Advancing Health Equity by Addressing Social Determinants of Health

National Minority Health Month marks a time to reflect on the health disparities that persist among racial and ethnic minority and American Indian/Alaska Native (AI/AN) populations. The US Department of Health and Human Services (HHS) Office of Minority Health (OMH) leads this annual observance and encourages everyone to take action to end inequities. The theme for 2024, Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections, is about understanding how the unique environments, cultures, histories, and circumstances of racial and ethnic minority and AI/AN populations impact our overall health. Visit the HHS National Minority Health Month page to learn more about this year’s theme, download resources and graphics to share with your network, and find National Minority Health Month events hosted by our partners.

Marking the End of the Holy Month of Ramadan

Delaware Not in the Path of Totality, But Eclipse Will Be Visible, Barring Weather

On Monday, April 8th, a total solar eclipse will cross North America, passing over Mexico, the United States, and Canada, plunging areas into darkness, marking a rare celestial phenomenon that will not return for decades. The next total solar eclipse in the contiguous U.S. won't be until August 23, 2044 in Montana and North Dakota, and the next to span coast-to-coast is slated for 2045. Due to the fact that April's total solar eclipse will be the last of its kind to occur in North America for 20 years, it is projected to be the U.S.'s largest mass travel event in 2024. A March 25, 2024 JAMA Internal Medicine report warned that a 2017 eclipse in the U.S. was linked with spikes in fatal car accidents and road traffic risks similar to what's seen on major holiday weekends. Safety is the number one priority when viewing a total solar eclipse. The American Academy of Ophthalmology offers these tips. There is only one safe way to look directly at the sun, whether during an eclipse or not: through special-purpose solar filters. These solar filters are used in “eclipse glasses” or in hand-held solar viewers. They must meet a very specific worldwide standard known as ISO 12312-2. The only time that you can look at the sun without a solar viewer is during a total eclipse. When the moon completely covers the sun’s bright face and it suddenly gets dark, you can remove your solar filter to watch this unique experience. Then, as soon as the bright sun begins to reappear very slightly, immediately use your solar viewer again to watch the remaining partial phase of the eclipse. However, keep in mind that Delaware will not experience the total eclipse. Never look at the uneclipsed or partially eclipsed sun through an unfiltered camera, telescope, binoculars or other similar devices. This is important even if you are wearing eclipse glasses or holding a solar viewer at the same time. The intense solar rays coming through these devices will damage the protective filter in your solar glasses and put your eyes at risk. You can also use an indirect viewing method, such as a pinhole projector. Delaware is not in the path of totality, so the view in Delaware will be about 80% coverage, a partial eclipse. The closest place to Delaware with complete coverage will be Erie, PA. According to Delaware Online, action in Delaware will take place at the following times:

• Partial eclipse begins at 2:07 p.m.  
• Maximum eclipse begins at 3:23 p.m.  
• Partial eclipse ends at 4:34 p.m. 

Registration Closes April 11th

Registration is open for all MSD members to register to attend the MSD 2024 Interim Council Meeting to be held on Thursday, April 18th at the Smyrna Opera House, located at 7 W. South St., Smyrna, DE. The evening will begin at 6:00 p.m. with sign-in and a half-hour cocktail social, followed by the Interim Council business meeting beginning promptly at 6:30 p.m. As a member of MSD, this event affords you the opportunity to connect with your peers and meet new colleagues, all the while enjoying fine food and beverage at a historic Delaware location!

Reports being submitted must be received no later than Monday, March 25th.

Consider submitting a resolution. Resolutions are a vehicle to submit to Council your issues for change. Learn more about writing a resolution from the MSD Resolution Writing Guide or the brief training video developed. Resolution submission deadline is Friday, April 5th. All submissions must be correctly formatted prior to the submission deadline (in final format). For example, no edits/corrections will be accepted after the deadline of April 5th. Please email resolutions to Mary.LaJudice@medsocdel.org.

To register go to: https://reg.planetreg.com/INTERIM2024. Absolute registration deadline is Thursday, April 11 by end of business day.

Communications to Stop for Those Who Have Not Renewed

MSD depends on the support of its members to continue the important work that positively impacts the practice of medicine, such as the following:

• MSD continued the collaborative Primary Care Investment Initiative, providing financial stimulus awards to eligible practices who proposed an implementation-ready, qualified method to prepare their practice for sustainable success in value-base care.
• MSD and the Delaware Healthcare Association authored a bill to significantly reform the prior authorization process. SB 10, the "Delaware Pre-Authorization Reform Act of 2023," currently is awaiting consideration in committee.

There is so much more that we do for you! Why miss out? But, we are sorry to say that, starting April 8th, all members who have not renewed their 2024 membership by that date will no longer receive MSD communications. This includes notifications of events and important information relative to health care, as well as the Practice Matters communication that is valued by your staff. Renew online or contact Michelle.Seymour@medsocdel.org for assistance. (Note that this is a general announcement that is being sent to all members.)

Ensure International Travelers are Current on MMR Vaccination

The Delaware Division of Public Health (DPH) sent a health advisory to advise clinicians and health care partners of the need to ensure Delaware children and those traveling internationally are current on their Measles Mumps Rubella (MMR) vaccination. The Centers for Disease Control and Prevention (CDC) has noted a significant increase in measles cases across the country. Measles is a highly contagious viral illness and can cause severe health complications, including pneumonia, encephalitis (inflammation of the brain), and death, especially in unvaccinated persons. Additionally, even after recovering from initial infection, severe neurologic complications of measles have been known to occur up to a decade after the initial illness. The CDC immunization schedules currently recommend routine vaccination with two doses of MMR vaccine, with the first dose at 12 to 15 months of age, and the second dose at 4 to 6 years of age. However, the recommendations are different for persons travelling internationally. All individuals 6 months and older who are planning to travel internationally and who have not been fully vaccinated against measles should receive an MMR vaccine at least one month before departure. Infants ages 6 to 11 months who receive one dose of MMR vaccine pre-travel, will need two more doses of MMR vaccine later in life, the first of which should be administered when the child is at 12 through 15 months old and the second at least 28 days later. Children aged 12 months or older should receive two doses of MMR vaccine, separated by at least 28 days. Teenagers and adults without evidence of measles immunity (or history of being fully vaccinated against measles) should receive two doses of MMR vaccine separated by at least 28 days. MMR vaccines are safe and highly effective, with one dose being 93% effective and two doses being 97% effective against measles. 

Patient Alerts Through Event Notification and Clinical Gateway Aren't Delivering

The Delaware Health Information Network (DHIN) sent a communication this morning advising that patient alerts through the Event Notification and Clinical Gateway services were not delivering. Their technical teams were working to fix the problem and DHIN will keep physicians posted on a resolution. To contact the DHIN Service Desk: (302) 480-1770, servicedesk@dhin.org.

Decrease Marks the First Time in a Decade

The Delaware Department of Health and Social Services (DHSS) announced today that, for the first time in a decade, the number of overdose deaths in Delaware has decreased. According to data from the Delaware Division of Forensic Science, there were 527 accidental drug overdose deaths in 2023, representing a 1.8% decrease compared to 2022. When looking at this issue holistically, more than 140,000 Delaware adults are living with a substance use disorder. Additionally, the state has seen challenging trends that deserve attention; Delaware Division of Substance Abuse and Mental Health (DSAMH) statistics indicate rising fatal overdoses and drug use in Black and Hispanic/Latino communities. To address the root causes of this crisis on the ground, there have been policy and education efforts, coordinated behavioral health care, and increased funding for the opioid crisis through the years. Additionally, the Prescription Opioid Settlement Distribution Commission (POSDC), a subcommittee of the Delaware Behavioral Health Consortium, is charged with distributing over $250 million in opioid settlement funds to expand access to substance use treatment services and combat the opioid crisis in Delaware.  

MA Insurers Will Receive Reduced Payments in 2025

On Monday, the Centers for Medicare & Medicaid Services (CMS) finalized the Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs that updates payment policies for these programs and ensures payment accuracy. The Rate Announcement complements policies in the CY 2025 MA and Part D proposed rule that would strengthen protections for the millions of people who rely on MA and Medicare Part D prescription drug coverage, which will be finalized in the coming days. Under this CY 2025 Rate Announcement, payments from the government to MA plans are expected to increase on average by 3.70 percent, or over $16 billion, from 2024 to 2025. The federal government is projected to pay between $500 and $600 billion in Medicare Advantage payments to private health plans in 2025. CMS is also finalizing improvements to the structure of the Medicare Part D drug benefit for CY 2025 that will result in lower drug costs for millions of people with Medicare through the concurrent release of the Final CY 2025 Part D Redesign Program Instructions. Thanks to the Inflation Reduction Act, President Biden’s lower-cost prescription drug law, annual out-of-pocket costs will be capped at $2,000 for people with Medicare Part D in 2025, leading to even more savings for people with Medicare Part D in CY 2025.

First in US in 2024

On March 29, 2024, CDC reported the first U.S. human infection this year with an influenza A(H1N2) variant (v) virus that normally circulates in pigs. This infection was detected in a person living near a pig farm in Pennsylvania who had direct contact with pigs. The person was hospitalized and has since recovered from their illness. No person-to-person spread of this virus has been identified. Learn more.

Person Had Exposure to Dairy Cattle in Texas Presumed to Be Infected

The Centers for Disease Control and Prevention (CDC) reports that a person in Texas has tested positive for highly pathogenic avian influenza (HPAI) A(H5N1) virus (“H5N1 bird flu”). This person had exposure to dairy cattle presumed to be infected with H5N1 bird flu viruses. The person reported eye redness (consistent with conjunctivitis), as their only symptom, and is recovering. APAI in dairy cows was first reported by the US Department of Agriculture (USDA) March 25, 2024. These are the first ever reports of HPAI virus infections in cows. HPAI viruses have been detected in unpasteurized milk collected from sick cattle on dairy farms.

This infection does not change the H5N1 bird flu human health risk assessment for the U.S. general public, which CDC considers to be low. However, people with close or prolonged, unprotected exposures to infected birds or other animals (including livestock), or to environments contaminated by infected birds or other animals, are at greater risk of infection. CDC has recommendations for clinicians on monitoring, testing, and antiviral treatment for patients with suspected or confirmed avian influenza A virus infections.

According to FDA and USDA, there are not concerns with the safety of the commercial milk supply at this time because products are pasteurized before entering the market. Dairies are required to send only milk from healthy animals into processing for human consumption; milk from impacted animals is being diverted or destroyed so that it does not enter the human food supply. In addition, pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk. 

Letter Sent to Nation's Teaching Hospitals and Medical Schools

On Monday, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released new guidance to teaching hospitals and medical schools to reiterate and provide clarity regarding hospital requirements for informed consent from patients as it relates to medical professionals performing sensitive examinations, particularly on patients under anesthesia. HHS indicated its awareness of media reports, as well as medical and scientific literature highlighting instances where, as part of medical students’ courses of study and training, patients have been subjected to sensitive and intimate examinations – including pelvic, breast, prostate, or rectal examinations – while under anesthesia without proper informed consent being obtained prior to the examination. 

CMS Releases Web-Based Validation Tool

The Centers for Medicare and Medicaid Services (CMS) released a web-based validation tool that assists hospitals with price transparency compliance.  The V2.0 Online Validator tool assists hospitals in developing a machine-readable file (MRF) to ensure it conforms to the required form and manner requirements (45 CFR 180.50(c)(2)). These form and manner requirements are described in the CY 2024 OPPS/ASC Final Rule, and detailed technical specifications can be found in the Hospital Price Transparency Data Dictionary GitHub Repository. The Online Validator reviews a hospital's uploaded MRF against the required CMS template layout and data specifications. If a hospital's MRF does not conform to the form and manner requirements, the Online Validator will generate an output consisting of 'errors' and 'warnings'. Online Validator 'errors' represent requirements that are enforced beginning July 1, 2024, whereas 'warnings' represent requirements that are enforced beginning January 1, 2025. Additionally, the Online Validator tool runs in a web browser and does not store, record, report, or share any information with CMS related to a hospital's use of the tool.

Primary Care Physicians Needed to Complete Brief Survey for Johns Hopkins

The Johns Hopkins Bloomberg School of Public Health is looking for primary care physicians to complete a 5-minute survey on their thoughts about digital health tools. Interested physicians, physician assistants, and nurse practitioners who have experience treating patients with diabetes or depression are invited to participate. Those who complete the survey will receive a $10 gift card. If you have any questions, please reach out to Odia Kane at okane1@jh.edu. (Principle investigator: Dr. Nancy Kass.) Scan the QR code or go to: https://jh.qualtrics.com/jfe/form/SV_ewXiR3xzpicR4zQ

Hologic's Tomosynthesis System Wins Title

In a contest created by Delaware State Chamber of Commerce and the Delaware Manufacturing Association to highlight the state’s manufacturing sector and promote it as a career path, a device that helps detect breast cancer has been named the Coolest Thing Made in Delaware. Hologic Inc.’s 3Dimensions Mammography System, designed to provide higher quality images and a more comfortable screening procedure for women, won the state’s first Coolest Thing contest. The online contest ultimately had more than 40 products from 20 companies nominated for consideration. About 20,000 members of the public voted on their favorites in a March Madness-style bracket system. The company has been making the detector — one of three components for its machines — in Delaware for more than a decade. It recently decided to move all its production lines from Danbury, Connecticut to Newark. Hologic was founded in 1985, focusing on improving women’s health and well-being through early detection and treatment, and it’s been in Delaware for a quarter of a century. Its 3Dimensions Mammography System was introduced in 2011 and can be found around the globe.

HOSA State Leadership Conference

Aspiring Delaware health care workers will represent the First State at a national leadership conference this summer after winning state awards last week. More than 1,000 middle and high school students participated last week in the 13th annual HOSA State Leadership Conference at Wilmington University. HOSA members earning a medallion at last week's State Leadership Conference qualify for the International Leadership Conference June 26-29, 2024, in Houston, Texas. Delaware HOSA is a Career and Technical Student Organization (CTSO) dedicated to students who are interested in pursuing their future in a career in health care. Through HOSA-Future Health Professionals, more than 1,300 Delaware members have the opportunity to participate in career focused competitive events, take part in community service, and become leaders for the organization in their school, state, and at the international level. HOSA-Future Health Professionals incorporates curricular and co-curricular experiences to emphasize the importance of knowledge, leadership, skill development, and teamwork. A list of all state award winners and events is located at delawarehosa.org. To learn more about Delaware HOSA, please contact Peg Enslen by email at: peggy.enslen@doe.k12.de.us.

Kind to Kids Charity Foundation: A Future for Every Child, All Year Round

As a year-round charity fundraising effort, MSD continues to support the Kind to Kids Foundation to make an impact in the lives of children and teens in foster care. You can donate items throughout the year from the "My Blue Duffel" Amazon Wish List. Your donation will provide direct support for a child in foster care. "My Blue Duffels" are emergency care kits given to children entering the foster care system. From the wish list, donors purchase items that are then sent to Kind to Kids to distribute. The children are victims of child abuse and neglect and are coping with trauma. Your gift will bring hope, love, and kindness to a vulnerable child. Kind to Kids Foundation is a 501c3 nonprofit charity and your donations are tax deductible. Thank you for your support.

MSD is pleased to highlight one of our 2024 Premier Educational Program Partners. Quality Insights has been a part of the effort to keep our professional medical and public education programs growing through its partnership with MSD as a Premier Educational Program (PEP) Partner.

Quality Insights has long been a go-to resource for physicians and stakeholders seeking to improve quality. They can help identify the source of quality-related issues and offer solutions based on best practices, staff expertise and years of experience. The Quality Insights team provides educational resources and tools, baseline and ongoing performance data, collaborative learning opportunities, and one-on-one technical assistance. Quality Insights is leading several state-based initiatives in partnership with the Delaware Division of Public Health and the Pennsylvania Department of Health, with funding from the Centers for Disease Control and Prevention (CDC). https://www.qualityinsights.org/home

If you would like to become a PEP Partner, please contact Lynn Robinson, MSD's Director of Professional Education. 

Create a Team Compact

One way to bolster your organization's culture is through a team compact, a written document detailing how team members should treat each other. Everyone in your practice should contribute to developing this document and vote for the final version. The process of drafting a compact focuses the team on the practice's core values and strengthens team culture. Review and update the compact annually to involve new team members in the process.

LEARN MORE:

Toolkit:

• Team Culture

Playbook:

• Wellness-Centered Leadership

Podcast:

• Listen and Be Curious: Strategies to Build Relationships and Solve Problems Together

AMA STEPS Forward^® offers a collection of engaging and interactive educational content designed to help put the joy back into medicine.

Information on Recent Product Recalls and Safety Announcements

Methocarbamol Injection Single Dose Vial

Eugia US is recalling lot number 3MC23011 of Methocarbamol Injection USP, 1000 mg/10 mL (100 mg/mL) Single Dose Vial - 10 mL Vial due to a customer product complaint for the presence of white particles floating inside of the vial. Administration of an injectable product that contains particulate matter may result in local irritation or swelling. If the particulate matter reaches the blood vessels or is injected intravascularly it can travel to various organs and block blood vessels in the heart, lungs or brain which can cause stroke and even lead to death. To date, Eugia US LLC has not received any reports of adverse events related to this recall.

Vancomycin Hydrochloride for Oral Solution

Amneal Pharmaceuticals, LLC. Bridgewater, New Jersey (Amneal), is voluntarily recalling 4 lots (see table below) of Vancomycin Hydrochloride for Oral Solution, USP, 250 mg/5mL packaged in 80 mL, 150 mL, or 300 mL pack sizes, to the Consumer Level. Some bottles may have been overfilled which can result in an over potent dosing regimen. The recommended maximum daily dose allowance for this product is up to 2gm/day and patients prescribed a dosing regimen of 500 mg/10mL would exceed this daily allowance, which may be harmful to patients with renal insufficiency. The error occurred during the manual bottle filling stage of manufacturing.

Atovaquone Oral Suspension, USP 750 mg/5 mL

AvKARE, LLC. is voluntarily recalling lot # AW0221A of Atovaquone Oral Suspension, USP 750mg/5mL to the Consumer/User level, due to the potential Bacillus cereus contamination in the product found during stability testing at a 3rd party lab. In the population most at risk, immunocompromised population, there is a reasonable probability that microbial contamination of Atovaquone Oral Suspension can result in disseminated, life threatening infections such as endocarditis and necrotizing soft tissue infections. To date, AvKARE has not received any reports of adverse events related to this recall. Atovaquone Oral Suspension, USP is indicated for prevention and treatment of Pneumocystis jiroveci pneumonia (PCP) in adults and children 13 years of age and older who cannot tolerate other medicines, such as trimethoprim-sulfamethoxazole.

ARROW QuickFlash Radial Artery, Radial Artery/Arterial Line Catherization Kits

Teleflex and Arrow International are recalling the ARROW QuickFlash Radial Artery and Radial Artery/Arterial Line Catheterization Kits after receiving reports of increased resistance in the guidewire handle and chamber during use. This issue may cause serious injury, including injury to blood vessel walls, narrowing of the blood vessels (vasospasm), artery blockage (embolism), or death. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries, serious health consequences, or death.

PneuPac ParaPAC Plus 300, 310 Ventilator Kits

Smiths Medical is recalling the PneuPac paraPAC Plus 300 and 310 Ventilator Kits after receiving reports that the ventilator may intermittently provide continuous positive gas flow instead of the intended cycling like a human breath when it is switched to the “Ventilate” operating mode. This non-cycling and continuous positive gas flow when in cycling mode is a malfunction that prevents the ventilator from functioning properly. As a result of this issue, patients may not receive the right amount of ventilation or enough oxygen (hypoventilation). The issue may also cause a complete or partial airway obstruction. Any of these occurrences can lead to serious injury or death. The FDA has identified this as a Class I recall, the most serious type of recall. Please be aware, this recall is a correction, not a product removal.

Cerenovus CEREBASE DA Guide Sheath

Medos International Sàrl is recalling Cerenovus CEREBASE DA Guide Sheath due to a crack found in the far end of the catheter, where different parts of the catheter are joined together. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Beebe Medical Foundation

At its most recent meeting, the Beebe Medical Foundation Board of Directors welcomed three new members. Directors serve for a three-year term with the possibility of two more consecutive terms for a total of nine years of possible service. Brad Travis, Jr. was born and raised in Lewes. He is a 2003 graduate of the University of Delaware majoring in Finance and Operations Management. He began his career out of college working in Beebe Healthcare’s accounting department. He now serves locally as a Financial Advisor and Certified Financial Planner. Jason Abela is a native of Michigan and graduated from Western Michigan University with a degree in Political Science. He worked in the Pennsylvania government and served in the Governor’s office as a legislative liaison for the Department of Environmental Protection. Jason is a realtor with Jack Lingo Realty. He has served on the Board of Ambassadors since 2018 and was elected Chair of the Board of Ambassadors. Leanne Silicato Prosser was born in Milford and is a 2003 graduate of Syracuse University with degrees in English Textual Studies and Inclusive Education. She is the former owner of Make My Day Event Planning and Maven Event Management and Consulting. Leanne served as the 100th Anniversary Coordinator of Beebe Healthcare’s Centennial events. 

April 9 - Delaware Cancer Consortium 2024 Retreat, 9:00 a.m.-3:30 p.m., Bally's Dover Casino Resort, Conference Center Ballroom D). This activity has been approved for a maximum of 4.25 AMA PRA Category 1 credit.

April 9 - Mind Matters: The Intersectionality Between Behavior Health, HIV, and Substance Use, 8:30 a.m.-4:00 p.m., Del One Conference Center, 100 Campus Dr., Dover. This activity has been approved for a maximum of 5 AMA PRA Category 1 credit.

April 12 - Climate and Health Conference, 8:00 a.m.-4:00 p.m., John H. Ammon Education Center, ChristianaCare Newark Campus. This activity has been approved for a maximum of 6.75 AMA PRA Category 1 credit. No fee to attend, but registration is required, no late in-person registrations will be accepted. Registration deadline is April 10th.

April 13 - Delaware Academy of Family Physicians Annual Meeting, Bayhealth SIM Center, Dover.

April 13 - Bayhealth 4th Annual Nurse on the Run 5k/1 Mile Walk, 9 a.m., Bayhealth Sussex Campus, Milford.

April 17 - 18th Annual Delaware Healthy Mother & Infant Consortium Summit, 8:30 a.m.-4:00 p.m., Chase Center on the Riverfront.

April 18 - DEAAP Spring Conference, "Paving the Way to Pediatric Wellness: Chronic Disease Management and Mental Health in Primary Care," 2:00-5:30 p.m., Hyatt Place Wilmington Riverfront (760 S. Justison St.). This activity has been approved for a maximum of 3 AMA PRA Category 1 credit.

May 7 - 61st Annual William J. Holloway Infectious Disease Symposium, 8:30 a.m.-3:30 p.m., virtual and in person at the John H. Ammon Education Center, ChristianaCare Newark Campus. This activity has been approved for a maximum of 5 AMA PRA Category 1 credit.

October 29 - SAVE THE DATE! 28th Annual Delaware Healthcare Forum, 8:30 a.m.-4:30 p.m., Bally's Dover Casino Resort, Rollins Center, Dover.

September 19 - SAVE THE DATE! DAFP Geriatric Medicine Symposium, ChristianaCare, Newark.

October 19 - DAFP Research & Education Foundation Healthcare Heroes 5k, Cape Henlopen State Park.

November 23 - SAVE THE DATE! MSD Annual Meeting and Presidential Reception, Bally's Dover Casino Resort

• Information for Delaware Medical Professionals - https://publichealthalerts.delaware.gov/mpox/

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.