New Rural Health Report from the National Quality Forum

From the NQF:

More than 59 million individuals—approximately 19 percent of the U.S. population—live in rural areas. Data indicate that those living in rural areas in the U.S. are more disadvantaged, collectively, than those in urban or suburban areas, particularly with respect to sociodemographic factors, health status and behaviors, and access to the healthcare delivery system. In recognizing the lack of representation from rural stakeholders in the Measures Application Partnership (MAP) pre-rulemaking process, CMS tasked the National Quality Forum (NQF) to establish a MAP Rural Health Workgroup. Between November 2017 and July 2018, the MAP Rural Health Workgroup focused on two primary tasks: (1) identifying a core set of the best available rural-relevant measures to address the needs of the rural population and (2) providing recommendations from a rural perspective regarding measuring and improving access to care. In conjunction with these tasks, the Workgroup also identified and prioritized rural-relevant gaps in measurement and provided input on alignment and coordination of measurement efforts. This report describes the selection criteria and processes used to generate the core set of measures, catalogs the core set of measures along with the rationale for inclusion for each measure, summarizes measurement gap areas identified by the Workgroup, and presents the Workgroup’s recommendations on access to care from a rural perspective.

Iowa Narcan (Naloxone) Kits Project

Memo from the IDPH:

The Iowa Department of Public Health (IDPH), in collaboration with the Iowa Hospital Association (IHA) and the Iowa Healthcare Collaborative (IHC), are working to resolve the issue of opioid misuse in Iowa, including preventing the deaths of Iowans struggling with opioid dependency.

On July 1, 2018, IDPH added opioid overdoses requiring administration of naloxone to the state’s reportable conditions list. Since then, Iowa hospitals have reported over 240 suspected opioid overdoses (both fatal and non-fatal) treated with naloxone. While that volume of reported overdoses could not have been predicted, what we do know is that if further treatment services are not received for those experiencing a non-fatal overdose, these individuals are at significant risk of experiencing a fatal  overdose in the next 12 months.

As part of our ongoing Opioid Initiatives, IDPH is teaming up with IHA and IHC to help prevent future overdoses by offering free Narcan (naloxone) kits to hospital emergency departments, to be distributed free of charge to persons being released from the emergency department following an opioid overdose.

In addition to the Narcan kit, participating hospitals will be asked to distribute referral information provided by IDPH to help connect individuals with local treatment services.

All distribution of kits should be done in accordance with established hospital policies.

If your hospital would like to participate, please contact Jennifer Nutt, IHA Director of Nursing and Clinical Services, at 515-288-1955 or at, by September 30, 2018, to place an order.

IDPH is funding this project through its Iowa Opioid State Targeted Response (STR) grant from the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). Because these are federal grant funds, orders placed by hospitals should be for the projected annual need, based on the number of prior opioid overdoses treated.

If you have questions or would like additional information on IDPH’s Opioid Initiatives, please contact Kevin Gabbert, Opioid Initiatives Director, at 515-281-7080 or at

Anthem’s ER Policy: HHS Response Leaves Senator Unsatisfied

From Healthleaders Media:

A lawmaker behind the ‘prudent layperson’ standard has been pressing HHS, DOL, and CMS for progress reports on what he deems to be the insurer’s ‘likely’ violations of federal law.

HHS Secretary Alex Azar responded to concerns raised about Anthem’s controversial payment policy for emergency department services.

Both HHS and DOL agree that CPT codes should not be used as the sole basis to determine whether emergency services were justified, Azar says.

Anthem argues that its actions have been made as part of a reasonable response to rising costs.

Increasing antibiotic resistance leads to emergency department visits for children

From MultiBriefs:

Emergency department visits for antibiotic adverse events accounted for 46.2 percent of all emergency department visits for adverse events from a systemic medication in children 19 years of age and younger.

Among children younger than 2 years, antibiotics were implicated in nearly two-thirds (63.9 percent) of the emergency department visits for adverse events from a systemic medication, whereas among children aged 10 to 19 years, an antibiotic was implicated in one-third (32.4 percent) of the emergency visits for adverse events. Just over one-half (53.7 percent) of emergency department visits for antibiotic-adverse events involved girls, and 3.0 percent resulted in hospitalization.

The researchers were unable to determine which of the antibiotic prescriptions were unnecessary or inappropriate because the necessary data were not available. Also, the study results only address children taken to the emergency department for adverse events not children taken to urgent care facilities or their physicians’ offices.

Effect of Aspirin on Disability-free Survival in the Healthy Elderly

From the NJEM:


Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disability-free life in healthy seniors is unclear.


From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage.


A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11; P=0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001).


Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo. (Funded by the National Institute on Aging and others; ASPREE number, NCT01038583.)