North Carolina Medical Journal最新文献

{"title":"Building and Supporting Interprofessional Teams to Support Population Health","authors":"Kae Rivers Livsey, Sofia Aliaga, Jennifer Wells","doi":"10.18043/001c.117213","DOIUrl":"https://doi.org/10.18043/001c.117213","url":null,"abstract":"High-functioning teams can positively impact health care delivery and support population health. The authors discuss enabling and interfering factors that impact team-based care delivery and how the AHEC system can promote inter­professional education and practice across North Carolina.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Update on Interprofessional Education and Practice in North Carolina: The State of the State","authors":"Jill Forcina, M. Zomorodi","doi":"10.18043/001c.117087","DOIUrl":"https://doi.org/10.18043/001c.117087","url":null,"abstract":"Team-based care, the optimal result of interprofessional education and often referred to as interprofessional practice, is a critical ingredient in the success of efforts to address health and workforce needs. Articles in this issue provide an update on what has occurred across North Carolina related to team-based care since this journal last covered it in 2018, highlighting innovations and infrastructure that address health equity, population-based care, reducing costs, and increasing quality.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"30 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Residential Treatment Facilities for Child Behavioral Health Services in North Carolina Medicaid.","authors":"Paul Lanier, Roderick Rose, Daniel Gibbs, Jacob Hyman, Neil Kamdar, Joseph Konstanzer, Kristen Hassmiller Lich","doi":"10.18043/001c.117075","DOIUrl":"https://doi.org/10.18043/001c.117075","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric residential treatment facilities (PRTFs) are non-hospital inpatient treatment settings for children with severe be-havioral health disorders. PRTFs are a restrictive and costly form of care that can potentially be avoided with community-based behavioral health services.</p><p><strong>Methods: </strong>Statewide Medicaid enrollment and claims data for 2015-2022 were used to describe PRTF utilization in North Carolina. We examined annual episodes of care in PRTFs and compared trends before and during the COVID-19 public health emergency.</p><p><strong>Results: </strong>From 2015 to 2022, 10,038 children insured by NC Medicaid entered a PRTF across 10,966 episodes of care. In the past five years (2018-2022), care in PRTFs resulted in Medicaid expenditures of over $550 million total, or over $100 million per year. In 2022, 42% of children who entered PRTFs were in foster care and 44% of children were placed in PRTFs outside of North Carolina.</p><p><strong>Limitations: </strong>The analysis was limited to data collected for administrative purposes.</p><p><strong>Conclusions: </strong>Current trends indicate an ongoing overrepresentation of children in foster care placed in PRTFs and increased out-of-state PRTF placements. Coordinated efforts in future research, policy, and practice are needed to determine the cause of these trends and iden-tify solutions.</p>","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"85 3","pages":"215-221"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to “Syndemic Approaches Are Needed to Address Maternal Substance Use and Syphilis in North Carolina”","authors":"NC Medical Journal","doi":"10.18043/001c.108606","DOIUrl":"https://doi.org/10.18043/001c.108606","url":null,"abstract":"","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying High-Risk ZIP Codes for Childhood Lead Exposure: A Statewide ZCTA-Level Priority List for North Carolina","authors":"Rashida Callender, Carolina Avendano, Mercedes A. Bravo, Joshua L. Tootoo, Ed Norman, Marie Lynn Miranda","doi":"10.18043/001c.94878","DOIUrl":"https://doi.org/10.18043/001c.94878","url":null,"abstract":"Research has consistently shown that there is no safe blood lead level (BLL) for children. Despite progress in lead poisoning prevention, lead exposure remains a persistent threat to the health and neurological development of children. To identify high-risk ZIP codes for use by families and health care providers for the entire state of North Carolina, we developed a risk model using ZIP Code Tabula­tion Area (ZCTA)-level census data. We obtained all available BLL testing data from the North Carolina Department of Health and Human Services for the years 2010–2015 via data use agreement. We fit a multivariable regression model with the ZCTA-level mean of log normalized BLLs as the de­pendent variable and ZCTA-level census data for known risk factors of childhood lead exposure as predictors. We used this model to create a priority risk categorization. We organized ZCTAs into 20 quantiles, or priority risk categories, that can be used in local and statewide screening programs. The first six (of 20) quantiles were identified as particularly high-risk areas for childhood lead exposure. Because BLL testing is not universal, the BLL testing data used in this study are likely biased toward those most at risk for lead exposure. This study demonstrates the utility of ZCTA-level census data in identifying high-risk ZIP codes for childhood lead exposure, which can be used to ensure that the highest-risk children are tested in a timely manner. This approach can be replicated to address lead exposure nationally.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"269 1‐4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of NCCARE360, a Digital Statewide Closed-Loop Referral Platform to Improve Health and Social Care Coordination: Evidence from the North Carolina COVID-19 Support Services Program","authors":"Connor Drake, Eugenia R McPeek Hinz, B. Granger, Isa Granados, Abigail Rader, Ariana Pitcher, Shemecka Mcneil, William K. Bleser, Carolyn Avery, Janet Prvu Bettger, Elena Tenenbaum, Megan Shepherd-Banigan, Eleanor Wertman, Lisa McNerney, Marissa Mortiboy, John Purakal, Dev Sangvai, Susan E Spratt","doi":"10.18043/001c.94877","DOIUrl":"https://doi.org/10.18043/001c.94877","url":null,"abstract":"Efforts to improve population health by being responsive to patients’ social and economic conditions will benefit from care models and technologies that assess and address unmet social needs. In 2019, NCCARE360 launched in North Carolina as the first state­wide digital care coordination network to “close the loop” on referrals between community-based organizations (CBOs), health service providers, and social service agencies. The platform creates a shared network for sending and receiving electronic referrals and track client outcomes. As a case study, we compare NCCARE360 resolution rates for community resource referrals originating from a large integrated health system primarily in Durham County from September 1, 2020, through February 28, 2021. In the first year, COVID-19 Support Ser­vices Program (COVID-SSP) funding was available to reimburse associated CBOs for providing food assistance and case management services. We compared this with the same period the following year after funds had been exhausted. We present frontline implementation experiences and highlight opportunities, challenges, and recommendations for NCCARE360 implementation. Multi-level considerations for individual end users, organizations adopting the platform, and policymakers are presented. Addi­tionally, we find that when COVID-SSP funding was available, more referrals were placed (3,220 cases) and referrals were more likely to be resolved (88% resolution rate) when compared to the same time frame when funds were no longer available (860 cases; 30% resolution rate). These results underscore the importance of reimbursement mechanisms and funding. The examination of referral rates is observational and may not generalize to other contexts. The shift to value-based care is an opportunity to embrace structural solutions to health and social care fragmentation. There is also an opportunity to realize the potential of NCCARE360 and efforts like it to contain costs and improve health outcomes and equity.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"285 S8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Q&A: Continuous Coverage Unwinding and Medicaid Expansion on the Ground in Two North Carolina Counties","authors":"Shannon Dowler","doi":"10.18043/001c.94873","DOIUrl":"https://doi.org/10.18043/001c.94873","url":null,"abstract":"After three years of continuous Medicaid coverage as permitted by COVID-19-related waivers, in 2023 counties had to begin redeterminations of eligibility, “unwinding” this continuous coverage. As unwinding and eligibility determination continues, Medicaid expansion has begun, and county public health leaders are navigating uncertain but exciting waters. Lisa Macon Harrison, MPH, of Granville Vance Public Health, and Joshua Swift, MPH, of Forsyth County Department of Public Health, share their experiences, concerns, and hopes for the future.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping North Carolina Insured: Strategies to Support County Departments of Social Services and Continuous Enrollment","authors":"Melanie Bush","doi":"10.18043/001c.94849","DOIUrl":"https://doi.org/10.18043/001c.94849","url":null,"abstract":"NC Medicaid experienced a dramatic increase in enrollment during the COVID-19 pandemic. To support county Departments of Social Services, NC Medicaid worked quickly to improve automation, provide flexibility, and streamline processes to better manage the workload increased by pandemic enrollment and Medicaid expansion implementation.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"47 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intro: Expanding Medicaid, Expanding Life in North Carolina","authors":"Peter J. Morris","doi":"10.18043/001c.94839","DOIUrl":"https://doi.org/10.18043/001c.94839","url":null,"abstract":"","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"3 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping People Enrolled During Medicaid Expansion and COVID-19 Continuous Coverage Unwinding","authors":"Emma Sandoe","doi":"10.18043/001c.94842","DOIUrl":"https://doi.org/10.18043/001c.94842","url":null,"abstract":"North Carolina is expanding Medicaid insurance coverage while simultaneously removing coverage from individuals as a result of the end of the COVID-19 emergency. These large-scale eligibility changes have created an opportunity for improved processes. North Carolina chose to build upon the existing Medicaid Family Planning program to maintain access to health care while launching Medicaid expansion.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"72 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140234998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}