Automating WIC Screening and Enrollment in Pediatric Primary Care

New England Journal of Medicine · 2025-10-25 · 1 citations

Addressing food insecurity: a paediatric academic advocacy collaborative quality initiative

BMJ Open Quality · 2025-04-01

OBJECTIVE: This quality improvement (QI) initiative aimed to address food insecurity (FI) by improving FI identification and referral to food assistance programmes for the families served by the eight paediatric academic institutions in North and South Carolina. METHODS: The primary process measures were screening 80% of eligible families for FI and coding for FI. The outcome measure was referring 80% of families identified with FI to appropriate resources. The balancing measure was maintaining a rate below 20% of missed opportunities for referral. Change ideas were organised into four main key drivers. The eight teaching clinics of the Carolinas Collaborative completed monthly chart audits using the Quality Improvement Data Aggregator (QIDA). Baseline was December 2020 and implementation occurred January 2021-May 2022. Creation of run charts was later transferred to statistical process control charts. Standard probability or Montgomery rules were used to identify special cause variation. Sites used individual QIDA data to conduct Plan-Do-Study-Act cycles; aggregated data were shared during bimonthly meetings. RESULTS: A total of 4270 eligible charts were audited, 3430 patients screened and 525 identified as having FI. The rate of FI screening shifted from 68.5% to 86%. The rate of FI identified remained at 15%, and food referrals were consistently offered 90% of the time. While FI diagnostic coding did not reach the 80% goal, there was a shift from 38.3% to 70.5%. The balancing measure remained well below the goal of less than 20% of missed opportunities to discuss positive FI (centreline of 9.5%). CONCLUSIONS: A paediatric academic collaborative QI initiative focused on FI demonstrated collective improvement and allowed for rapid implementation, dissemination and spread.

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

UNC Libraries · 2024-09-06

Introduction 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. Methods 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. Results 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. Limitations The examination of referral rates is observational and may not generalize to other contexts. Conclusion 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.

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

North Carolina Medical Journal · 2024-03-18 · 4 citations

Introduction: 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 state-wide 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. Methods: 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 Ser-vices 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. Results: Multi-level considerations for individual end users, organizations adopting the platform, and policymakers are presented. Addi-tionally, 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. Limitations: The examination of referral rates is observational and may not generalize to other contexts. Conclusion: 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.

Addressing Health-Related Social Needs Through Systematic Screening and Integration of a Social Care Technology Platform

NEJM Catalyst · 2023 · 12 citations

• Computer Science
• Political Science
• Medicine

SummaryDuke Health successfully implemented systematic screening for health-related social needs (HRSNs) and NCCARE360, a social care referral network and technology platform, within its electronic health record (EHR). Using a tandem strategy of discrete HRSN identification (screening) and then referral placement, Duke Health increased overall identification of patient HRSNs and the ability to track outcomes of referrals. Using flexible point-of-care screening workflows led to effective and sustained HRSN screening, averaging 8,500 patients per month across 32 ambulatory clinics and inpatient encounters over 18 months. Duke Health negotiated an enterprise-wide license of NCCARE360 to permit all EHR users to place and view referrals to community and government resources rather than limiting the referral function to its social workers. Distributing the work across clinical roles and leveraging the EHR integration to screen and refer, Duke Health attained a tenfold higher referral rate than peer North Carolina institutions that were also using NCCARE360. Clinical locations with dedicated support staff, such as a population health nurse trained in social resource allocation, were more successful in placing initial referrals. Duke Health recognized a need for a human connector to facilitate follow-up for service navigation and verification of referral completion.

Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years

Journal of Primary Care & Community Health · 2022 · 89 citations

• Medicine
• Gynecology
• Family medicine

Breast cancer screening in the United States is complicated by conflicting recommendations from professional and governmental organizations. The benefits and risks of breast cancer screening differ though by age which should influence shared decision-making discussions. Compared to older women, women ages 40 to 49 years have a lower risk of breast cancer, but the types of breast cancer that develop are often more aggressive with a poorer prognosis. Furthermore, younger women have a longer life expectancy and fewer comorbidities. The primary benefits of screening for women in their 40s are a reduction in breast cancer mortality, years of life lost to breast cancer, and morbidity of breast cancer treatment by detecting cancers at an earlier stage. Compared to older women, the risks of breast cancer screening in women ages 40 to 49 years includes more false positive recalls and biopsies as well as transient anxiety. Concerns regarding radiation induced malignancy and overdiagnosis are minimal in this age group. The shorter lead time of breast cancer in women ages 40 to 49 years also favors shorter screening intervals. This information should help inform providers in their shared decision-making discussions with patients.

Updates to the Pediatrics Asthma Management Guidelines

JAMA Pediatrics · 2021 · 18 citations

• Medicine
• Pediatrics
• Intensive care medicine

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A Faculty Development Workshop for High-Value Care Education Across Clinical Settings

MedEdPORTAL · 2018-08-24 · 5 citations

Introduction: Despite rising health care costs, trainees frequently do not receive formal high-value care (HVC) training. As medical education often occurs through informal learning, it is imperative that medical educators be prepared to teach HVC concepts across clinical settings. Methods: This workshop was created to provide frameworks for teaching HVC across four pediatric educational settings: (1) case-based conferences, (2) inpatient rounding, (3) ambulatory visits, and (4) conversations with patients and families. Frameworks were developed based on literature review, content experts' knowledge, and internal assessment and feedback. The workshop was divided into two sections: a didactic overview of HVC education and interactive small-group sessions to practice application of the Toolkit for Teaching High-Value Care. At the end of the workshop, participants completed the Prescription for High-Value Care to create a personal action plan. Results: This workshop has been presented at both national and local pediatric conferences. From over 89 evaluations (83% response rate), participants felt the workshop met objectives, served as a valuable use of their time, and provided useful resources. Evaluations elicited specific actions that participants gleaned from workshop content along with proposed behavior changes, such as creating HVC case-based conferences at their home institution and initiating more value-based discussions. Discussion: This workshop has been successfully presented in both national and local settings and has been well received by participants. The workshop is targeted for clinical educators and aims to address the gap in faculty development for HVC education.

Developing the PedsValue Modules—A National Pediatric High Value Care Curriculum

Academic Pediatrics · 2017-04-18 · 8 citations

Recommendations to Reduce Diagnostic Radiology Resident Misrepresentation in Postinterview Communications

Journal of the American College of Radiology · 2016-05-20 · 2 citations