Rural Health Information Hub Latest News

Anti-Fluoride Memo Introduced in Pennsylvania Senate

Senator Dawn Keefer (R-31) has proposed a bill to ban fluoride in Pennsylvania’s public water systems, modeled after legislation recently passed in Utah.
Click here to read the full memo.

PCOH strongly affirms our support of adjusting fluoride in water to optimal levels. Community water fluoridation (CWF) remains the single most effective public health measure to prevent tooth decay and protect oral health. 

In Pennsylvania, each water system decides whether to adjust the natural levels of fluoride in the water they provide to their customers. Optimally fluoridated water reaches entire communities and addresses oral health needs for everyone in the community in a way that no other oral health tool can; it’s an accessible resource for all, regardless of insurance status, socioeconomic status, or access to dental care.

PCOH continues to offer resources to assist individuals and communities in protecting this effective public health measure. Please consider joining the Statewide Water Action Team (SWAT).

New Study Released: Oral Health and Patients with Intellectual Disabilities

In a cross-sectional study published in Clinical Oral Investigations, investigators used data from the 2023 Special Olympics World Games to analyze the relationship between dental visits and oral health habits among more than 2,100 athletes with intellectual disabilities who took part in voluntary dental screenings. The findings highlighted the critical need for initiatives to minimize barriers to oral health care in this patient population.

Click here to read the journal.

Emergency Medicine Experts Separate ‘Myth’ from Reality in ED Boarding

From Becker’s Hospital Review

There’s a longstanding notion in healthcare that patients with low-acuity conditions are a key driver of overcrowding and boarding in emergency departments (ED) — one that emergency medicine experts describe as a misconception that distracts from real solutions.

“I’m not really sure how that myth has been given any legs,” Michael Bublewicz, MD, vice president and chief medical officer of emergency medicine at Houston-based Memorial Hermann Health System, said on a recent episode of the Becker’s Healthcare Podcast.

For years, efforts to ease strain on emergency departments have centered on the idea that healthcare providers should do more to educate patients on when it is appropriate to visit the ED versus an urgent care clinic, or that more urgent care centers should be built near high-volume EDs.

While well intentioned, emergency medicine experts say these efforts are ineffective because they are solely focused on ED input factors, rather than systematic issues across the broader healthcare delivery ecosystem.

“Programs to keep low-acuity patients out of the ED do not reduce boarding because low-acuity patients are rarely admitted to the hospital,” said the Agency for Healthcare Research and Quality (AHRQ) in a recently published report summarizing key outcomes from its October 2024 summit on ED boarding. The event brought together hospital and health system executives, patients, clinicians and policymakers who emphasized that input-focused interventions alone are ineffective at addressing the systemic throughput failures and misaligned incentives that drive boarding.

The perception that low-acuity patients tie up resources in EDs also ignores the reality that today’s health systems are increasingly caring for patients with complex medical needs. In the U.S., utilization rates of emergency services are highest among homeless individuals, nursing home residents and infants under the age of 1, according to an analysis of national data from the Emergency Department Benchmarking Association (EDBA). Demand for emergency services is only expected to grow as the nation’s population ages.

Estimates vary on the exact share of ED visits that are low acuity, but analyses from EDBA — which pulls data from more than 1,000 emergency departments across the country — indicate  these cases account for a relatively small share of overall visits. National data consistently indicate that the share of high-acuity and medically complex ED visits has been rising over time, reflecting broader demographic and clinical trends.

“The low acuity folks that present to EDs are pretty few and far between and they tend to present in hours where access isn’t available,” such as weekends, late-nights and holidays, Dr. Bublewicz said.

James Augustine, MD, vice president of the EDBA, said that EDs today are caring for a much different patient population than in decades past.

“Our ED patients are increasingly senior and they’re increasingly medical – meaning that injured patients occupy less and less of the ED volume,” he told Becker’s. “In my career, we used to see a lot of industrial injuries, sprained ankles and lacerations. The injury population is very much shrinking.”

At AHRQ’s summit, stakeholders unpacked several systemic factors that drive ED boarding, including reduced inpatient bed capacity, financial incentives that prioritize high-revenue surgical cases, administrative issues, and burdensome payer requirements that lead to delays in discharging patients.

Emergency medicine leaders say addressing these root causes requires coordinated efforts that go beyond ED-specific fixes. Hospital-led strategies proven to be effective include smoothing elective surgery schedules across the full week to even out inpatient demand, establishing discharge lounges and protocols to streamline patient flow, and using inpatient bed managers to expedite bed assignments​.

Beyond hospital-level efforts, leaders emphasized the need for broader policy changes, including revised payment incentives, public reporting of boarding metrics, development of real-time regional bed tracking systems and expanded access to timely behavioral health services.

Applications Open Now: Appalachian Leadership Institute

Appalachians are leading the way to economic development in their communities!

We’re accepting applications now for our Appalachian Leadership Institute (ALI), which trains people who live or work in the region to:

🌳 Recognize and utilize unique assets in their communities

💡 Identify and implement strategies to improve infrastructure, workforce development, tourism and more

🤝 Collaborate with other leaders to plan for Appalachia’s growth

ALI — at no cost to participants — focuses on skill-building, mentoring and cooperation. Six multi-day seminars will take place across the region from October to June 2026.

Applications are open until June 15, 2025! Learn more and apply now.