Do you know these facts? March of Dimes report and Maternal & Child Health.

-In Illinois, 34.3 percent of counties are defined as maternity care deserts compared to 32.6 percent in the U.S. 

• -4.6 percent of women had no birthing hospital within 30 minutes compared to 9.7 percent in the U.S. 

-Overall, women in Illinois have a low vulnerability to adverse outcomes due to the availability of reproductive healthcare services. 

-13.7 percent of birthing people received no or inadequate prenatal care, less than the U.S. rate of 14.8 percent. 

-Women with chronic health conditions have a 54 percent increased likelihood of preterm birth compared to women with none.

See full report here> Maternity-Care-Report-Illinois.March of Dimes.pdf

Other info here> 

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Medicaid is the primary health insurance program for low-income people in the US, offering comprehensive health care coverage to over 90 million people and ensuring millions of patients with cancer receive essential care.¹ Expanded Medicaid eligibility has been associated with increased access to care, earlier stage at diagnosis, increased receipt of cancer-directed treatment, and improved survival.² 

However, much less is known about how Medicaid variation between states influences equity of cancer care delivery. Section 1115 waivers are a key mechanism through which states can customize Medicaid enrollment, coverage, and benefits. Currently, 48 states and Washington, DC, use these waivers to modify Medicaid within the state.³ Gaps remain in our understanding of how these different 1115 waivers influence access to, receipt of, and outcomes from cancer care. Filling these gaps is critical to improve equity of cancer care in the US. [JAMA]

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Can AI use real-world data to teach us something randomized clinical trials can’t? How can physicians collaborate with companies to develop AI tools that benefit patients? And is AI a democratizing force that can scale privileged medical care to broader patient populations? [JAMA]

This conversation is part of a series of interviews in which JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, and expert guests explore issues surrounding the rapidly evolving intersection of artificial intelligence (AI) and medicine.

The future is to learn from the data, says Atul Butte, MD, PhD (Video), a distinguished professor and director of the Baker Computational Health Sciences Institute at the University of California San Francisco (UCSF) and chief data scientist over the entire University of California Health System.

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U.S. medical societies belonging to the AMA Federation of Medicine are at different stages in advancing health equity, with 74% reporting they have taken at least one action to ground their efforts in local history and context. In contrast, 16% say they have taken action to identify opportunities for improvement. [AMA]

Those were key findings included in AMA Health Equity in Organized Medicine 2023 Survey Report: Insights, Solutions, and Resources to Take Action (PDF), which is based on the first-ever survey conducted of state medical associations, national medical specialty societies and county medical  organizations about health equity. 

The survey data collected helped provide insights on actions to advance health equity taken by these organizations, while identifying barriers and resources needed to take further action. The report is intended to effectively assess the collective progress made, build on learning and achievements, and identify where future action and attention are needed.

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CHICAGO (CBS) -- Lawmakers in Springfield are focusing on high prescription drug prices.

On Wednesday, they announced the Prescription Drug Affordability Act. The legislation would create an independent Prescription Drug Affordability Board.

"Drugs don't work if people can't afford them. Today, 28% of Illinoisans have reported not filling their prescriptions or rationing their medication to save money," said State Rep. and co-sponsor Nabeela Syed (D) Palatine. 

If passed into law, the board could set upper limits on what people would pay for their medications.

Supporters said high prescription drug prices are a major factor in rising health insurance premiums.

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Ear infections became the norm, usually eased by a round of antibiotics. But as the years passed, the bacteria in 61-year old Horton’s ear became resistant to antibiotics, often leaving her with little to no relief. [CNN Health]

“These multi-drug-resistant superbugs can cause chronic infections in individuals for months to years to sometimes decades. It’s ridiculous just how virulent some of these bacteria get over time,” said Dwayne Roach, assistant professor of bacteriophages, infectious disease and immunology at San Diego State University.

Last year doctors offered to treat Horton’s infection with one of nature’s oldest predators — tiny tripod-looking viruses called phages designed to find, attack and gobble up bacteria.

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On December 15, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the new Transforming Maternal Health (TMaH) Model. CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in Spring 2024. Applications will be due in Summer 2024. [CMS.gov]

TMaH is the newest CMS model designed to focus exclusively on improving maternal health care for people enrolled in Medicaid and Children's Health Insurance Program (CHIP). The model will support participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy. The goal of the model is to reduce disparities in access and treatment. The model aims to improve outcomes and experiences for mothers and their newborns, while also reducing overall program expenditures.

The model is projected to run for 10 years.

Model Overview

Despite spending more per capita on maternal health care than any other nation, the U.S. has disproportionately high rates of adverse pregnancy outcomes as compared to other high-income nations. The TMaH Model provides SMAs with targeted support in the form of funding and technical assistance. The goal of this support is to improve maternal health care and birth outcomes while reducing associated health disparities.  This support also enables states to develop a value-based alternative payment model for maternity care services which will improve quality and health outcomes and promote long term sustainability of services.

TMaH’s initiatives will center on three main pillars:

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Joseph Wright, MD, MPH, and his team at the American Academy of Pediatrics (AAP) are in the midst of a herculean task—reviewing the AAP’s catalog of roughly 400 policies, guidelines, and algorithms to identify those that inappropriately use race as a proxy for biology and may exacerbate health disparities. The goal is to replace them with race-conscious approaches that explicitly aim to enhance equity. [JAMA Network]

“We cannot ignore the impact that race and ethnicity have on differential lived experiences and that those lived experiences contribute to differential health status and health outcomes,” Wright, chief equity officer and senior vice president of equity initiatives at the AAP, said in an interview.

While he and his team started with the 150 or so policies that explicitly involve race, they also plan to review policies with less obvious connections.

“What I’m concerned about is the more insidious embedding of bias into many clinical practice guidelines,” Wright said. “That’s what we are determined to ferret out.”

The AAP is among a growing number of medical societies that are systematically reviewing the way race is used in clinical guidelines or algorithms. Some have already replaced race with clinical factors or social determinants of health in their widely used clinical algorithms.

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His mother, Michelle Staten, said her son, who has autism and other conditions, reacted as many children with disabilities would when he was confined to the seclusion room at Buckhorn Creek Elementary. [KFF Health News]

“I still feel a lot of guilt about it as a parent,” said Staten, who sent the photos to the federal government in a 2022 complaint letter. “My child was traumatized.”

Documents show that restraint and seclusion were part of the special education plan the Wake County Public School System designed for Staten’s son. Starting when he was in kindergarten in 2017, Staten said, her son was repeatedly restrained or forced to stay alone in a seclusion room.

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Parents often bask in the glow of their children’s accomplishments, so if SARS-CoV-2 variants were like people, BA.2.86 would be busting its buttons right about now. [JAMA]

BA.2.86’s spawn, JN.1, has become the dominant SARS-CoV-2 variant in the US, status its parent variant never achieved. Fortunately, although COVID-19 cases have surged, hospitalizations and deaths from the disease are still considerably lower than they were the same time a year earlier.

When BA.2.86 joined the SARS-CoV-2 Omicron family last summer, it grabbed pandemic trackers’ attention because it was so different from its progenitor, BA.2. Compared with BA.2, BA.2.86’s spike protein carries more than 30 mutations, suggesting that it might spread more easily than its predecessors.

But even armed with those new mutations, BA.2.86 failed to dominate the other subvariants. Through early January of this year, BA.2.86 never exceeded much more than a 3% share of circulating SARS-CoV-2 subvariants in the US, according to Nowcast estimates from the US Centers for Disease Control and Prevention (CDC).

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