New data show health care spending in Rhode Island rebounded in 2021 after pandemic-driven declines

The article focuses on new data from the Office of the Health Insurance Commissioner (OHIC) in Rhode Island, which shows a rebound in overall health care spending in 2021 after declines during the COVID-19 pandemic, particularly in the commercial market and Medicare.

English Language Arts Instructional Systems in the First Full Year of COVID-19. Research Report. RR-A279-2

Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented stresses on the public education system in the United States. At every level, from the U.S. Department of Education down through local districts and individual schools, the pandemic has presented formidable challenges. Many of these challenges have been operational in nature but there have also been substantial instructional challenges during the pandemic. Early insight into the effects of the COVID-19 pandemic on public schooling identified the challenges that schools faced in the pivot to online learning in spring 2020. Large proportions of teachers reported through the RAND American Teacher Panel (ATP) that they had not received adequate guidance from their school systems to serve particular populations of students, such as students with disabilities (SWDs), homeless students, and English learners (ELs). These pandemic-era instructional challenges compound existing barriers to quality instruction. This report examines issues of instructional system coherence during the 2020-2021 school year. Specifically, the report investigates teachers' perceptions of: (1) guidance they received about ELA instruction, (2) guidance around addressing the needs of traditionally underserved students, (3) coherence of their ELA instructional system, and (4) presence of contextual conditions identified through literature as supporting coherence.

Fostering Faculty Innovation: Colleges Strive Individually and Collectively to Provide Resources, Leeway for Faculty

As the world takes two steps forward toward normalcy, typically followed by a step backward into pandemic mode, the truism that faculty success leads to student success probably has never been more resonant. To achieve professional success, faculty need a culture--along with a budget--to try out new, innovative ideas. Both at the individual campus or district level, as well as statewide, community colleges are working to make these sorts of initiatives happen.

Special Issues Brief: How Region 2 States Are Leveraging Innovative Strategies to Address Critical Shortages of Education Personnel

This special issues brief provides an overview of the education workforce shortage trends both nationally and in Region 2 states (Connecticut, New York, and Rhode Island). The brief also highlights examples of how Region 2 states are innovating to address these shortages and provides additional considerations for strategies to address shortages in both the short term and the long term.

The Promise and Challenges of Pandemic Innovation in High Schools

In summer 2020, the Center on Reinventing Public Education (CRPE), with support from the Barr Foundation, began observing and learning from students, parents, and educators in New England high schools as they navigated the uncertainty of the pandemic. The authors wanted to see what challenges and opportunities they faced, the ways in which they adapted to disruptions, and the new strategies and capacities that took hold. After more than a year of disruption, the boundaries of what it means to "reinvent" high school stretched, and in some systems, the momentum for change accelerated. Students and teachers learned to work in new ways and reached new understandings about each other. When COVID wanes, schools will encounter a host of new and complex demands as they make sense of the pandemic's challenges and opportunities, including addressing unfinished learning, spending a tidal wave of federal funding, and navigating continued calls for racial and social justice amid a national culture war. The path forward raises a host of critical questions: (1) Will school systems leverage momentum from the pandemic to remake high school? If so, what adaptations and innovations will they embrace? And which students will benefit from these shifts?, (2) How do school system leaders, educators, families, and students redefine success in high school? To what extent and how are these aspirations reflected in the adaptations and innovations that school systems embrace?, and (3) What opportunities and obstacles do school system leaders, educators, families, and students confront as they seek to chart a new course to high school? How can they avoid the pitfalls that threaten to stall progress, especially for the most marginalized students? As the pandemic endures, and as we emerge from it, CRPE will continue to investigate whether and how the trends described lead to a more equitable, student-centered high school experience. In this effort, Think Forward New England explores not only what shifts emerge postpandemic but also why, for whom, and with what effect.

Statewide Genomic Surveillance of SARS-CoV-2 Variants in Rhode Island

Background. Global genomic surveillance has allowed identification of SARS-CoV-2 circulating variants responsible for the COVID-19 pandemic. Statewide variant characterization can guide local public health mitigations and provide educational opportunities. We characterized statewide evolution of SARS-CoV-2 variants in Rhode Island (RI). Methods. De identified RI SARS-CoV-2 sequences since 2/2020, generated at authors, CDC and commercial laboratories, were extracted from https://www.gisaid. org. Genomic and phylogenetic analyses were conducted with available tools and custom python scripts and, after quality control, sequences were classified as variants of Concern (VOC), variants being monitored (VBM), or non-VOC/ non-VBM, per CDC definitions. Specific mutations that are characteristic of the most recent VOCs (Delta or Omicron) were explored outside of their designated lineages. Results. Of the 1.1 million RI population, 14,933 SARS-CoV-2 sequences were available between 2/2020 and 3/2022. These included 1,542 (11%) sequences from 37 non-VOC/non-VBM lineages until 2/2021, most commonly B.1.2 (21%), B.1.375 (13%), and B.1.517 (6%);2,910 (19%) sequences from 7VBM lineages between 3-6/2021, most commonly Alpha (48%), Iota (34%), and Gamma (10%);and 10,481 (70%) sequences from 2 VOC lineages, including 7,574 (72%) Delta mostly between 6/2021 and 12/2021, and 2,907 (28%) Omicron mostly between 1/2022 and 3/2022. Phylogeny showed expected clustering of local variants within regional and global sequences, and continued viral evolution over time. Further VOC evolution was observed, including 87 Delta sub-lineages, most commonly AY.103 (17%), AY.3 (15%), and AY.44 (12%);and 4 Omicron sub-lineages BA.1 (61%), BA.1.1 (32%), BA.2 (7%), and BA.3 (< 1%). Omicron-associated mutations S:del69/70, S:H655Y, or N: P13L were observed in 219 Delta sequences, and Delta-associated mutations ORF1b: G662S, N:D377Y, or M:I82T were observed in 16 Omicron sequences. Conclusion. Statewide SARS-CoV-2 genomic surveillance allows for continued characterization of locally circulating variants and monitoring of viral evolution. Such data guide public health policies, inform the local health force, and mitigate the impact of SARS-CoV-2 on public health.

Rhode Island and the Changing Paradigm of Health Care Delivery

The author offers insights on the delivery of health care services in Rhode Island. Topics discussed include the challenges brought by the coronavirus disease 2019 (COVID-19) pandemic to the sector, factors which contribute to health care dysfunction in the region such as poor business conditions and disputes between health systems and labor unions, and the need to improve emergency department (ED) operational efficiency.

Controlled Substance Prescription History among Individuals Who Died of an Accidental Opioid-Involved Drug Overdose in Rhode Island.

Background: Accidental opioid-involved overdose deaths are increasing nationally in the wake of the COVID-19 pandemic, but it is unclear if this reflects a change in populations most at risk. Objective: To determine whether the demographic characteristics and controlled substance prescription history of accidental opioid-involved drug overdose decedents in 2020 differed from prior years. Methods: We identified accidental opioid-involved overdose decedents using Rhode Island (RI) State Medical Examiner's Office data. Decedents were linked to the RI Prescription Drug Monitoring Program database. We compared demographic characteristics and prescription history by year of death. Results: From 2018 to 2020, 763 RI residents died from accidental opioid-involved overdose in RI. From 2018 to 2019, deaths decreased by 7%, but then increased by 31% from 2019 to 2020. Demographic characteristics were similar by year of death (all p > 0.05). The percentage of decedents with a prior opioid prescription and a prior benzodiazepine prescription declined from 2018 to 2020 (p < 0.01 and p = 0.03). Conclusions: We found that opioid-involved overdose deaths in RI are increasing overall, but without significant changes in demographics. While prior exposure to some controlled substances did decline over time, it is not clear if these changes reflect more responsible prescribing practices, or a more concerning pattern such as patient abandonment or decreased healthcare access. More studies are needed to better describe the current trend of increasing opioid-involved deaths while also pursuing current evidence-based interventions.

SAFETY OF 30-ML/KG IV FLUID ADMINISTRATION PER SEP-1 TO ADULT PATIENTS IN THE ED MEETING CRITERIA FOR SEPTIC SHOCK BEFORE KNOWN COVID-19 STATUS

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: ED clinicians play a critical role in the early detection and management of septic shock. Intravenous fluid (IVF) resuscitation is a central component of the recommended treatment for septic shock (SEP-1), but experts have expressed concerns that excessive fluid administration to patients with COVID-19 could lead to poor clinical outcomes due to the development of ARDS like lung physiology. COVID-19 status is often unknown in the first several hours after ED arrival and withholding adequate IVF resuscitation to patients with septic shock is known to be harmful. Our objective was to evaluate whether adult ED patients meeting criteria for septic shock (≥2 SIRS + initial lactate ≥4 or Mean Arterial Pressure (MAP) <65) who receive 30ml/kg of IV fluids in the ED have poor clinical outcomes, if they are later found to have COVID-19, compared to adult ED patients with non-COVID-19 septic shock. METHODS: In this retrospective cohort study we analyzed EHR of adult patients who visited any of 3 EDs within a single academic health system in Rhode Island. We included patients who had a discharge diagnosis of septic shock and presented to the ED between February 15 -September 30, 2020. The exposure was the receipt of 30ml/kg of IVF and outcomes were intensive care unit (ICU) admission, ventilator receipt, and inpatient mortality. We used multivariate logistic regression and adjusted for fluid volume, age, receipt of antibiotics, and Charlson Comorbidity Index. RESULTS: Of 278 patients with septic shock, 39 (14%) were COVID positive. 15 (38%) COVID positive patients received 30ml/kg IVF per SEP-1 bundle compared to 163 (68%) of COVID negative patients. The overall inpatient mortality rate of COVID positive septic shock patients (n=25, 64%) was three times higher as compared to COVID negative septic shock patients (n=51, 21%). Receipt of 30ml/kg IVF in the ED did not increase the odds of ICU admission [AOR 0.46 (0.07-3.26), p = 0.43], receipt of ventilator [AOR 0.40 (0.07-2.28), p=0.30], or inpatient mortality [AOR 0.15 (0.020-1.10), p=0.06] in patients who were COVID positive. However, in COVID negative patients, receipt of 30ml/kg IVF in the ED significantly reduced the odds of ICU admission [AOR 0.50 (0.27-0.93), p=0.029], receipt of ventilator [AOR 0.41 (0.22-0.74), p=0.003] and inpatient mortality [AOR 0.44 (0.22-0.87), p=0.018]. CONCLUSIONS: Optimal and timely fluid resuscitation per the SEP-1 bundle reduces the odds of unfavorable clinical outcomes in patients with septic shock who test negative for COVID-19, while causing no increased odds of harm to patients with COVID-19 and septic shock. Replication of our work in a post-vaccination cohort and during waves with different variants is advisable as the clinical outcomes may vary. CLINICAL IMPLICATIONS: Early fluid resuscitation in patients diagnosed with septic shock in the ED appears to be a safe strategy even in patients that are later diagnosed with COVID-19. DISCLOSURES: No relevant relationships by Natalie Davoodi No relevant relationships by Elizabeth Goldberg No relevant relationships by Richa Nahar

Use of Telemedicine by Rhode Island Physicians

The article discusses a 2021 survey which provided an opportunity to explore the effect of the COVID-19 pandemic on the adoption of telemedicine and physicians' experience using it. Topics include a 2017 review of telemedicine policy trends, findings on physicians who had used telemedicine in the prior year, and barriers to providing telemedicine according to the respondents.

'I'll Never Be Your Beast of Burden': Physician Burnout and Moral Injury

[...]on Saturday afternoon, a troubleshooter from the help desk at Genesis Systems called me on my cell phone. Because of this error, my help desk friend was unable to complete the program, and so, after 3 days and rising tensions, it was referred to someone at the state level, who sent me an automatic reply that he was unavailable. First used to describe veterans returning from the Vietnam War, moral injury has been extended to the health care field to help further explain and refine causes of burnout.2 Burnout suggests individual deficit.

American Lung Association seeks grant applications from RI researchers

The organization is now accepting research grant applications from researchers here in Rhode Island and across the nation with the potential to improve prevention, detection and treatment options for all lung diseases including lung cancer. Successful applicants have evidence of ongoing excellence and productivity in a related field. * Lung Cancer Discovery Award: $100,000 per year for up to two years Intended to support independent investigators conducting clinical, laboratory, epidemiological or any groundbreaking project aimed at revolutionizing our current understanding of lung cancer and improving diagnostic, clinical and treatment methods. A Letter of Intent (LOI) is required for this award. * Allergic Respiratory Diseases Award: $75,000 per year for up to two years A long-standing joint effort between the American Lung Association and the American Academy of Allergy, Asthma & Immunology to encourage and support early-stage investigators with a primary faculty appointment in an allergy/ immunology division or section, to conduct research into advancing the understanding of allergic respiratory disease. * Innovation Award: $75,000 per year for up to two years This award will support promising independent investigators who are leveraging their existing body of work to conduct basic science, behavioral, clinical or translational research for lung health. * Catalyst Award: $50,000 per year for up to two years This award champions the next generation of scientists who are ascending toward independence by supporting mentored investigators who are conducting basic science, behavioral, clinical or translational research into lung health. * Public Policy Research Award: $50,000 per year for up to two years This mechanism is designed to help stimulate and inform important public policy debates around healthy air and lung disease.

The Partnership for Integrating Oral Health Care into Primary Care Project-top Accomplishments

Background: The Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project was launched to improve access to oral health care by integrating the interprofessional oral health core clinical competencies into primary care. The competencies, described in the Health Resources and Services Administration's (HRSA's) report Integration of Oral Health and Primary Care Practice, facilitate change in the clinical practice of primary care health professionals (PCPs) working in safety net settings.1 Health professionals providing primary care include family physicians, pediatricians, obstetricians, nurse midwives, nurse practitioners, and physician assistants. The PIOHCPC project was funded by the Maternal and Child Health Bureau and supported by the National Maternal and Child Center for Oral Health Systems Integration and Improvement (COHSII). COSHII, led by the National Maternal and Child Oral Health Resource Center, worked with the National Network for Oral Health Access to provide technical assistance to the PIOHCPC project teams. Methods: The PIOHCPC project teams were selected from five states-Georgia, Illinois, Maryland, Michigan, and Rhode Island. Each team consisted of a state Title V maternal and child health (MCH) program or oral health program that was addressing the Title V national performance measure (NPM) on oral health, NPM 13, as well as a local primary care setting. The PIOHCPC project targeted pregnant women, children, and adolescents at high risk for oral disease. It was implemented from January 2019 through June 2021. Results: The PIOHCPC projects had several accomplishments related to integrating oral health care into primary care, even amid the COVID-19 pandemic that ushered in changes in direct patient care and primary care setting foci. Accomplishments at the primary care setting level included educating PCPs about oral health using Smiles for Life: A National Oral Health Curriculum and in-person trainings;incorporating oral health risk assessment into clinical workflows;implementing current dental terminology (CDT) codes and dot phrases in electronic health records to document oral health care;establishing effective systems for oral health referrals;and integrating oral health education and self-management goal setting into primary care visits. Additionally, state Title V MCH programs or oral health programs and primary care settings established strong partnerships to support and expand upon the success of their work in other settings across the states. Conclusion: The PIOHCPC projects had notable accomplishments. Findings from the project will contribute to the field's understanding of integrating oral health care into primary care. More work is needed at federal, state, and local levels to ensure that oral health is an integral component of primary care visits to ultimately improve oral health and reduce oral health disparities and inequities for pregnant women, children, and adolescents. 1. Health Resources and Services Administration. 2014. Integration of Oral Health and Primary Care Practice. Rockville, MD: Health Resources and Services Administration.

Recognition

The evaluation is based on three data sources: a nationwide online survey in which hospital managers and maternity healthcare professionals (e.g., neonatal care providers and OB/GYNs) were asked to recommend leading maternity hospitals;medical key performance indicator data relevant to maternity care (e.g., a hospital's rate of cesarean births);and patient satisfaction data (e.g., how patients rated a hospital's medical staff for responsiveness and communication). V Thundermist NP Fellowship programs gain national accreditation WEST WARWICK - Thundermist Health Center achieved national accreditation of its Psychiatric Mental Health Nurse Practitioner Fellowship Program and Primary Care Nurse Practitioner Fellowship Program. The accreditation will further our efforts in developing our program's ability to support achieving outstanding clinical quality outcomes, address social determinants of health and health inequity amongst the populations we serve. " "Since 2015, Thundermist Health Center trained 20 primary care Nurse Practitioner Fellows and 10 psychiatric Nurse Practitioner Fellows," said MILAGROS COLON PILLA, Program Manager, Nurse Practitioner Fellowships.

Guidelines in Practice: Surgical Smoke Safety: The Official Voice of Perioperative Nursing

Surgical smoke is the vaporous and gaseous byproduct of the use of heat-producing devices on tissue. The contents of surgical smoke include harmful chemicals, viable and nonviable material, and viruses. Personnel and patients experience an unpleasant odor when smoke is not evacuated and risk developing symptoms, such as headaches, throat irritation, and dizziness. The recently updated AORN "Guideline for surgical smoke safety" provides perioperative nurses with background information on surgical smoke and ways to mitigate the hazard. This article provides an overview of the guideline and discusses recommendations for a smoke-free environment, smoke evacuation and filtration, respiratory protection, education, policies and procedures, and quality. It also includes scenarios describing specific concerns in two patient care areas. Perioperative nurses should review the guideline in its entirety and apply the recommendations to protect personnel and patients from the dangers of surgical smoke.

States of Emergency

We are wrestling with so many heavy dilemmas in our country and world right now, and "lil' Rhody" as people fondly refer to our lovely Ocean State, is not exempt. The children's mental health crisis is one that impacts us all. Between 2009 and 2019, the rate of Rhode Island students reporting feeling "sad or hopeless" for a 2‐week period within the past year rose from 25% to almost 33%. And in 2019, 17% of middle schoolers and 13% of high schoolers "seriously considered suicide" within the past year (YRBS). In general, rates like these are disproportionally higher for those most at risk — people of color, LGBTQ, and those with disabilities. The inequality and injustice in our society is not only a barrier, but also a cause for those most at risk for physical and mental health issues, especially those of the BIPOC community. Much like lack of green spaces, housing, and adequate food options in marginalized communities, there are also fewer resources and many structural barriers to healthcare (including mental healthcare) for these children from communities of color.

SARS-CoV-2 Variants in Rhode Island; May 2022 Update.

BACKGROUND: Genomic surveillance allows identification of circulating SARS-CoV-2 variants. We provide an update on the evolution of SARS-CoV-2 in Rhode Island (RI). METHODS: All publicly available SARS-CoV-2 RI sequences were retrieved from https://www.gisaid.org. Genomic analyses were conducted to identify variants of concern (VOC), variants being monitored (VBM), or non-VOC/non-VBM, and investigate their evolution. RESULTS: Overall, 17,340 SARS-CoV-2 RI sequences were available between 2/2020-5/2022 across five (globally recognized) major waves, including 1,462 (8%) sequences from 36 non-VOC/non-VBM until 5/2021; 10,565 (61%) sequences from 8 VBM between 5/2021-12/2021, most commonly Delta; and 5,313 (31%) sequences from the VOC Omicron from 12/2021 onwards. Genomic analyses demonstrated 71 Delta and 44 Omicron sub-lineages, with occurrence of variant-defining mutations in other variants. CONCLUSION: Statewide SARS-CoV-2 genomic surveillance allows for continued characterization of circulating variants and monitoring of viral evolution, which inform the local health force and guide public health on mitigation efforts against COVID-19.

Effect of the COVID-19 Pandemic on Autopsy Rate

Background: Hospital autopsy rates have been steadily dropping over the past 50 years in the United States. It is unclear whether concerns of potential risks of exposure to SARS-CoV-2 through aerosols generated during dissection of lungs, infusion of formalin into lungs, and during opening skulls with an oscillating saw affect the overall autopsy rate. Design: Autopsy rate was calculated during a period from March 2019 to February 2020 (before COVID-19 pandemic in Rhode Island) and that from March 2020 to February 2021 (COVID-19 pandemic period). Death and autopsy numbers were also analyzed. Results: Autopsy rate over a year before the COVID-19 pandemic (between March 2019 and February 2020) was 8.4% (117/1391), whereas it was 9.1% (136/1492) during the COVID-19 pandemic (March 2020-February 2021). The difference was not statistically significant. During the COVID-19 pandemic between October 2020 and April 2021, the autopsy rate for non-COVID patients was 11%, whereas it was 8.6% in patients with COVID-19. The autopsy rate was slightly lower in COVID-19 patients, but the difference was not statistically significant. The death number and the percentage of death of patients with COVID-19 among all deaths reached a peak in December 2020, whereas the death number in non-COVID patients was relatively stable. The autopsy number also reached the peak in December 2020 and January 2021. From October 2020 to February 2021, the total autopsy number increased by 38-200%, when compared with one year ago (October 2019 to February 2020). The autopsy rate also increased from 7.9% before COVID-19 (from October 2019 to February 2020) to 10.7% during the same months of the COVID-19 pandemic, but the increase did not have the statistical significance. Conclusions: The COVID-19 pandemic did not affect the overall autopsy rate, but it increased the number of autopsy cases.

Towards an Improved Substance Use Disorder Treatment Landscape in Rhode Island – Barriers, Current Progress, and Next Steps

Expanding addiction treatment services in Rhode Island has never been more urgent. Today, we face colliding syndemics of COVID-19, preventable drug overdoses, and HIV, with another year of record overdoses. While the treatment of substance use disorder (SUD) is an sential of general medical care, numerous barriers prevent broader treatment access for patients in Rhode Island. Buprenorphine and methadone therapy have restrictions that are not applied to other areas in medicine, including for more dangerous medications. In this piece, we highlight existing barriers to care, applaud current progress being made in our state, and provide recommendations for next steps to turn the tide of this deadly epidemic. We hope that these proposed changes will help develop a robust treatment landscape for all patients with SUD in Rhode Island.

Data Modernization: Making Environmental Health Services Data More Accessible

The National Environmental Health Association (NEHA) strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, NEHA features this column on environmental health services from the Centers for Disease Control and Prevention (CDC) in every issue of the Journal. In these columns, authors from CDC's Water, Food, and Environmental Health Services Branch, as well as guest authors, will share tools, resources, and guidance for environmental health practitioners. The conclusions in these columns are those of the author(s) and do not necessarily represent the official position of CDC. CDR Luis Rodriguez is an environmental health specialist and Holly Wilson is a health communication specialist at the National Center for Environmental Health within CDC.