Health And Human Services Research Articles

Understanding We Can Do This COVID-19 vaccine campaign elements through message frames and emotional appeals

This study looks into the message frames, emotional appeals, and approaches used in the We Can Do This COVID-19 vaccine campaign by the U.S. Department of Health and Human Services (HHS). A quantitative content analysis of 145 audio-visual campaign elements was guided by framing theory. Results indicate that the campaign messages primarily focused on vaccine benefits and used an informational approach to messaging. Consistent use of hope is observed alongside frames, such as vaccine information, facts and findings, and preventive measures. The moral obligation frame uses a more negative appeal (i.e., guilt) across the campaign elements. Additionally, while informational messages incorporate a more fear appeal, sadness, guilt, and hope remain the consistent emotional appeals in the transformational message approach. The findings of this study can serve as a valuable resource for the U.S. Government authorities and other healthcare experts in the implementation of comparable vaccination campaigns.

Going in Blind: A Common Scenario in an Uncommon Situation.

Medical students, interns, junior resident physicians, senior resident physicians. Power outages have been increasing in frequency in the past few years, therefore becoming an increased threat to healthcare delivery.1 While most studies related to the effects of power outages are focused on outpatient care, such as acute exacerbations of chronic lung conditions and the lack of chargeable equipment, with the increasing number of power outages, hospitals must be prepared for this situation as well.2,3 Although agencies such as the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) have provided guidelines for the response of hospitals to temporary loss of power,12,13 hospitals generally rely on institutional policies in response to the event of a power outage. Given the relative rarity but increasing frequency of power outages in hospital settings, this medical simulation was created to present a common occurrence in the emergency department (eg, cardiac arrest) in an uncommon setting of a power outage. Simulation has been shown to improve learner self-efficacy, confidence, and leadership skills among resuscitation teams.4,5 The role of simulation also helps learners identify latent safety threats, in this case a power outage.6 The goal of this simulation is to improve the skills of healthcare professionals with regards to managing cardiac arrest and to encourage these practitioners to consider their own hospital guidelines in response to a power outage. By the end of this simulation, learners will be able to (1) evaluate and treat a patient experiencing myocardial infarction and subsequent cardiac arrest during a power outage, (2) describe the local protocols for managing patient care during a power outage, (3) demonstrate the ability to coordinate a medical team during a simulated power outage in an emergency department with limited resources, (4) manage a cardiac arrest patient by following Advanced Cardiac Life Support (ACLS) protocols for bradycardia and ventricular fibrillation, and (5) justify the urgency of transfer to a certified ST segment elevation myocardial infarction center/cardiac intensive care unit, referencing the recommended 120-minute door-to-balloon time. This simulation was conducted with a high-fidelity mannequin. A total of six residents of various post-graduate year (PGY) levels participated in the simulated patient encounter as part of the simulation competition at the Western Regional meeting of the Society for Academic Emergency Medicine. This case was assessed for educational content and piloted by emergency medicine attendings from several institutions prior to running the case for the Western Regional meeting. The efficacy of the content was assessed by oral feedback. The case was well-received by both the attending physicians who evaluated the case prior to running the scenario at the Western Regional meeting and the emergency medicine residents who participated in the case at the Western Regional meeting. Overall, this simulation was well received by both the learners and the debriefers. General feedback was positive, with the perception of increased confidence among learners and reflection upon individual hospital policy in the event of a power outage. Simulation, acute myocardial infarction, cardiac arrest, power outage.

The Community-Based Health Workforce in Public Health and Health Care Delivery.

The "community-based workforce" is an umbrella term used by a workgroup of U.S. Department of Health and Human Services (HHS) leaders to characterize a variety of job titles and descriptions for positions in the public health, health care delivery, and human service sectors across local communities. Definitions, expectations of the scope of work, and funding opportunities for this workforce vary. To address some of these challenges, a workgroup of HHS agencies met to define the roles of this workforce and identify existing opportunities for training, career advancement, and compensation. The community-based workforce has demonstrated success in improving poor health outcomes and addressing the social determinants of health for decades. However, descriptions of this workforce, expectations of their roles, and funding opportunities vary. The HHS workgroup identified that comprehensive approaches are needed within HHS and via public health sectors to meet these challenges and opportunities. Using the common term "community-based workforce" across HHS can encourage alignment and collaboration. As the environment for this public health and health care community-based workforce shifts, it will be important to understand the value and opportunities available to ensure long-term sustainability for this workforce to continue to advance health equity.

Understanding the Regulatory Pathways Used to Develop, Evaluate, Authorize, and Approve New Drugs and Vaccines in the United States.

The United States (U.S.) Food and Drug Administration (FDA) oversees the safety and quality of drugs and vaccines that are used in the U.S. Administration of the FDA falls under the jurisdiction of the U.S. Department of Health and Human Services (HHS). The regulatory oversight of the FDA is complex and comprehensive, requiring the various roles and responsibilities to be divided across six main centers. The activities of two of these centers, the Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER) are the primary focus of this review.

Millions in BH funding to advance Unity Agenda announced

The Biden‐Harris administration last week announced $46.8 million in behavioral health funding opportunities to advance President Biden's Unity Agenda as part of May Mental Health Awareness Month, according to a U.S. Health and Human Services (HHS) news release.

First federal action plan for suicide prevention released by administration

The Biden administration on April 23 unveiled the launch of the National Strategy for Suicide Prevention initiative, a bold new 10‐year, comprehensive, whole‐of‐society approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide prevention field, U.S. Department of Health and Human Services (HHS) officials stated.

A Novel Machine Learning Algorithm for Creating Risk-Adjusted Payment Formulas

Models predicting health care spending and other outcomes from administrative records are widely used to manage and pay for health care, despite well-documented deficiencies. New methods are needed that can incorporate more than 70 000 diagnoses without creating undesirable coding incentives. To develop a machine learning (ML) algorithm, building on Diagnostic Item (DXI) categories and Diagnostic Cost Group (DCG) methods, that automates development of clinically credible and transparent predictive models for policymakers and clinicians. DXIs were organized into disease hierarchies and assigned an Appropriateness to Include (ATI) score to reflect vagueness and gameability concerns. A novel automated DCG algorithm iteratively assigned DXIs in 1 or more disease hierarchies to DCGs, identifying sets of DXIs with the largest regression coefficient as dominant; presence of a previously identified dominating DXI removed lower-ranked ones before the next iteration. The Merative MarketScan Commercial Claims and Encounters Database for commercial health insurance enrollees 64 years and younger was used. Data from January 2016 through December 2018 were randomly split 90% to 10% for model development and validation, respectively. Deidentified claims and enrollment data were delivered by Merative the following November in each calendar year and analyzed from November 2020 to January 2024. Concurrent top-coded total health care cost. Model performance was assessed using validation sample weighted least-squares regression, mean absolute errors, and mean errors for rare and common diagnoses. This study included 35 245 586 commercial health insurance enrollees 64 years and younger (65 901 460 person-years) and relied on 19 clinicians who provided reviews in the base model. The algorithm implemented 218 clinician-specified hierarchies compared with the US Department of Health and Human Services (HHS) hierarchical condition category (HCC) model's 64 hierarchies. The base model that dropped vague and gameable DXIs reduced the number of parameters by 80% (1624 of 3150), achieved an R2 of 0.535, and kept mean predicted spending within 12% ($3843 of $31 313) of actual spending for the 3% of people with rare diseases. In contrast, the HHS HCC model had an R2 of 0.428 and underpaid this group by 33% ($10 354 of $31 313). In this study, by automating DXI clustering within clinically specified hierarchies, this algorithm built clinically interpretable risk models in large datasets while addressing diagnostic vagueness and gameability concerns.

HHS announces funding to support care transition for individuals leaving incarceration

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), took new policy action and announced the availability of $51 million for the first‐ever funding opportunity for HRSA‐supported health centers to implement innovative approaches to support transitions in care for people leaving incarceration, HHS officials announced last week. Aligned with the White House Second Chance Initiative, the action, for the first time, explicitly supports the provision of health services to individuals during the 90 days prior to their release to help them return to the community by expanding access to primary health care, including mental health and substance use disorder treatment, furthering public health and strengthening public safety. HRSA‐funded health centers provide primary care, regardless of ability to pay, and are a cornerstone of our country's health care system, especially for individuals and families who are uninsured; enrolled in Medicaid; living in rural, remote, or underserved areas; struggling to afford their health insurance co‐pays; experiencing homelessness; residing in public housing; or otherwise having difficulty finding a doctor or paying for the cost of care. The 1,400 HRSA‐funded health centers operate more than 15,000 service sites, providing care for more than 30 million patients.

OTP leaders on Part 2: Tell patients what consent means

The confidentiality regulation governing substance use disorder (SUD) treatment records has been constantly weakened since 2010. Most recently, the final rule came out (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34035) which further weakens privacy, most importantly by allowing the first initial consent to release of patient information, signed by the patient, to be used forever, to go to almost anyone, except for law enforcement. When the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) jointly released that final rule, they did not comply with the requirement by Congress in the CARES Act that while sharing of information should be easier, anti‐discrimination provisions needed to be tightened. There was no addition of anti‐discrimination provisions.

'Patient' or 'professional'? Negotiating accommodations and identity in fieldwork education.

Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice. Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations. Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures. The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care.

HHS approves New Mexico's community‐based care expansion

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services, has approved a proposal from New Mexico for community‐based mobile crisis intervention teams to provide Medicaid crisis services, a cms.gov news release stated. The Feb. 6 announcement is the latest in HHS' ongoing efforts to support President Biden's whole‐of‐government strategy to transform mental health services for all Americans — a key part of the President's Unity Agenda, the news release stated. New Mexico is the 15th state to expand access to community‐based mental health and substance use crisis care through President Biden's American Rescue Plan. With this approval, the state will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year. This work builds on HHS' broader work to expand dramatically the full continuum of mental health crisis services, including through the nationwide launch of the 988 Suicide & Crisis Lifeline and expansion of Certified Community Behavioral Health Clinics under the Bipartisan Safer Communities Act, providing crisis services 24 hours a day, 7 days a week, regardless of a person's ability to pay.

Part 2 Final Rule: Where are the anti‐discrimination provisions?

The Legal Action Center has been a central resource for information on 42 CFR Part 2, the regulation protecting (ostensibly, now) confidentiality of substance use disorder (SUD) treatment records, for more than three decades. This article is our 350th one on Part 2 since 2010, when the move to weaken the consent part of the regulations began. So we talked to Legal Action Center attorneys Jacqueline Seitz and Deborah A. Reid last week about the Final Rule for Part 2, issued this month by the Department of Health and Human Services (HHS) (see Confidentiality for SUD records: Final rule issued, ADAW Feb. 19; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34035).

Confidentiality for SUD records: Final rule issued

A week after the federal Department of Health and Human Services (HHS) issued a final rule liberalizing treatment for opioid use disorder (OUD) in opioid treatment programs, it issued a less patient‐friendly rule. ADAW has written about 400 articles on confidentiality and substance use disorder treatment, an area that has seen continued erosion since 2010 when the government started acceding to claims that requiring a patient to consent to the release of his or her substance use disorder (SUD) treatment information in a digital age (think “Electronic Health Record”) would be just too inconvenient. The most recent step came in the Federal Register issued Feb. 8, which changes the confidentiality rules to align with those of HIPAA. The rule, through the HHS Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), finalized modifications to the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations at 42 CFR part 2 (“Part 2”), which protect the privacy of patients' SUD treatment records. In a press release about the rule, HHS said this: “Specifically, today's final rule increases coordination among providers treating patients for SUDs, strengthens confidentiality protections through civil enforcement, and enhances integration of behavioral health information with other medical records to improve patient health outcomes.”

A Dyadic Framework of Care for Opioid-exposed Birthing Persons and Their Infants and Children

ObjectiveTo develop a dyadic-centered framework focused on clinical care, surveillance, and research for birthing persons with opioid use disorder (OUD) and their infants and children. Study DesignBetween February and March 2023, an analysis was conducted within the US Department of Health and Human Services (HHS) of activities directed at opioid-exposed birthing persons and their infants and children (the dyad) to identify: 1) number of activities, stratified by type, and 2) characteristics across health and supportive activities that serve the dyad vs. birthing persons or infants and children individually. Descriptive and thematic analyses were used to assess quantity and characteristics of fiscal year 2023—2024 activities aggregated across eleven HHS agencies. ResultsOf 181 activities examined, 75 met inclusion criteria specific to serving birthing persons with OUD and opioid-exposed infants and children. Sixty-two percent of activities were dyad focused. Five categories of dyadic activities were identified: research (45%), education and training (28%), health and supportive services (21%), surveillance (4%), and quality improvement (2%). Eight specific characteristics were key to dyadic activities: a life course and generational approach, emphasis on relationship, dyadic outcomes, wraparound services, payment structures supporting dyadic care, data linkage, and social determinants of health. ConclusionsThis analysis of HHS activities directed at birthing persons with OUD and opioid-exposed infants and children showed that most programs had a dyadic focus. Synthesizing elements identified from activities serving the dyad facilitated the development of a dyadic framework integrating clinical care, public health surveillance, and research.

NACSD RECOMMENDATIONS FOR OLDER ADULT DISASTER PREPAREDNESS, RESPONSE, AND RECOVERY

Abstract This presentation shares the recommendations drafted by the National Advisory Committee on Seniors and Disasters (NACSD). This federal advisory committee provides advice and guidance to the Assistant Secretary for Preparedness and Response within the U.S. Department of Health and Human Services (HHS) and the HHS Secretary. The NACSD is comprised of seven non-federal members with expertise in geriatric disaster planning, preparedness, response, or recovery and ten federal (non-voting) members who are ex officio representatives from agencies within HHS and other Executive Branch departments. The voting members drafted recommendations intended to address the immediate and persistent challenges in public health emergency preparedness, response, and recovery affecting older adults in the United States. Numerous meetings with federal and non-federal subject matter experts from various disciplines were held to develop the recommendations. The NACSD was also tasked with evaluating issues and programs and providing findings, advice, and recommendations to the Secretary of Health and Human Services to support and enhance all-hazards public health and medical preparedness, response, and recovery activities related to meeting the unique needs of older adults and their families across the entire spectrum of their wellbeing. The NACSD evaluated and provided input concerning the medical and public health needs of older adults related to preparation for, response to, and recovery from all-hazards emergencies; and may provide advice and consultation with respect to State emergency preparedness and response activities relating to older adults.

The use of blockchain technology in the scientific research workflow

This paper is based upon a lightening talk that was given on February 14, 2023 at the 2023 NISO Plus conference. The presentation described the research for the creation of a white paper on the use of blockchain technology along the scientific research workflow that will be released in early 2024 by the International Union of Pure and Applied Chemistry (IUPAC). What the three-year study found is that the technology is indeed being used in almost all the steps in the scientific research workflow - from hypothesis development through to publication - by commercial organizations as well as by non-profits and across all market sectors, even governments. For example, the U.S Department of Health and Human Services (HHS) uses blockchain technology in a pilot program, the Grant-recipient Digital Dossier (GDD), to manage their grant program more efficiently. As of July 2021, GDD had reduced the time required to complete grant assessment tasks from four-plus-hours to a fifteen-minute process. This paper briefly summarizes the findings, discusses the pros/cons of the technology, and provides a glimpse of how the technology is impacting the future of scientific research.

In Case You Haven't Heard…

The United States Surgeon General Dr. Vivek Murthy on Dec. 4 launched the 5‐for‐5 Connection Challenge, calling on Americans to take five actions over five days to build more connection in their lives, a U.S. Department of Health and Human Services (HHS) news release stated. Dr. Murthy recently issued this challenge to students across the country on his “We Are Made to Connect” college tour, which concluded in early December. As we enter the holiday season, the 5‐for‐5 Connection Challenge aims to inspire people of all ages to build, strengthen, and prioritize their relationships. For the next two weeks, from Dec. 4 to 15, the Surgeon General will encourage people to take five actions over five days that express gratitude, offer support to, or ask for help from people in their lives. These types of actions are outlined in the Surgeon General's advisory, “Our Epidemic of Loneliness and Isolation,” (www.hhs.gov/sites/default/files/surgeon‐general‐social‐connection‐advisory.pdf) as some of the ways that people can catalyze social connection. As outlined in the advisory, social connection can advance physical, mental and cognitive health, and it is even associated with a decreased risk of mortality.

What Healthcare Leaders Need to Know About Information Blocking Enforcement

On June 27, 2023, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) released its final rule implementing penalties for information blocking.

Mechanical properties of cemented tungsten carbide with nanocrystalline FeNiZr binder

The use of cemented tungsten carbide (WC) spans numerous commercial applications. Due to the extreme hardness and high modulus provided by the WC phase combined with added plasticity and resulting toughness contributed by the cobalt (Co) binder, cemented WC-Co is a good candidate for cutting tools, machining tools, and mining equipment. Co has been identified as a strategic and critical material from the Department of the Interior (DOI) and is “anticipated to be a human carcinogen” by the US Department of Health and Human Services (HHS). Nanostructured FeNiZr is being evaluated as a plausible binder replacement to Co since it doesn't exhibit these concerns. Preliminary consolidations of WC-FeNiZr powders utilizing Field Assisted Sintering followed by Hot Isostatic Pressing have generated (near) fully dense samples with hardness and toughness values exceeding 16 GPa (1630 HV) and 13 MPa-m1/2 (11.83 ksi-in1/2) respectively. Electron Backscatter Diffraction and Transmission Electron Microscopy are used to explain the structure-property relationship.

Supporting Solidarity

Supporting Solidarity