North Carolina Medical Journal最新文献

Background: Academic health centers (AHCs) have traditionally focused on 3 core missions: patient care, research, and education. The current changing health care environment requires AHCs to broaden their focus to improve the health of their communities. This study reports the opportunities and challenges for the 5 North Carolina AHCs addressing social determinants of health (SDOH).

Methods: We used a mixed methods design. We analyzed financial data from systemwide community benefits reports and the Form 990 Schedule H of the primary medical centers (when available) from the 5 AHCs, and we conducted 4 key informant (KI) interviews at each of the 5 AHCs for a total of 20 interviews.

Results: Overall, AHCs spend a very small percentage of their total spending on community improvement services and community benefit operations. By far, the largest amount spent on community benefit is for treating patients eligible for charity care. Food insecurity and access to health care were the most addressed SDOH. Housing was viewed as a crisis that needed to be addressed at statewide and national levels.

Limitations: Community benefits reports from North Carolina AHCs lack important details. Key informant interviews provide far more recent information on the quantity and breadth of initiatives than the latest community benefits reports that were all completed pre-pandemic. We only interviewed 4 stakeholders from each AHC in North Carolina.

Conclusion: A new strategic vision must incorporate social accountability into the AHCs' core missions to remove barriers and institute and sustain change, but the AHCs face a steep challenge to incorporate social accountability at a core mission level.

North Carolina has adopted managed care for administration of its Medicaid program for management of medical benefits. The North Carolina Medicaid dental program, however, continues to be administered through a traditional fee-for-service model. This article addresses what a managed care model for Medicaid dental could look like in North Carolina.

The North Carolina Division of Mental Health, Developmental Disabilities, and Substance Use Services has implemented a strategic plan for limiting substance use overdose deaths, including increasing primary prevention and increasing public awareness of and access to evidence-based treatment options.

North Carolina's effort to hold drug companies account-able for their role in creating and fueling the overdose epi-demic has generated $1.4 billion for the state over 18 years. Securing these funds has been a victory, but ensuring they are used to save lives is equally critical.

Guided by the North Carolina Memorandum of Agreement (MOA), local governments are investing national opioid settlement funds to respond to the overdose crisis. Community Opioid Resources Engine for North Carolina (CORE-NC) partners have developed tools and resources that local governments are using as they plan, implement, and report on their opioid overdose response.

As the impact of the overdose crisis continues to worsen, some interventions are proving to be more impactful than others. This article provides insight on the history of harm reduction as it relates to the overdose crisis, how harm reduction strategies are saving lives in North Carolina, and the challenges that could hinder these efforts.

Background: This chart review aimed to assess the COVID-19 vaccination status of pregnant patients prior to hospitalization for delivery and vaccine administration while hospitalized postpartum.

Methods: This was a retrospective chart review of pregnant patients admitted for delivery at WakeMed Hospital during a six-month period who were offered COVID-19 vaccination immediately following delivery. We analyzed demographic characteristics by vaccination status prior to admission, during hospitalization, and at discharge. ANOVA, chi-squared, and multinomial logistic regression analyses were performed.

Results: Data analysis was performed on 1,476 obstetric patients admitted for delivery, of which 260 (17.6%) were vaccinated prior to admission. Of the 1,216 unvaccinated postpartum patients, 257 (21.1%) received a vaccine dose. Among our population, for every year increase in age, the odds of being vaccinated before admission and receiving vaccination while hospitalized postpartum were higher than those of remaining unvaccinated. The odds of being vaccinated before admission versus remaining unvaccinated at discharge were lower for Black patients compared to White patients. The odds of receiving vaccination during hospitalization were higher for Asian and Hispanic/ Latino patients compared to White patients. The odds of being vaccinated prior to admission versus remaining unvaccinated at discharge were higher for those with private insurance compared to those with public insurance.

Limitations: At the time of our intervention, we did not collect data on COVID-19 infection status of the patient at the time of admission. Additionally, vaccination counseling and administration had not been added to standardized order sets, thus variations in counseling by providers may have impacted patient acceptance.

Conclusions: Compared to patients who remained unvaccinated following discharge, patients vaccinated prior to admission were more likely to be older with private insurance, and less likely to be Black, while patients vaccinated during hospitalization once postpartum were more likely to be older and either Asian or Hispanic/Latino.