05-01

  articleOpen access

  PURPOSE: Ballistic mandibular fractures can cause devastating injury. However, there is a lack of data regarding their management. Here, we examine the management and outcomes of patients with ballistic mandibular fractures. METHODS: A retrospective study was conducted reviewing patients with firearm-related mandibular injury presenting to a Level 1 Trauma Center from 2018-2023. RESULTS: 90 patients were included. The average age was 29.3 ± 13.2 years and 74 (82.2%) were male. 82 (91.1%) presented post-assault, 6 (6.7%) after self-inflicted injury, and 2 (2.2%) after accidental injury. Body fractures were the most common (40.0%) followed by ramus (25.6%) and angle (13.3%) fractures. 47 patients (52.2%) also had non-facial injuries. On presentation, 68 patients (75.6%) were intubated; 34 (37.8%) of them later required tracheostomy. 40 patients (44.4%) presented with significant bleeding; 14 (15.6%) were taken to the operating room and 8 (8.9%) were taken for embolization. 67 patients (74.4%) required surgical repair; 48 of them (71.6%) were repaired with internal fixation, 16 (23.9%) required bone grafts, 45 (67.2%) were placed in maxillomandibular fixation, and 3 (3.3%) required microvascular reconstruction. 14 patients (15.6%) had complications post-operatively; 2 (2.2%) had wound healing complications, 6 (6.7%) had infection, 3 (3.3%) had exposed hardware, 3 (3.3%) had malunion, and 1 (1.1%) had palatal fistula and carotid-cavernous fistula, respectively. 12 (13.3%) required surgery for complications. Neurologic complications led to mortality in 6 (6.7%) patients. CONCLUSION: Ballistic mandible fractures present a unique challenge. Our study is one of the few to examine management and complications of ballistic mandibular trauma.

  PublisherDOI

• Text Message Reminders About Free Transportation for Outpatient Substance Use Disorder Treatment: A Pilot Randomized Encouragement Study

  Journal of General Internal Medicine · 2025-04-29

  articleOpen access

  INTRODUCTION: Substance use disorders (SUDs) are a major epidemic in the USA. Patients who lack transportation may have limited access to outpatient SUD treatment programs and are less likely to remain in care. Encouraging the use of free, reliable transportation during enrollment is an untested mechanism for greater retention. METHODS: A pragmatic pilot study was conducted in Southwest Ohio between November 2020 and July 2022, among people with SUDs like opioid and alcohol use disorders who enrolled in an outpatient treatment program and screened positive for transportation barriers. Eligible patients were offered free, unlimited transportation for the first 12 weeks of treatment and randomized 1:1 to receive weekly text message reminders to schedule their ride (intervention) versus none (control). The primary outcome was retention in care at 12 weeks. Secondary outcomes included retention at 24 weeks and retention at weeks 12 and 24 when stratifying by those dispensed SUD medications (e.g., buprenorphine/naloxone, buprenorphine, methadone) at the treatment site versus not, and SUD type. RESULTS: The intervention arm included 171 patients and 190 patients were in the control arm. For retention in care at 12 weeks, there was not a statistically significant difference between intervention (77/171 = 45.0%) and control (81/190 = 42.6%) arms (odds ratio (OR) 1.10; 95% confidence interval (CI) 0.57 to 2.00, p=0.69). At 24 weeks, retention was lower for both the intervention (44/171 = 25.7%) and control (54/190 = 28.4%) arms but not statistically significantly different (p=0.54). Greater retention at 12 weeks was observed for the intervention versus the control arm among patients dispensed SUD medications but at week 24 there was no statistically significant difference. No differences were observed by SUD types at any time point. CONCLUSION: Weekly reminders did not affect overall care retention but did at week 12 among patients dispensed SUD medications.

  PublisherOA PDFDOI

• Real-world access to buprenorphine treatment in Philadelphia: A secret shopper study

  Drug and Alcohol Dependence · 2025-01-29 · 1 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Temporal Bone Gunshot Wounds: A Multi-institutional Retrospective Study

  Otology & Neurotology · 2024-11-08 · 1 citations

  article

  OBJECTIVE: To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW). STUDY DESIGN: Retrospective chart review. SETTING: Five participating hospitals. PATIENTS: Twenty-two patients met inclusion criteria: experienced a TBGSW, survived ≥30 days following the injury, and were evaluated and managed by a neurotologist between 2019 and 2023. INTERVENTIONS: No specific interventions were performed for the purposes of this study. MAIN OUTCOME MEASURES: Characteristics, evaluation, management, and outcomes of TBGSW survivors. RESULTS: Patients were found to have a mean age of 33 ± 18 years and were predominantly male (18/22, 81.8%). Majority of patients (17/22, 77.3%) had mastoid injury. Most patients (14/22, 63.6%) had some evidence for vascular injury, most frequently the internal carotid artery (9/22, 40.9%). Almost three-quarters (17/22, 77.3%) of patients had clinical exam findings of facial nerve injury, which was the most common indication for surgery. Otologic surgery was performed in 72.7% (16/22), with delayed adverse events most commonly including cholesteatoma and external auditory canal stenosis. Though evidence for hearing impairment was clinically present in at least 15 of 22 patients (68.2%), hearing rehabilitation was pursued in only two patients. CONCLUSION: With increasing numbers of TBGSW survivors, there is a growing need for practicing neurotologists to be familiar with the wide spectrum of injury patterns and possible complications to inform clinical management in these patients. Early neurotologic assessment and follow-up beyond the acute period is crucial to minimize morbidity in this high-risk cohort.

  PublisherDOI

• Leading a Healthcare Organization During a Period of Social Change: A Qualitative Study of Chief Executive Officers

  Journal of General Internal Medicine · 2024-06-27 · 1 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Antimicrobial stewardship program in one primary care hospital, a snapshot analysis

  European Journal of Public Health · 2024-10-28 · 1 citations

  articleOpen access

  Abstract Antimicrobic resistance (AMR) continues to rise, whereas development of new agents to counter it has slowed. A heightened need to maintain the effectiveness of currently available agents exists. Healthcare-associated infections (HAIs) are a significant cause of poor treatment outcomes and elevated healthcare and societal costs worldwide. At the beginning of 2024, we started a prospective, interventional, interrupted time-series study, based on Prospective Audit and Feedback in the Intensive Care Unit (ICU) and in the internal medicine ward of our hospital. The primary outcomes will be the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes will include the hospital mortality rate, the mean length of stay and the antibiotic expense. We conducted a snapshot analysis of the first three months to assess the efficacy our program. In the first three months we registered a global reduction in antibiotic expense (almost by half in comparison of 2023 first quarter) and consumption, particularly in the use of carbapenems: (change in level, CL: -51,26 DDD/1000 PD,) and third- generation cephalosporins (CL: -6 DDD/1000 PD). We registered a reduction in the use of hydroalcoholic gel, probably due to the reducted perception after the waning of risk perception towards Covid-19, although no big difference was observed in BSI incidence due to MDR Gram-negative organisms (CL: +1,2 events/1000 PD). Albeit partial, once again these findings demonstrated that implementation of an antimicrobial stewardship program, no matter the level of healthcare, is critical for fighting the AMR and to lessen the burden on Public Health; in particular our program induced a significant reduction in antibiotic consumption that lead to more funds at disposal to improve our clinical practice. Key messages • Once again our findings demonstrated that implementation of an antimicrobial stewardship, no matter the level of healthcare, is critical for fighting the AMR. • Our program induced a significant reduction in antibiotic consumption.

  PublisherDOI

• EPASCORE: A new indicator for prescriptive appropriateness of antimicrobials: our experience

  European Journal of Public Health · 2023-10-01

  articleOpen access

  Abstract Background Antibiotic resistance is being a crucial issue in hospitals, and its control, passes through an appropriate use of antibiotics. To evaluate the prescriptive appropriateness, we introduced a new indicator which takes into account the rate of infections together with antimicrobial consumption and the median time of treatment of each event. Methods The “Estimated Prescriptive Appropriateness Rate” (EPA-SCORE) “has been calculated for each group of bacteria, as the rate between the observed consumption of an antibiotic (DDD/1000days of hospitalization) and the expected one as if the same antibiotic had been used for 10 days exclusively for the observed infections for which it was indicated, according to the following formula: EPASCORE = (DDD observed/expected)*1/(N.of infections). Data from January 2020 and June 2022 were collected while restrictive and persuasive strategies of Antimicrobial Stewardship were implemented. Changes in EPA-SCORE were evaluated through the years. Results In our hospital, in the first semester of 2022 prevalence of ESBL+ Gram negative-infections was 0.90 cases/1000 doh/year. The observed consumption of drugs indicated for those infections was 86.9 DDD/1000 dof, whilst the expected one for the registered number of infections was 9.01 DDD/1000doh, with an EPASCORE of 10.37%. Regarding multi-drug-resistant gram negative-infections, prevalence was 1.48/1000doh/year; observed antibiotic consumption for them (whose prescription was restricted to ID specialists) was 43DDD/1000doh, whilts the expected DDD was 29.6 DDD/1000doh (EPASCORE 67.7%). Comparing data between 2022 and the same period of 2020, a significant increase in EPASCORE was detected (+4.2% and +7.1% for ESBL+ and MDR Gram- infections in 2022 respectively) Conclusions Our date demonstrate that the EPASCORE represents a feasible indicator of appropriateness of antimicrobial prescription, and restrictive strategies of antimicrobial stewardship can help to improve its outcome. Key messages • Antimicrobial Stewardship has a leading role to face antimicrobial resistance. • EPA-SCORE is a feasible indicator to measure appropriateness of antimicrobial prescription.

  PublisherOA PDFDOI

• Training Health Policy Researchers on Policy Engagement and Research Translation for Greater Impact: Evaluation of the Amplify@LDI Program

  Journal of General Internal Medicine · 2023-08-09 · 1 citations

  articleOpen access

  BACKGROUND: Few researchers receive formal training in research translation and dissemination or policy engagement. We created Amplify@LDI, a training program for health services and health policy researchers, to equip them with skills to increase the visibility of their research through translation and dissemination activities. AIMS: To describe the program's participants and curriculum, and evaluate the first 2 years of the program. SETTING: The Leonard Davis Institute (LDI) at the University of Pennsylvania (Penn). PARTICIPANTS: An annual cohort of 12 LDI Senior Fellows (Penn faculty) from multiple schools, disciplines, and ranks at Penn. PROGRAM DESCRIPTION: The Amplify@LDI curriculum includes 6 sessions on different aspects of research translation and dissemination, including media and social engagement, writing Op-Eds, and policy engagement. PROGRAM EVALUATION: Participants reported measurable increases in time spent on translation and dissemination activities, as well as new enthusiasm for and confidence in policy engagement. Participants' reach (as measured by Altmetric) increased during the program, compared to smaller increases or reductions in reach for two comparator groups. DISCUSSION: In our preliminary evaluation of Amplify@LDI, we find strong evidence of positive impact from participant evaluations, and suggestive evidence that participation in the program is associated with significant increases in the reach of their research.

  PublisherOA PDFDOI

• Factors Informing High-Risk Primary Care Patient Choice around Telehealth Use: a Framework

  Journal of General Internal Medicine · 2023-11-08 · 8 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

Recent grants

• Patient Preferences for Collecting and Repurposing Genetic, Consumer and Health Care Information

  NIH · $1.9M · 2017–2022

• NIH Grant R21HG006047

  NIH · $440k · 2014

Frequent coauthors

• Shreya Kangovi

  University of Pennsylvania

  44 shared

• Christian Stillson

  Clinton Health Access Initiative

  35 shared

• Nandita Mitra

  University of Pennsylvania

  31 shared

• Archana Radhakrishnan

  VA Ann Arbor Healthcare System

  30 shared

• Craig Evan Pollack

  University of Baltimore

  30 shared

• David A. Asch

  26 shared

• Carolyn C. Cannuscio

  University of Pennsylvania

  26 shared

• Judith A. Long

  24 shared

Labs

• Health Care ManagementPI