HRSA’s National Center for Health Workforce Analysis projects a 32 percent increase in certified nurse midwives and an 89 percent increase in women’s health nurse practitioners by 2030. HRSA has published a new report on the national-level supply and demand projections for women’s health service providers using HRSA’s Health Workforce Simulation Model.
Check out other highlights from the report.
As the more contagious Delta variant of COVID-19 surges in parts of the United States, a new study from Yale University and the Commonwealth Fund finds that the U.S. vaccination campaign has significantly curbed the virus’s death toll, saving as many as 279,000 lives and averting up to 1.25 million hospitalizations. The study examined the impact of the U.S. COVID-19 vaccination program on the pandemic’s trajectory through July 1, 2021, considering the emergence of more transmissible variants in recent months. The findings demonstrate that the speed of the U.S. vaccination rollout prevented numerous additional COVID-19 fatalities and hospitalizations. Researchers warn, however, that the Delta variant’s spread among unvaccinated populations could produce a surge in new cases and reverse the downward trend of infections and deaths across the country.
The United Health Foundation launched a new America’s Health Rankings report, which provides a deep dive into health disparities data in the United States. The inaugural report builds on over 30 years of data to provide a comprehensive portrait of the breadth, depth, and persistence of disparities across the nation.
Health Affairs, Commentary, June 14, 2021
Nearly 60 million rural Americans depend on local hospitals and their emergency departments (EDs) when serious (for example, trauma, stroke, heart attack) and potential (for example, chest or abdominal pain) emergencies occur. Yet, since 2010, 136 small and rural hospitals have closed. The COVID-19 pandemic accelerated this trend, with a record 20 new hospital closures in 2020 and many more at risk. Mortality worsens when hospitals close because of reduced access to the life-saving skills of emergency physicians and the hospitals where they work.
Recent policy initiatives have attempted to address rural hospital closures. Some Pennsylvania rural hospitals and all Maryland hospitals are funded through global budgets. Starting in January 2023, a new rural emergency hospital (REH) designation will allow rural critical access hospitals to convert to an REH and receive fixed payments to support infrastructure and a 5 percent increase in fee-for-service payments in return for maintaining an ED and specified outpatient services. A weakness of these models is that they focus on supporting the hospital facility alone. None ensure sufficient resources to pay for the 24/7/365 on-site emergency physician, plus some level of surge capacity, needed to provide ED patient care.
To understand why rural and small hospitals struggle to maintain high-quality emergency physicians in their EDs, it is important to describe the economics of ED staffing and how the COVID-19 pandemic changed those economics for the worse. Pre-pandemic, a delicate balance of volume, complexity, and payer-mix supported ED staffing with fee-for-service payments. Some visits reimbursed well and required few resources (for example, privately insured, low acuity). For other visits (for example, Medicare, Medicaid, high acuity, and uninsured), reimbursement did not cover costs. Medicaid expansion under the Affordable Care Act reduced uninsured visits but has been no panacea. Medicaid expansion replaces unreimbursed visits by uninsured patients but only with well-below-cost Medicaid rates. Expansion also generates payer crowd-out: Some visits, previously well-reimbursed by commercial insurance, become low-paying Medicaid visits.
According to a study funded by the Center for Rural Pennsylvania, between 1999 and 2018, suicide rates across the state significantly increased. In 2018, the researchers said, the suicide rate in rural areas of the state was 25% higher than in urban areas.
While the study of suicides showed that the rate is higher in rural areas, those numbers may be even higher still, researchers said.
While the study didn’t specifically address the causes of the discrepancy in suicide rates in urban and rural areas, it did look at some of the indicators of higher suicide rates.
Higher numbers of handgun sales per 1,000 residents, lower levels of education, lower incomes, larger populations over age 65, and higher levels of unemployment all correlate with higher county suicide rates, the study found.
“In terms of our particular report, we are not able to deduce exactly why those rates have been increasing,” said Dr. Daniel Mallinson, one of the study’s authors. “But others whose work has looked at that…they’ve been able to gather some quantitative evidence on that. For instance, there’s been a rise of deaths of despair, particularly in rural areas in the US, and not just in suicides but also in overdoses and alcohol-related deaths.”
The researchers connected these deaths of despair to the loss of quality of life and less economic opportunities, which have had “substantial impacts on people’s lives directly and on people’s resources but it also has damaged or undermined communities and families.”
Beyond the quality of life issues, according to the National Advisory Committee on Rural Health and Human Services, rural areas also tend to be at higher risk due to limits in the “accessibility, availability, and acceptability of mental health care services.”
Rural counties tend to have smaller ratios of mental health providers per capita. For instance, in Sullivan County, Pennsylvania, there are only 16 mental health providers per every 100,000 people, according to the Pennsylvania Department of Health. Compare that to Montgomery County, Pennsylvania, with 333 mental health providers per 100,000. And 23 of the 24 Health Professional Shortage Areas in Pennsylvania, identified by the U.S. Health Resources and Services Administration as areas that have a shortage of healthcare professionals, are rural areas of the state.
The National Network for Oral Health Access (NNOHA) and the National Health Care for the Homeless Council (NHCHC) developed a publication to bring awareness to the intersection of oral health and behavioral health concerns or cognitive impairment in people experiencing homelessness (PEH). The publication shares the impacts of behavioral health illness on oral health and how behavioral health and dental providers can work together to address this intersection in their practices.
A new CareQuest Institute survey found that poor mental health status may be linked to dental fear and delayed dental care. In January and February 2021, CareQuest conducted a nationally representative survey to examine attitudes, experiences, and behaviors related to oral health. Respondents self-rated their mental health and oral health status and answered questions about oral healthcare utilization. Findings from this study showed consistent oral health disparities among those with self-identified poor mental health.
The Flex Monitoring Team has released a new report on the community impact and benefit activities of Critical Access Hospitals (CAHs), rural non-CAHs, and urban hospitals. The report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally to the performance of CAHs in their state.
The national report and state-specific reports can be found on the Flex Monitoring Team website.
Scientists have long speculated about the prevalence of dental caries and their potential long-term risk factors among the geriatric population. Recently, the topic was further explored in an article titled, “Caries disease among an elderly population — A 10-year longitudinal study.” The piece was published in the International Journal of Dental Hygiene earlier this month.
Authors: Yunfeng Shi, Alejandro Amill-Rosario, Robert S. Rudin, Shira H. Fischer, Paul Shekelle, Dennis P. Scanlon, Cheryl L. Damberg
The existing literature provides little empirical understanding of barriers to using clinical decision support (CDS) in the ambulatory care setting. Using data from 821 clinics in 117 medical groups, based on Minnesota Community Measurement’s annual Health Information Technology Survey (2014-2016), the authors examined 7 CDS tools and 7 barriers in 3 areas (resource, user acceptance, and technology).
The study found that health system affiliated clinics used more CDS tools than those not in systems, but they also reported more barriers related to resources and user acceptance. The results indicated that health systems, while being effective in promoting CDS tools, may need to provide more assistance to their affiliated ambulatory clinics to overcome barriers, especially for the requirement to redesign workflow and more resources for training in rural clinics.
