Outcome Measures for State Flex Program Financial and Operational Improvement Interventions

Posted on by klb520

The Flex Monitoring Team has released a new policy brief:  https://www.flexmonitoring.org/publication/outcome-measures-state-flex-program-financial-and-operational-improvement-interventions

The brief reviews outcome measures for State Flex Program (SFP) interventions conducted under Program Area 2: Financial and Operational Improvement (FOI), a mandatory area of SFP activity. The FMT explored the types of FOI projects proposed by a subset of 14 SFPs during Fiscal Year 2015-2018 and the challenges they faced in monitoring the impact of their interventions on Critical Access Hospital (CAH) financial and operational performance.

This product describes key categories of interventions implemented by these 14 SFPs and their proposed output and high-level outcomes measures. It further outlines the theory of change for each category, and provides examples of short- and intermediate-term outcome measures to provide a bridge between project activities and long-term, high-level outcomes. The brief concludes with suggestions for SFPs to improve their ability to document the outcome of SFP FOI initiatives and evaluate overall program impact. A companion brief provides an inventory of all SFP FOI initiatives and a more detailed analysis of the interventions undertaken by a subset of 14 SFPs.

The State of Childhood Obesity Report Released

Posted on by lad3

The Robert Wood Johnson Foundation has released new data from their State of Childhood Obesity report that finds policies today are failing our children. The latest report dives into the latest childhood obesity rates and trends, discusses how food insecurity, structural racism, and COVID-19 have contributed to rising rates of obesity, and shares evidence-based recommendations and policy solutions for protecting children’s health.

Another resource, Reducing Childhood Obesity Now May Help in the Next Pandemic, suggests that obesity leads to a greater risk of becoming severely ill from diseases such as COVID-19 and asks how we can address health disparities that contribute to obesity to protect our children from future public health crises.

Report Looks at Pennsylvania Medical School Impact on Primary Care Physician Shortage

Posted on by lad3

The Joint State Government Committee, a research arm of the Pennsylvania General Assembly, has released the report “Medical School Impact on the Primary Care Physician Shortage in Pennsylvania.” The report, which resulted from a House resolution in 2020, studies efforts within medical schools to promote student choice in primary care, to include primary care experience in the curriculum and to accurately monitor and report graduate retention in primary care. The report includes extensive information about students, ongoing programs and new initiatives gathered during meetings with the Commonwealth’s nine medical schools. A page is devoted to the Pennsylvania Primary Care Career Center. The report concludes with findings and recommendations for the General Assembly’s consideration including:

  • Improve data collection of Pennsylvania’s primary care workforce to create more accurate predictions.
  • Overcome cultural and financial barriers preventing medical schools from promoting primary care.
  • Increase funding to the Pennsylvania Primary Care Loan Repayment Program.
  • Invest in the Primary Care Career Center and other programs targeting physician recruitment.
  • Expand Pennsylvania’s primary care pipeline programs.

University of Pittsburgh Study Finds Kids Lack Adequate Health Insurance

Posted on by lad3

As of 2019, nearly 1.5 million kids in Pennsylvania and New Jersey lacked adequate and continuous health insurance. A third of children in the United States had unreliable or insufficient health insurance in the years leading up to the COVID-19 pandemic — a problem to which the public health emergency has drawn even more attention. Researchers attributed the increase in underinsured children to rising out-of-pocket costs associated with private health plans.

Read more.

Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance

Posted on by lad3

Profound racial and ethnic disparities in health and well-being have long been the norm in the United States. Black and American Indian/Alaska Native (AIAN) people live fewer years, on average than white people. They are also more likely to die from treatable conditions, die during or after pregnancy and suffer pregnancy-related severe complications, and more likely to lose children in infancy. Black and AIAN people are also at higher risk for many chronic health conditions, from diabetes to hypertension. The COVID-19 pandemic has only worsened, with average life expectancies for Black, Latinx/Hispanic, and, in all likelihood, AIAN people falling more sharply compared to white people.

Read the full report report:  Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance

Medicaid Expansion Alone Not Associated with Improved Finances, Staffing or Quality at Critical Access Hospitals

Posted on by lad3

From Health Affairs

Critical access hospitals are important providers of care for rural and other underserved communities, but they face staffing and quality challenges while operating with low margins. Medicaid expansion has been found to improve hospital finances broadly and therefore may have permitted sustained investments in staffing and quality improvement at these vulnerable hospitals. In this difference-indifferences analysis, we found that critical access hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins relative to hospitals in nonexpansion states. Nor did we see evidence of statistically significant differential improvement at critical access hospitals in expansion versus nonexpansion states on either staffing measures (physicians and registered nurses per 1,000 patient days) or quality measures (percentage point changes in readmissions and mortality within thirty days of admission for pneumonia or heart failure).

These findings suggest that critical access hospitals may need to take additional measures to bolster finances to provide continued support for the delivery of high-quality care to rural and other underserved communities.

Access the full article at CAH Medicaid Study – 2021

KFF COVID-19 Vaccine Monitor: Differences in Vaccine Attitudes Between Rural, Suburban, and Urban Areas

Posted on by lad3

Throughout the past year, the Kaiser Family Foundation (KFF) COVID-19 Vaccine Monitor has provided a look into how the coronavirus pandemic has impacted people living in different areas of the U.S., including analyses of the vaccine intentions of rural residents. This latest report draws on two surveys conducted in November (before news of the omicron variant) – one of adults and one of parents – and shows that those living in different types of communities hold very different views of COVID-19 vaccines, particularly when it comes to children. In addition, parents living in different community types report getting different levels of information regarding COVID-19 vaccines from their children’s schools and pediatricians.

  • Rural and suburban adults continue to lag somewhat behind those living in urban areas in terms of vaccine uptake. As of November, eight in ten urban residents (79%) say they have gotten at least one dose of a COVID-19 vaccine compared to seven in ten suburban adults and 67% of rural adults. One in five (21%) of those living in rural areas and one in six (16%) of those living in suburban areas say they will “definitely not” get a COVID-19 vaccine, at least twice the share of urban residents who say the same (8%).
  • The rural-urban gap in vaccination intention is even larger when it comes to children. About half of rural parents say they will definitely not get their 12-17 year-old children or their 5-11 year-old children vaccinated for COVID-19. A quarter of rural parents (26%) say they have vaccinated their 12-17 year-old, compared to nearly two-thirds of parents in urban areas (64%) and about half of those living in suburban areas (47%) areas. One in ten rural parents and a similar share of suburban parents (14%) report that their 5-11 year-old child is vaccinated, compared to about a quarter (23%) of urban parents who say the same.
  • Four in ten parents overall say they have spoken to their child’s pediatrician about the COVID-19 vaccine. Yet, those living in rural areas are more likely than those living in suburban or urban areas to report their child’s pediatrician did not recommend the vaccine for their child. More than one-third of rural parents say they had a conversation with their child’s health care provider and the provider did not recommended they get their child vaccinated (compared to around one in ten urban and one in seven suburban parents).
  • Around half of all parents say their child’s school has provided them with information on how to get a COVID-19 vaccine for their child, but smaller shares of rural than urban parents say their child’s school has encouraged parents to get their child vaccinated (36%) compared to parents in suburban (44%) and urban (50%) areas.
  • Views on COVID-19 vaccine mandates also differ across communities. A majority of urban residents support the federal government requiring large employers to either have their employees be vaccinated or get tested weekly, while rural and suburban residents are more divided on this Biden administration guideline. In addition, most workers living in urban areas say their employer already requires employees to be vaccinated for COVID-19 or that they support such a requirement, while six in ten rural workers and half of suburban workers do not want their employer to issue a vaccine mandate. Opposition to schools requiring eligible students to be vaccinated for COVID-19 is also higher among rural and suburban parents compared to urban parents.
  • While differing partisanship and demographics may contribute to differences in vaccine attitudes between people living in urban, suburban, and rural communities, multivariate analysis suggests that there is a relationship between community type and COVID-19 vaccine uptake that exists even when controlling for party identification and demographics. Using a statistical technique called logistic regression, we find that rural and suburban adults are less likely than urban adults to report being vaccinated for COVID-19, even after controlling for age, race, ethnicity, education, income, party identification, and ideology.

To access the full set of findings and methodology, click here.

NIH Report Details 20 Years of Advances and Challenges of Americans’ Oral Health

Posted on by lad3

Despite important advances in the understanding and treatment of oral diseases and conditions, many people in the U.S. still have chronic oral health problems and lack of access to care, according to a report by the National Institutes of Health. Oral Health in America: Advances and Challenges, is a follow-up to the seminal 2000 Oral Health in America: A Report of the Surgeon General. The new report, which is intended to provide a road map on how to improve the nation’s oral health, draws primarily on information from public research and evidence-based practices and was compiled and reviewed by NIH’s National Institute of Dental and Craniofacial Research (NIDCR) and a large, diverse, multi-disciplinary team of more than 400 experts.

The report updates the findings of the 2000 publication and highlights the national importance of oral health and its relationship to overall health. It also focuses on new scientific and technological knowledge – as well as innovations in health care delivery – that offer promising new directions for improving oral health care and creating greater equity in oral health across communities. Achieving that equity is an ongoing challenge for many who struggle to obtain dental insurance and access to affordable care.

“This is a very significant report,” said NIH Acting Director Lawrence A. Tabak, D.D.S., Ph.D. “It is the most comprehensive assessment of oral health currently available in the United States and it shows, unequivocally, that oral health plays a central role in overall health. Yet millions of Americans still do not have access to routine and preventative oral care.”

The newly issued report provides a comprehensive snapshot of oral health in America, including an examination of oral health across the lifespan and a look at the impact the issue has on communities and the economy. Major take-aways from the report include:

  • Healthy behaviors can improve and maintain an individual’s oral health, but these behaviors are also shaped by social and economic conditions.
  • Oral and medical conditions often share common risk factors, and just as medical conditions and their treatments can influence oral health, so can oral conditions and their treatments affect other health issues.
  • Substance misuse and mental health conditions negatively affect the oral health of many.
  • Group disparities around oral health, identified 20 years ago, have not been adequately addressed, and greater efforts are needed to tackle both the social and commercial determinants that create these inequities and the systemic biases that perpetuate them.

“This is an in-depth review of the scientific knowledge surrounding oral health that has accumulated over the last two decades,” said Rena D’Souza D.D.S., Ph.D., director of NIDCR, which oversaw and funded the project’s three-year research program. “It provides an important window into how many societal factors intersect to create advantages and disadvantages with respect to oral health, and, critically, overall health.”

The COVID-19 pandemic emerged while the report was being written. The science around SARS-CoV-2 continues to come into focus in real-time, and, although data were only starting to surface about the oral implications of the disease, the authors included a preliminary analysis of it to assess initial impacts.

The authors make several recommendations to improve oral health in America, which include the need for health care professionals to work together to provide integrated oral, medical, and behavioral health care in schools, community health centers, nursing homes, and medical care settings, as well as dental clinics. They also identify the need to improve access to care by developing a more diverse oral health care workforce, addressing the rising cost of dental education, expanding insurance coverage, and improving the overall affordability of care.

“Although there are challenges ahead, the report gives us a starting point and some clear goals that offer reasons to be hopeful, despite those challenges,” added D’Souza. “It imagines a future, as I do, in which systemic inequities that affect oral health and access to care are more fully addressed, and one in which dental and medical professionals work together to provide integrated care for all.”

Scientists and public health professionals will use the report to identify areas of scientific inquiry and research as well as develop and implement programs that ultimately will improve the oral health of individuals, communities, and the nation.

To view or download the report, please visit the NIDCR website at www.nidcr.nih.gov/oralhealthinamerica.

Questions about the report? Email OralHealthReport@nih.gov or call NIDCR at 1-866-232-4528.

The Impact of Pandemics on Oral Health

Posted on by lad3

An article in the latest issue of the Journal of the American Dental Association (JADA) explores the role of pandemics on societal behavior and their impact on oral health care. The analysis explores the past, present, and future of pandemic and what measures the dental community should adopt moving forward. The latest issue also features articles about ultrasonic scaler aerosol and spatter mitigation, the use of teledentistry with older patients, and the promotion of community water fluoridation.

Click here to read the article.

Veteran Oral Health: Expanding Access and Equity

Posted on by lad3

Gaps in veteran oral health have been long overlooked. Now is the time for change. A forward-thinking white paper from the CareQuest Institute and the American Institute of Dental Public Health (AIDPH), “Veteran Oral Health: Expanding Access and Equity,” focuses on the need to better understand the significant deficits surrounding veteran oral health. The goal of the paper is to catalyze oral health professionals and policymakers toward advancing health equity for veterans. The social, structural, and individual drivers of disparate oral health outcomes experienced by veterans deserve more attention from the oral health community. This paper delineates the struggles veterans face with oral health care every day.

Click here to view the paper.