The collection, use, and meaning of race in biomedical research is complicated by the tension between the requisite interrogation of health disparities associated with race and the risk of continued insinuation of race as a biologic entity when interspersed with health outcomes.^1-3 As a social construct, the literature supports that, assessed at the individual level, race as a category has a nontrivial change with repeated assessment. For instance, 12.5% of childrens’ US census records had a changed racial category from 2000 to 2010 at the individual response level.⁴ Thus, given the duality of race as important yet mutable, we sought to quantify the frequency of change in race category in the electronic medical record (EMR) of a pediatric population. [JAMA Network] 

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Full paper here>  

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Still timely considering IOMC's webinar on Resistance to Adopting Childhood Vaccines- Is this a Rising Public Health Issue? 

The University at Buffalo (UB) is one of five universities that received a grant from the Association of American Medical Colleges (AAMC) and the Centers for Disease Control and Preventive (CDC) to dispel medical misinformation and vaccine hesitancy around the nation. [Patient Engagement HIT]

Medical misinformation has become a significant threat to healthcare, especially as more people turn to social media for medical advice.

The volume of medical misinformation has dampened the public trust in the COVID-19 vaccine. Additionally, studies have shown that people who greatly rely on family, friends, and social media for COVID-19 information have the lowest knowledge about COVID-19 and are among the least likely to engage in protective behaviors like social distancing or mask-wearing.

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Public health agencies that communicated clearly, led with science, and provided protective resources were able to build patient trust more than those agencies that appeared to be politically motivated, according to a new report in Health Affairs obtained via email. [Patient Engagement HIT]

The challenge? Perceptions of how agencies communicate are certainly in the eye of the beholder. While one individual might see advice for universal masking as science-based public health communication, another might see it as politically motivated, setting the scene for the public health trust problem the US has faced since the pandemic’s onset in 2020.

“Public trust in government and other major institutions across US society has been declining for decades, and the pandemic has raised concerns about trust in public health agencies in particular,” the Harvard University researchers wrote in the study. “Opportunities for misinformation to take root in the current social and traditional media environments raise concerns that trust will decline further.”

In order for public health agencies, each at the federal, state, and local levels, to recoup their image, they will need to better understand what influences an individual’s trust.

In a February 2022 survey of around 4,200 adults, the researchers found that people’s trust differed by agency and how that agency communicated. Generally speaking, trust in any public health agencies was low.

READ MORE: RWJF: How Public Health Sector, CDC Can Focus on Health Equity

Trust in federal entities like the Centers for Disease Control and Prevention (CDC), Surgeon General, National Institutes of Health (NIH), and the Food and Drug Administration (FDA) didn’t even reach the 50 percent mark. Trust in local and state public health agencies was even lower.

Rather, people trusted their doctors and nurses, plus the scientists researching COVID-19.

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Organizations to reduce social determinants of health barriers in under-resourced areas.

The American Heart Association, through its Social Impact Fund, will invest $400,000 in two Utah community-based organizations to combat health barriers related to social determinants in under-resourced communities.

AHA said that while Utah has made significant commitments to advance health equity, the state continues to see health disparities among racial and ethnic groups, which contribute to adverse health outcomes, impacting overall well-being, lifespan, and social and economic mobility.

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Sufferers’ mental illnesses experience changes in communication, cognition, and behavior, exposing differences in social behavior and relationships. Many who suffer from mental health problems notice that the reduced communication ability leads to social inclusion and distrust of others. Online Mental Health Communities (OMHCs) facilitate a new means of communication between patients and physicians. Based on the trust source credibility framework, trust transitivity theory, social resources and physician-patient interactions, this study aims to evaluate the factors that influence patients’ trust in OMHC's.  [JAMA Network] 

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 A new study from the NYU Grossman School of Medicine shows how community health workers helped patients achieve optimal blood pressure control, underscoring the role these non-clinical workers play in chronic disease management. [Patient Engagement HIT]

The community health worker (CHW) program was effective because CHWs helped promote cultural competence and filled in language barriers, the researchers said.

“As the demand for patient-centered approaches in clinical settings expands, CHW models have growing clinical and public health relevance in the context of hypertension management,” Nadia Islam, PhD, associate professor in the Department of Population Health, said in a press release.

“They offer a cost-effective model for chronic disease management among immigrant communities with limited English proficiency who are often underserved by health care systems,” added Islam, who is also an associate director at the Institute for Excellence in Health at NYU Langone.

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CMS wants you to be able to use a standard set of quality measures for the myriad value-based care contracts you might be involved in. Dubbed the Universal Foundation, these measures are set to streamline quality reporting in different contracts. The most exciting part? They include social determinants of health screening and the ability to quantify health disparities. [Patient EngagementHIT] 

The agency outlined the Universal Foundation in a February 1 article in the New England Journal of Medicine, explaining that in their 20-year history, quality measures have become more complex, redundant, and in some cases meaningless to improving clinical quality. Although integral to moving value-based care forward, quality measures can be a headache for many in the healthcare industry.

“Since there is tension between measuring all important aspects of quality and reducing measure proliferation, we are proposing a move toward a building-block approach: a ‘universal foundation’ of quality measures that will apply to as many CMS quality-rating and value-based care programs as possible, with additional measures added on, depending on the population or setting,” CMS leadership wrote in the NEJM article.

The proposed Universal Measures include 23 measures ranging from preventive care and screenings, behavioral health, and chronic disease management. These measures, which CMS has made room to iterate in the future, would start as a baseline and some programs might require supplemental measures. The agency emphasized that additional measures would go under strict scrutiny before being added to program requirements.

To much celebration from Gary Price, MD, the CEO of the Physician’s Foundation, the measures also include two that look at the social drivers of health.

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GETTING IT RIGHT ON QUALITY MEASURES

In some ways, the Universal Foundation is a CMS effort to course correct on quality measures. Quality measures are instrumental to any quality improvement program, including certain value-based care programs. As the old adage goes, you cannot improve what you do not measure.

But as both CMS and Price indicated, those quality measures had become overly complex. Different programs might measure different outcomes, or they might be looking at the same outcome but use different language when detailing the measure.

“One of the problems with the quality measures up to this point is that they often weren't aligned with each other either within the coding system itself or between hospitals and physicians or even between different insurers and the way they're coded,” Price explained. “That's become kind of a mess, and I think CMS has signaled that they want to help improve that.”

Full article> 

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 The medical industry is far from achieving racial health equity, according to a new report from Accenture. But it could be. [Patient Engagement Hit] 

...In an analysis of peer-reviewed research and expert commentary, the researchers outlined the five interconnected barriers blocking health equity from coming to light: implicit bias, lack of trust and fear, access barriers, uneven quality and experience, and racism in research and development or clinical practices.

Barriers to Achieving Racial Health Equity 

• Implicit bias
• Patient Trust 
• Care Access Barriers
• Unequal quality 
• Patient Experience 
• Racism

The report, which outlines some of the stark racial health disparities still plaguing the US, also looks at the barriers keeping the nation from confronting its problems and a roadmap for mitigating these issues.

Looking at race, specifically, because it is the most prominent predictor of health inequity, the researchers noted that outcomes still aren’t equitable for all. There are 3,400 more infant mortalities among Black babies than White, the report authors said, and an additional 9,200 Black cancer deaths each year, too.

Full article here> 

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Questions Remain About What SARS-CoV-2 Variants Should Go Into the Annual COVID-19 Vaccines Proposed by the FDA | FDA proposes one single vaccine per year. [JAMA]

From the beginning, a scorecard might have come in handy for keeping track of the whos, whats, and whens of COVID-19 vaccination.

...Three years into the COVID-19 pandemic and more than 2 years since vaccines became available, however, the US Food and Drug Administration (FDA) wants to get down to 1 vaccine dose per year for most people, following an annual review of the circulating SARS-CoV-2 variants du jour to determine the shot’s optimal makeup.
Under the FDA’s proposed plan, everyone’s annual vaccine,
administered in the fall, would be composed of the same variant or variants, no matter whether it’s their 1st or 5th or 15th dose. (“I think this virus is going to be with us forever,” vaccine expert Paul Offit, MD, said in an interview.)

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Full article here> 

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Race-based medicine in the US, which has unjustly contributed to racial inequities in clinical care and health outcomes, has reinforced well-documented mistrust toward the health care enterprise.¹ The urgency of abolishing race-based medical practices, including the use of algorithms informing risk stratification, diagnosis, and treatment approaches, has fueled national efforts to identify and reform these practices.² The recent US Organ Procurement and Transplantation Network (OPTN) decision to modify kidney transplant wait times for Black individuals affected by race-based kidney function estimating equations provides an exemplar of how a focus on justice, reform, and repair can advance our efforts to pursue equity.

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Full article here> 

Video - You may be interested in viewing the IOMC video " Systemic Issues Impacting Kidney Disease and Equity" here. 

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