Inequities in COVID-19 Vaccination Coverage Among Pregnant Persons, by Disaggregated Race and Ethnicity - Massachusetts, May 2021-October 2022.

National estimates suggest that COVID-19 vaccination coverage among pregnant persons is lower among those identifying as Hispanic or Latino (Hispanic) and non-Hispanic Black or African American. When examining COVID-19 vaccination coverage during pregnancy by race and ethnicity, however, data are typically limited to large, aggregate categories that might obscure within-group inequities. To address this, Massachusetts examined COVID-19 vaccination coverage among pregnant persons by combinations of 12 racial and 34 ethnic groupings. Among 102,275 persons with a live birth in Massachusetts during May 1, 2021-October 31, 2022, receipt of ≥1 dose of a COVID-19 vaccine before or during pregnancy was 41.6% overall and was highest among persons who identified as Asian (55.0%) and lowest among those who identified as Hispanic (26.7%). However, within all broad racial and ethnic groupings, disparities in COVID-19 vaccination coverage were identified when the data were disaggregated into more granular categories; for example, COVID-19 vaccination coverage ranged from 10.8%-61.1% among pregnant persons who identified as Hispanic. Disaggregated analyses reveal diverse experiences within broad racial and ethnic groupings. This information can be used to guide outreach to pregnant persons in communities with lower rates of COVID-19 vaccination coverage during pregnancy.

Massachusetts flu vaccination and application for COVID-19 routine vaccination planning.

Background: SARS-CoV-2 has affected communities of color at disproportionate rates. In particular, Black Americans have higher COVID-19 mortality rates, rooted in health disparities and institutionalized racism. We describe Massachusetts (MA) influenza (flu) vaccination data by race and vaccination location to inform yearly COVID-19 vaccination plans. Methods: We analyzed self-reported, pooled data from the 2017, 2018, and 2019 Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS) of adults. Using the questions around race and ethnicity and flu vaccination, we calculated location types most visited as a percent of people receiving flu vaccine, stratified by race. Results: The 3 years combined yielded 6031 completed surveys. Compared to White non-Hispanics, Black non-Hispanics, Hispanics, and other non-White adults combined reported flu vaccination less frequently (p < 0.01). Doctor's office or a health maintenance organization (HMO) were the primary flu vaccination locations among all race subcategories. Within each race category, the top three locations covered 82.7 % of White respondents, while covering only 75.9 % of Hispanic respondents, and 71.0 % of Black respondents. Fewer Hispanic (16.1 %) and Black respondents (13.8 %) were vaccinated at supermarkets or drug stores compared to White respondents (25.2 %). Conclusion: As COVID-19 vaccination will likely be a yearly occurrence, the above findings can help support future COVID-19 vaccination plans. Since the frequency and location of receipt of flu vaccination varied by race/ethnicity in Massachusetts, the state should ensure specific COVID-19 vaccination locations are available going forward.

The financial advantages of medical scribes extend beyond increased visits.

Employing medical scribes can boost revenue for a practice, the authors show, well beyond being an opportunity to expand patient volume.

How Can Local Governments Address Pandemic Inequities?

COVID-19 is exposing a nexus between communities disproportionately suffering from underlying health conditions, policy-reinforced disparities, and susceptibility to the disease. As the virus spreads, policy responses will need to shift from focusing on surveillance and mitigation to recovery and prevention. Local governments, with their histories of mutual aid and familiarity with local communities, are capable of meeting these challenges. However, funding must flow in a flexible enough fashion for local governments to tailor their efforts to preserve vital services and rebuild local economies. The authors argue that the Community Development Block Grant and the Energy Efficiency and Conservation Block Grant programs are mechanisms for providing funds in a manner that is adaptable to local context while also focusing on increasing social equity. Administrators must emphasize the fourth pillar of public administration-social equity-in framing government responses to the pandemic.

Reducing the Use of Ad Hoc Interpreters at a Safety-Net Health Care System.

BACKGROUND: Providing effective communication assistance is critical to ensuring that patients with limited English proficiency (LEP) receive safe and high-quality health care services. Health care providers often use ad hoc interpreters such as patients' family members or friends to communicate with LEP patients; however, this practice presents risks to communication accuracy, patient safety, quality of care, and privacy. METHODS: Cambridge Health Alliance (CHA) undertook a quality improvement (QI) initiative to reduce the use of patients' family members and friends as interpreters during clinical encounters. A centralized QI team monitored data across clinics and implemented several improvement activities, including systemwide informational campaigns and policy changes, operational improvements within interpreter services, and site-specific outreach. In addition, individual clinics identified and tested improvement strategies with support from the QI team. RESULTS: The number of clinics with high (> 10%) utilization of family/friends as interpreters decreased from 16 to 11 between 2012 and 2018. Trends over time varied across sites, and two clinics had particularly striking and sustained improvement. At these clinics, there were several factors that facilitated improvement, including having trusted leadership champions, using clear and consistent messaging reinforcing CHA's policy, and implementing workflows promoting use of professional interpreters. CONCLUSION: Changing practice to reduce the use of ad hoc interpreters in a large multisite organization is challenging and takes sustained and prolonged effort. Strong institutional policies and site-specific outreach can help stimulate change, and partnership with leadership champions is critical to success. CHA's experience provides strategies and lessons that can be leveraged by other institutions seeking to improve care for LEP patients.

Incorporating Economic Policy Into A 'Health-In-All-Policies' Agenda.

Recognizing the health effects of nonhealth policies, scholars and others seeking to improve Americans' health have advocated the implementation of a culture of health-which would call attention to and prioritize health as a key outcome of policy making across all levels of government and in the private sector. Adopting this "health-in-all-policies" lens, policy makers are paying increasing attention to health impacts as they debate policies in areas such as urban planning, housing, and transportation. Yet the health impacts of economic policies that shape the distribution of income and wealth are often overlooked. Pooling data from all fifty states for the period 1990-2010, we provide a broad portrait of how economic policies affect health. Overall, we found better health outcomes in states that enacted higher tax credits for the poor or higher minimum wage laws and in states without a right-to-work law that limits union power. Notably, these policies focus on increasing the incomes of low-income and working-class families, instead of on shaping the resources available to wealthier individuals. Incorporating these findings into a health-in-all-policies agenda will require leadership from the health sector, including a willingness to step into core and polarizing debates about redistribution.