An AHRQ-funded resource–"Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care How-To-Implement Toolkit"—is available to help primary care teams reduce the number of patients on long-term opioid therapy for chronic pain. The evidence-based toolkit offers a quality improvement roadmap for redesigning patient care without practice facilitators or other external support. It helps clinical staff develop standardized workflows, track key measures and use electronic health record tools and registries. ###

A federal appeals court in New Orleans has suspended a COVID-19 vaccination requirement announced by President Joe Biden's administration for private employers with more than 100 employees, according to The Washington Post. [Becker's Health Review 11.7.2021) 

What is ahead for Illinois and other states? 

The U.S. Court of Appeals for the Fifth Circuit issued the decision Nov. 6 after a group of plaintiffs — including Louisiana, Utah, Texas, South Carolina and Mississippi — filed a lawsuit Nov. 5 questioning the Occupational Safety and Health Administration's authority in issuing the rule. 

In the decision, a panel of three judges wrote there is "cause to believe there are grave statutory and constitutional issues with the mandate."

The court's decision — which is not a ruling on policy merits — temporarily stops the vaccination requirement while the court does a more thorough review. The Justice Department has until 5 p.m. Nov. 8 to respond to the lawsuit's request for a more permanent freeze of the requirement.

Louisiana Attorney General Jeff Landry issued a statement praising the Fifth Circuit's decision, describing it as "a win for the liberty of job creators and their employees." He said the court's action "not only halts Biden from moving forward" but also "commands the judicious review we sought." 

OSHA issued an emergency temporary standard Nov. 4 outlining COVID-19 vaccination requirements for employers with 100 or more employees. The standard is expected to cover 84 million private-sector workers and two-thirds of the U.S. private-sector workforce. 

OSHA said businesses covered by the emergency temporary standard must put in place a mandatory COVID-19 vaccination policy, unless they adopt a policy requiring employees to be vaccinated or undergo regular testing and wear a face covering at work. Under the standard, employers also must provide paid time off to workers to get inoculated and provide paid leave to employees to recover from any side effects.

In an interview Nov. 7 on ABC , U.S. Surgeon General Vivek Murthy, MD, defended the vaccination requirement.

"The President and the administration wouldn't have put these requirements in place if they didn't think that they were appropriate and necessary, and the administration is certainly prepared to defend them," he told "This Week" co-anchor Martha Raddatz, adding that there is a history of vaccination requirements in the U.S.

But the emergency temporary standard has received some pushback from states and business groups, which are concerned about disruptions during the holiday season.

In addition to the Fifth Circuit case in Louisiana, a coalition of 11 states sued President Biden's administration Nov. 5 in the U.S. Court of Appeals for the Eighth Circuit over the rule for private businesses.

CMS has also announced a separate vaccination rule expected to cover 17 million healthcare workers at healthcare facilities participating in Medicare and Medicaid programs. The CMS regulation preempts state laws and other federal regulation requirements for all facilities that are regulated by CMS' Conditions of Participation.

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Chicago’s top doctor said Thursday the city continues to see a slight uptick in its COVID-19 metrics. [Health News Illinois  11.5.2021]

The seven-day average for new daily cases in Chicago is 328, a 12 percent increase from the prior week. The seven-day test positivity rate is 1.8 percent, a 0.2 percentage point increase from the prior week.

Chicago is also averaging 19 COVID-related hospitalizations per day, up two from the prior week.

“If we take a look, we still are seeing a little bit of an uptick in our numbers,” Chicago Department of Public Health Commissioner Dr. Allison Arwady said during a Facebook live event. While all metrics outside of daily deaths are increasing, she stated that none are yet in a high-risk category for transmission. 

Arwady also said the city continues to make progress on its goal to have at least 77 percent of eligible residents receive at least one dose of vaccine by the end of the year. 

About 75.5 percent of eligible Chicago residents have received at least one dose of a COVID-19 vaccine as of Thursday, while 69.6 percent are fully vaccinated.

Data on kids ages 5 to 11 will be on the website by next week, Arwady said.

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State and Chicago-area health officials said Wednesday they will adopt federal recommendations for Pfizer-BioNTech’s COVID-19 vaccine for children ages 5 to 11 years old, with initial shipments of doses already being received by providers. [Health News Illinois 11.4.2021]

The Centers for Disease Control and Prevention on Tuesday authorized the vaccine for use in the age group, with a smaller dose to be administered three weeks apart.

Chicago Department of Public Health Commissioner Dr. Allison Arwady said they have already received 30,000 doses.

“This is great news for our children and our families, and a decision that I know parents have been waiting for,” she said. “We have been planning our roll out for weeks ... and vaccinations can begin right away.”

The Illinois Department of Public Health previously said it expects to receive an initial shipment of 500,000 doses, with nearly 306,000 of the initial doses going to the state, 73,000 to the city of Chicago and over 100,000 to the federal government’s pharmacy partners.

Approximately 2,200 pediatric providers in Illinois have enrolled in the state’s immunization registry and can administer the COVID-19 vaccine to their patients, the agency said in a statement. Work also continues with schools to set up vaccination clinics and more than 1,200 youth vaccination events have been held or are scheduled.

“We need as many people as possible, including children, to be vaccinated to stop the spread of the virus and end this pandemic,’ said IDPH Director Dr. Ngozi Ezike.

Chicago’s in-home vaccination program will begin offering pediatric vaccination for all eligible children starting Nov. 15.

The Illinois Department of Public Health reported 1,746 new COVID-19 cases and 41 deaths on Wednesday.

The new cases bring the state’s total to 1,705,777, while the death toll is 25,898.

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Importance: Rural hospitals are increasingly merging with other hospitals. The associations of hospital mergers with quality of care need further investigation.

Objectives: To examine changes in quality of care for patients at rural hospitals that merged compared with those that remained independent.

Design, setting, and participants: In this case-control study, mergers at community nonrehabilitation hospitals in Federal Office of Rural Health Policy-eligible zip codes during 2009 to 2016 in 32 states were identified from Irving Levin Associates and the American Hospital Association Annual Survey. Outcomes for inpatient stays for select conditions and elective procedures were derived from the Healthcare Cost and Utilization Project State Inpatient Databases. Difference-in-differences linear probability models were used to assess premerger to postmerger changes in outcomes for patients discharged from merged vs comparison hospitals that remained independent. Data were analyzed from February to December 2020. 

... Conclusions and relevance: These findings suggest that rural hospital mergers were associated with better mortality outcomes for AMI and several other conditions. This finding is important to enhancing rural health care and reducing urban-rural disparities in quality of care.

See full article here>

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Children ages 5-11 should be vaccinated against COVID-19 with the Pfizer/BioNTech vaccine, the CDC's Advisory Committee on Immunization Practices (ACIP) said on Tuesday. [MedPage 11.2.2201]

ACIP voted 14-0 to recommend vaccinating this population with a two-dose regimen of 10 μg apiece, 21 days apart, citing the favorable benefit-risk association, the idea of restoring normalcy to children, and especially the extensive data presented by FDA and CDC staff.

"Today is a monumental day in the course of this pandemic and one that many of us will be very eager to see," said CDC Director Rochelle Walensky, MD, once again addressing the panel. She added that since the first vaccines were authorized for ages 16 and up, the question has been when protection might be expanded to younger children. 

This is a "recommendation likely to have tremendous impact," Walensky said. She said she was eager to see how committee members "interpret what we know and acknowledge areas of uncertainty."

Walensky also said that 745 children have died of COVID during the pandemic, including 94 children ages 5-11, and over 2,300 children in this population have been diagnosed with multi-system inflammatory syndrome (MIS-C).

Many committee members spoke as parents and grandparents and explained how they have vaccinated their children and grandchildren. Consumer representative Veronica McNally, JD, got a bit choked up when talking about how she would vaccinate her child after this recommendation, and would do so to prevent "the 95th death" in a child.

In an unusual move, several liaison representatives from the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), National Association of Pediatric Nurse Practitioners (NAPNAP), and the Pediatric Infectious Diseases Society (PIDS) read statements in support of vaccination for this age group prior to the ACIP vote.

Full article here> 

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Healthcare algorithms are frequently used to guide decision making for the direct care of patients and for population management. An AHRQ project is reviewing published research on: how algorithms and algorithm-informed decision tools can introduce racial or ethnic bias into care; how the use of algorithms affect racial/ethnic disparities in access to and quality of care and health outcomes; strategies to avoid bias in algorithms; and standards for the development of equitable algorithms. AHRQ is accepting public comment on the key questions that will inform this evidence review. Access the draft key questions and the online form to provide comments by 11:59 pm ET Nov. 15.

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The Robert Wood Johnson Foundation established a commission to better understand the ways in which the nation’s health data infrastructure perpetuates inequities. Now the National Commission to Transform Public Health Data Systems offers its recommendations on how data can be best collected, shared, and used to improve health equity—and RWJF will fund projects that carry out these findings. 

Download 54-page report here

Charting a Course for an Equity-Centered Data System 

Recommendations from the National Commission to Transform Public Health Data Systems 

Data are the building blocks for how we describe the health of people and the communities

where they live—stories that emerge from data help the nation understand and contextualize

what drives or impedes health and how structural factors like racism and other forms of 

discrimination influence one’s ability to live a healthy life.

The Issue

The COVID-19 pandemic laid bare the gaps in our public health and health data infrastructure and illuminated the many ways in which they perpetuate vast health inequities. To work toward a modernized health data system, the Robert Wood Johnson Foundation established a first-of-its-kind National Commission to Transform Public Health Data Systems to reimagine how data are collected, shared, and used, and identify the investments needed to improve health equity. Commissioners examined both the systems and the data needed to ensure public health information works for all, including: who the data we collect elevates, who is being centered in our data, who is being excluded, and why.   

The Commission’s recommendations for the nation call on government at all levels, business, community-based organizations, philanthropy, and others to take specific action to reimagine and modernize the public health data system.

View full article here> 

Download PDF of article here> 

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Health and Human Services Secretary Xavier Becerra today announced the release of the new HHS Overdose Prevention Strategy, designed to increase access to the full range of care and services for individuals who use substances that cause overdose, and their families.  This new strategy focuses on the multiple substances involved in overdose and the diverse treatment approaches for substance use disorder.

“With this new strategy, we’re breaking new ground to address the full range of drug use and addiction that can result in overdose and death,” said Secretary Becerra. “We’re changing the way we address overdoses. Our new strategy focuses on people -- putting the very individuals who have struggled with addiction in positions of power. And thanks to the American Rescue Plan, we can address what so many people have seen in recent years: a rise in overdoses that can risk a person’s life – and affect their entire family.”

The overdose epidemic has developed over the past decades, from increases in the prescribing of opioids in the 1990s, to rapid increases in heroin overdoses starting around 2010, to growth in overdoses from illicitly-manufactured synthetic opioids like fentanyl beginning in 2013. The epidemic continues to evolve, underscored by increased overdose deaths involving stimulants.

The new strategy prioritizes four key target areas—primary prevention, harm reduction, evidence-based treatment, and recovery support—and reflects the Biden-Harris Administration principles of maximizing health equity for underserved populations, using best available data and evidence to inform policy and actions, integrating substance use disorder services into other types of health care and social services, and reducing stigma.

Download full article here> 

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Healthcare is a personal and individualized relationship between a provider and patient. Each patient is treated according to their particular symptoms and personal health characteristics. For this reason, the wide variability in patient responses to the same medical treatments must be acknowledged and accounted for in making public health decisions. Yet, there has been a lack of specific government guidance to help those with autoimmune diseases navigate COVID-19 vaccination. [MedPage Today 10.22.2021-10.25.2021]

Public health officials must focus more on the unique needs of patients with autoimmune disease or they will miss achieving long-term public health and vaccination goals.

Many of us either have an autoimmune disease or know someone living with one, such as multiple sclerosis (MS), rheumatoid arthritis, lupus, Crohn's disease, psoriasis, or others. While the pandemic is difficult for all of us, these patients have faced higher rates of severe COVID-19 and death.

The incomplete messaging on vaccination for this population is only making things more challenging. Patients with autoimmune diseases who are taking drugs that may suppress their immune response have been told the vaccines may not fully benefit them, if at all. In August, the CDC stated: "giving [immunocompromised patients] an additional shot is almost not considered a booster" because "it's considered part of what their original regimen should have been." Following this, the CDC issued a blanket recommendation that all patients on active treatment with "drugs that may suppress [their] immune response" receive an additional dose of a COVID-19 mRNA vaccine. More recently, FDA amended the emergency use authorizations (EUA) for the Pfizer-BioNTech and Moderna vaccines to allow for use of a booster dose by people at high risk of severe COVID-19, and for all Johnson & Johnson recipients. CDC clarified who is considered high-risk by endorsing boosters for adults with underlying medical conditions, which includes people in an "immunocompromised state." Taken together, current guidance appears to cumulatively recommend autoimmune patients taking drugs that may suppress their immune system secure both an additional dose and a booster, but in fact the CDC and FDA have still not weighed in on this specific scenario.

It's true that some patients with autoimmune disease on therapies that affect their immune system experience a reduction in immune response, thereby impairing their ability to achieve the full benefits of COVID-19 vaccines. However, emerging evidence suggests this diminished immune response may not be the rule; some of these patients may achieve similar vaccination benefits from a standard COVID-19 vaccine regimen as the general population. Reconciling this distinction could have major implications in health policy and the ability to determine not merely the percentage of those vaccinated, but more importantly, a better understanding of overall public immunity to COVID-19 after vaccination.

Take MS for example. A new peer reviewed study published in the Journal of Neuroimmunology examines the immune response to mRNA vaccines for COVID-19 in patients with MS who simultaneously are being treated with immunomodulating therapies. The study determined that certain medications for MS did not blunt the vaccine response in these patients, finding overall that "[v]accination and [these therapies] can be timed to maintain disease control and also allow effective vaccination against SARS-CoV-2." Public health officials should be disseminating this information to the MS community to potentially increase understanding of their protection from COVID-19 and enable more informed healthcare decisions.

This study provides important information for patients suffering from MS; it indicates these patients might not have to compromise between treating their disease and eliciting a standard immune response to the COVID-19 vaccine. But the study also raises the bigger public health question of vaccine effectiveness in the autoimmune disease space. Public health leaders should focus on researching how different therapies for the whole spectrum of autoimmune diseases affect COVID-19 vaccine response. While it is encouraging that NIH is investigating the antibody response from an additional dose in autoimmune disease patients who had a suboptimal response to an initial COVID-19 vaccine regimen, it is just as important to research which autoimmune therapies do allow for a vaccine response similar to that of the general population.

The CDC encourages patients taking drugs that may suppress their immune response -- such as many patients with an autoimmune disease -- to act like they are unvaccinated regardless of their vaccination status. They are advised to wear a mask, maintain social distance, and avoid crowds and poorly ventilated indoor spaces. When public health officials again relax recommended precautionary measures for the general population, a more nuanced understanding of which patients in the immunocompromised community should continue to follow restrictive measures is vital. Without such information, members of this heterogenous population may be unnecessarily curtailing activities of daily living.

COVID-19 is not going away any time soon. Public health officials must focus more on the unique needs of patients with autoimmune disease or they will miss achieving long-term public health and vaccination goals. The administration, FDA, and CDC must provide tailored guidance on which autoimmune disease therapies do and do not have an impact on vaccine effectiveness. This information will empower physicians to treat these patients with more precise approaches and public health officials to make evidence-based health policy. Most importantly, it can give patients with autoimmune disease a chance to reclaim their lives.

Kirk Taylor, MD, serves as senior vice president of North America Medical Affairs for EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany.

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