INSIDE THE ISSUE
CDC Issues Hospital Sepsis Guidance
Last week, the Centers for Disease Control and Prevention (CDC) released its first-ever Hospital Sepsis Program Core Elements to assist all hospitals – of any size or location – implement and sharpen programs to fight sepsis. In releasing the guidance, the CDC noted that in the U.S., one in three people who dies in a hospital had sepsis during that hospitalization.
The CDC identifies the core elements of a sepsis program as: hospital leadership commitment, accountability, action, tracking, reporting, and education. The document gives “priority examples” and “additional examples” for each element of the program. In the commonwealth, MHA is a member of the Massachusetts Sepsis Consortium, which is a component of the Betsy Lehman Center for Patient Safety. September is national Sepsis Awareness Month.
Back to School Immunization Rates
As children across the state head back to school in the coming weeks, the focus is turning to whether the students are properly immunized. In Massachusetts, students in kindergarten through twelfth grade are required to be immunized with DTaP/Tdap, polio, MMR, Hepatitis B, and Varicella vaccines. The complete guidelines are here.
“Massachusetts students must provide documentation of immunization, according to school requirements, or show a medical or religious exemption,” according to the state. “Medical exemptions come from the student’s doctor and document a contraindication — the reason why an individual cannot medically receive the vaccine. Religious exemptions come from the parent/guardian, and state in writing that a vaccine conflicts with his/her sincerely held religious belief.”
The webpage link above shows the proportion of students with exemption by county, as well as other data. This CDC page provides information on the national back-to-school vaccination campaign.
MHA is among a wide group of healthcare organizations and public health advocates supporting state legislation that would tighten acceptable vaccine exemptions for school-aged children, given the growth of such exceptions in recent years and the resulting public health concerns.
CHIA: Mass. Beset by “Systemic Inequities and Institutional Racism”
The state’s Center for Health Information and Analysis (CHIA), using data from the Massachusetts Acute Hospital Case Mix Database, last week released a report showing that patients other than non-Hispanic White patients face, in varying degrees, higher emergency department (ED) visits, longer waits in EDs, more ED revisits, and higher rates of inpatient readmission, among other metrics. The data in the report is from July 1, 2020, to June 30, 2021.
“While many Massachusetts residents still struggle to access high quality, affordable, and timely healthcare, the systemic inequities and institutional racism faced by historically marginalized groups exacerbate these issues,” CHIA wrote.
Among the findings:
- Regardless of age group or sex, non-Hispanic Black patients had the highest readmission (i.e., returns to the inpatient setting) and revisit (i.e., returns through the ED) rates compared to other racial and ethnic groups (17.8% and 30.1%, respectively).
- Non-Hispanic Black patients had the longest average length of stay (ALOS) (5.9 days) and the highest proportion of ED visits associated with excess length of stay (LOS) (defined as spending more than four hours in the ED) (39.6%) compared to other racial and ethnic groups.
- Non-Hispanic Black patients with behavioral health conditions had higher readmission rates (23.2%) and a higher proportion of ED visits (69.7%) associated with excess LOS compared to other racial and ethnic groups.
- Hispanic patients had the second highest ED revisit rates after non-Hispanic Black patients among all racial and ethnic groups (29.8%), regardless of age group or sex.
While non-Hispanic Asian patients had lower acute care utilization, they had the longest ALOS for discharges resulting in a readmission and those associated with behavioral health compared to other racial and ethnic groups.
Take DPH’s Community Health Equity Survey
The CHIA report (above) tells the equity story using utilization numbers from a state database. Now the Department of Public Health (DPH) is seeking equity-related information directly from those who use the healthcare system.
DPH is encouraging residents to fill out the Community Health Equity Survey that it developed in collaboration with community members and partners across the state. The information provided by those filling out the survey will help DPH and community partners determine how best to allocate funding, improve programming, and develop policies to address health inequities.
The survey is intended for anyone over the age of 14 who lives in Massachusetts. DPH specifically seeks to hear from communities that have been affected by health inequities.
The survey is available in Arabic, Cape Verdean Creole, Chinese (simplified or traditional), English, Haitian Creole, Khmer, Portuguese, Russian, Spanish, and Vietnamese. It takes about 30 minutes to complete. Those who are deaf or hard of hearing can also take the survey in American Sign Language later this summer. All survey responses are anonymous and cannot be traced back to the respondent.
Mass. Distributes Workforce Grants; More to Come
The Massachusetts Executive Office of Health and Human Services (EOHHS) last week announced that 2,935 primary care and behavioral health providers have received $140 million in education loan repayment grants.
The program, created at the end of 2022, uses funding from the American Rescue Plan Act and the Opioid Recovery and Remediation Fund, and is administered through the Massachusetts League of Community Health Centers. The legislature in the FY2024 budget added an additional $120 million to the program that will become available in the coming months.
Applications for three separate loan repayment initiatives were open to qualifying employees with a range of credentials, including but not limited to, psychiatrists, master’s level behavioral health providers, mental health workers/technicians/counselors, primary care providers, nurses, recovery coaches, peer specialists, community health workers, and case managers who work at community health centers, community mental health centers, psychiatric units in acute care hospitals and inpatient psychiatric hospitals.
EOHHS said that nearly half of the awardees identify as people of color, 70% identify as women, and 47% are under the age of 35. More than 900 awardees speak a language other than English. The student loan repayment awards range from $12,500 to $300,000, depending on the healthcare professional’s qualifications, work settings, and hours worked.
“The MA Repay Program will be life-changing for thousands of our hardworking healthcare professionals while also helping more people enter and stay in this critical industry that has been suffering from workforce shortages,” said Governor Maura Healey. “I’m grateful to our legislative partners for prioritizing this funding that will positively impact the health and wellbeing of Massachusetts residents, strengthen our economy and competitiveness, and promote equity in the healthcare profession.”
September is National Recovery Month
September is National Recovery Month and this year the tag line that the Substance Abuse and Mental Health Services Administration (SAMSHA) is using to disseminate information about programs now underway is: “Hope is real. Recovery is real.” SAMSHA is part of the U.S. Department of Health & Human Services.
SAMSHA has created a toolkit to help increase awareness about recovery and to celebrate the individuals, families, and caregivers involved in mental health and substance use programs. The toolkit consists of shareable social media postings, weekly themes, and other resources.
At the local level, MHA continues to maintain its Help is Here microsite and collateral resources to point community members to behavioral health and substance use services in their area.