Low-Volume Emergency Departments are More Likely to Use Telehealth for Sepsis Care in a National Rural Telehealth Network

A Research & Policy Brief is available from the Rural Telehealth Research Center:

Sepsis is an expensive disease that is responsible for over 270,000 deaths in the U.S. annually. Early and aggressive treatment with antibiotics and hemodynamic resuscitation have been associated with improved outcomes, but many sepsis patients do not receive guideline-concordant care. Patients treated in low-volume emergency departments (EDs) have 38% higher mortality than those in high-volume EDs suggesting that volume is associated with elements of care that improve survival. Provider-to-provider ED-based telehealth (tele-ED) has been one strategy proposed to improve sepsis care in low-volume EDs. In tele-ED, local ED staff can request consultation with a remote physician and nurse who can connect using a 24-hour on-demand high-definition video connection allowing remote staff to see a patient, review records, provide advice, arrange for inter-hospital transfer, and provide clinical documentation. By connecting a clinician in a high-volume hospital with a care team in a low-volume hospital, rural sepsis patients and providers may benefit from high-volume experience and training even in a local rural facility.

The purpose of this study was to (1) report on the prevalence of tele-ED use for sepsis care across an established network, (2) quantify variation in use between hospitals, and (3) identify predictors of tele-ED consultation in tele-ED-capable hospitals.

631 Rural Hospitals at Risk of Closure, by State

Across the U.S., a total of 631 rural hospitals — or about 30 percent of all rural hospitals — are at risk of closing in the immediate or near future due to persistent financial losses on patient services, inadequate revenues to cover expenses, and low financial reserves, according to a report from the Center for Healthcare Quality and Payment Reform.

More than 200 of the rural hospitals in the report are identified as being at immediate risk of closure. These hospitals were losing money on patient services before the COVID-19 pandemic, and they did not have sufficient resources to cover those losses, according to the report.   Click here to view the numbers and percentage of rural hospitals by state at risk as of October 2022, based on the Center for Healthcare Quality and Payment Reform analysis.

Rural Adults have Lower Rates of Employer Sponsored Health Insurance in Pennsylvania

The Penn State Rural Health Disparities Lab in the Department of Biobehavioral Health has released a report showing rates of employer-sponsored health insurance in rural Pennsylvania. Employer sponsored health insurance (ESHI) is typically subsidized by employers, which can reduce the overall cost for employees. Using data from the American Community Survey, we found that working-age adults living in rural areas in Pennsylvania are less likely to have ESHI than those in urban areas. Across all rural-urban categories, females were least likely to have ESHI. The lower rates in rural areas may reflect fewer job opportunities with established ESHI plans. These findings raise concerns about access to the benefits of ESHI in rural contexts, especially for females. Author: Melanie Dececco, RHO Undergraduate Research Assistant

American Institute of Public Health Releases Dental Workforce Report

The American Institute of Public Health (AIDPH) released a research brief, “The Financial and Policy Impacts of the COVID-19 Pandemic on U.S. Dental Care Workers.”

The brief evaluates trends and differences of the dental health care workforce before and after the onset of the COVID-19 pandemic and assesses the impact of dental health care worker shortages by state and geographic region. Executive Director Helen Hawkey and Dr. Sean Boynes are among the authors. An interactive dashboard is being developed to map the changes among dental health care workers.

Click here to read the report.

New! Rural Health System Value-Based Care Innovators Roundtable: Strategies and Insights Released

The Rural Health Value team recently released a new Innovators Roundtable Report:

  • Rural Health System Value-Based Care Innovators Roundtable: Strategies and Insights
    This report describes interviews with five health systems supporting value-based care in their rural affiliates. Interview topics included organizational structure, governance and decision-making, operations, data and communication, contracts, and social determinants of health. The report includes common health system tensions and opportunities as they facilitate rural affiliate success in value-based care.

 Related resources on the Rural Health Value website:

Contact information:

Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu

Pennsylvania State Data Center Releases Latest Brief Highlights Hispanic Heritage Month 

The latest brief from the Pennsylvania State Data Center looks at Pennsylvania’s Hispanic and Latino population, specifically indicators related to business ownership and employment. Read more at https://pasdc.hbg.psu.edu/Data/Research-Briefs 

Updates from the Census Bureau 

Global Diversity Awareness Month 

Click here to read more on how the Census Bureau celebrates diversity and advances equity.

Road to the 2030 Census 

It’s already that time again. Click here to see the Bureau’s preliminary timeline for the 2030 Census.

2022 Economic Census Mailings Begin 

Click here to read more about the preparations being undertaken for the 2022 Economic Census.

2019 Nonemployer Statistics (NES) by Industry 

Click here to see the latest NES data. Nonemployer Statistics (NES) is an annual series that provides subnational economic data for businesses that have no paid employees and are subject to federal income tax.

Report Finds Potential Medicare Dental Benefit Savings

The CareQuest Institute released a new report analyzing Medicare beneficiary data. Medicare does not include dental benefits, and dental coverage varies within Medicare Advantage plans. The report analysis concludes, adding dental coverage to Medicare has the potential to save the health care system billions of dollars per year in care for patients with diabetes and/or heart disease alone.

Click here to read the report.

Brief Explores Barriers to Oral Health Equity

The Center for Health Care Strategies, with support from the CareQuest Institute for Oral Health, published a brief, “Advancing Oral Health Equity for Medicaid Populations.” The brief describes common barriers for addressing oral health equity for Medicaid populations and outlines recommendations to improve oral health access and quality within four key areas: coverage and access, workforce capacity building, partnerships, and payment.

Click here to view the brief.

Children Living Near Pennsylvania Fracking Sites At Increased Risk of Leukemia, Study Finds

From State Impact PA

Correction: Nicole Deziel of the Yale School of Public Health says Pennsylvania’s wellhead setback from schools and homes should be 1,000 meters. That distance was incorrect in the original version of this story.  

Children who live close to fracking sites in Pennsylvania have a higher risk for the most common form of childhood cancer, a new study found.

Researchers at the Yale School of Public Health used the Pennsylvania Cancer Registry, along with state data on unconventional oil and gas drill sites, to determine that children born within two kilometers, or 1.24 miles, of an active well site were two to three times more likely to be diagnosed with acute lymphoblastic leukemia between the ages of 2 and 7.

The study was published in the journal Environmental Health Perspectives. It looked at 405 children diagnosed with that type of leukemia between 2009 and 2017, and included 2,080 controls matched by birth year.

“The magnitude of the elevated risk that we observed was fairly striking,” said Dr. Cassandra Clark, a post-doctoral fellow at the Yale School of Public Health and co-author of the report. “After accounting for a variety of socioeconomic, demographic and biological factors that could potentially be underlying this association, it was consistent.”

Acute lymphoblastic leukemia is one of the most common childhood cancers, which is why the researchers chose to look at it. Additionally, a known cause is benzene, a chemical released by oil and gas drilling activities into both air and water. The five-year survival rate in children with acute lymphoblastic leukemia is high, at 90 percent.

Unconventional gas development is also referred to as fracking, which is a part of the overall process that injects water with chemicals at high pressure into shale rock formations deep underground to release oil and gas. Water that returns to the surface often includes those chemical additives, along with long-buried naturally occurring toxins and radiological material.

More than 10,000 unconventional natural gas wells were drilled and fracked in Pennsylvania between 2002 and 2017. The Department of Environmental Protection has reported more than 1,000 spills in that period, along with fielding about 4,000 residential well water complaints between 2005 and 2014. Many who live in rural areas rely on water from private wells, about one-third of which are within two kilometers of a wellhead.

The natural gas industry maintains it operates under regulations meant to protect public health. The Marcellus Shale Coalition has said the industry’s “top priority” is protecting health and safety of workers, the environment, and people who live near fracking operations.

One unique aspect of the Yale research includes tracing potential drinking water exposure.

“It really is a superb study,” said Dr. Bernard Goldstein, former dean of the University of Pittsburgh School of Public Health and an expert in environmental causes of childhood leukemia.

Goldstein is not associated with this study. He has conducted prior research into exposures due to oil and gas wastewater in Pennsylvania.

“It looks at a potential problem in ways that include new exposure metrics, which are really needed,” he said.

Goldstein says that though the factors that contribute to childhood leukemia are complex and still unclear, benzene is the one known link.

The interdisciplinary team of researchers included experts on leukemia and environmental science, as well as hydrogeologists. In addition to the location of well sites, researchers mapped individual watersheds and determined the flow of water from well heads to the children’s homes. They did not survey the families to determine individual sources of drinking water.

Still, they say the research shows that a child living within 1.2 miles of a well site, which is within their watershed, could be at a higher risk of exposure through drinking water.

Previous research has shown an association between fracking activities and health impacts, but determining the path to exposure is more difficult.

“I think we have about 50 epidemiological health studies demonstrating increased adverse health outcomes in communities that live near unconventional oil and gas sites,” said Dr. Nicole Deziel, a co-author of the study and associate professor at the Yale School of Public Health in the Department of Environmental Health Sciences. “I think it would be very important to understand which exposures or hazards might be driving these associations.”

Deziel says she wants the study to impact public policy, including regulations on residential setbacks from wellheads and density of drilling sites. Pennsylvania requires a 500-foot setback from schools and homes. Deziel says it should be 1,000 meters, especially since her findings show greater impacts for children exposed in utero.

Those results, she said, suggested “that that may be a sensitive time window, which is also consistent with some other studies of other environmental exposures.”

ARC Chartbook Provides Updated Look at Appalachia

ARC has released its 12th annual update of The Appalachian Region: A Data Overview from the 2016-2020 American Community Survey. Written in partnership with Population Reference Bureau, “The Chartbook” features over 300,000 data points on Appalachia’s economy, income, employment, education, and more prior to–and during–the first 10 months of the COVID-19 pandemic.

The 2022 report indicates that Appalachia was improving in educational attainment, labor force participation, income levels, and reduced poverty prior to the onset of COVID-19 in March 2020. However, unique vulnerabilities among the region’s oldest, youngest, and most rural residents were likely exacerbated by the pandemic.

“Each year, The Chartbook provides critical data about the Appalachian Region, enabling policymakers and ARC partners to make data-driven economic development decisions. This particular report, however, may be one of the most critical to date,” said ARC Federal Co-Chair Gayle Manchin.