Collaborative accountability for care transitions: the community care of North Carolina transitions program

Community Care of North Carolina initiated efforts to improve care transitions for North Carolina Medicaid recipients in 2008. The transitions program is now statewide, serving more than 4,000 patients every month, virtually every North Carolina hospital, and more than 1,400 primary care practices. This commentary describes program components, early outcomes, and future challenges.     

Use of health information to improve care: the Southern Piedmont Beacon Community Grant

In 2009, the Office of the National Coordinator for Health Information Technology solicited proposals to participate in the Beacon Community Program. The program is designed to support communities with established reputations for adopting health information technology solutions. This commentary reviews Community Care of Southern Piedmont, a Beacon Community Program in North Carolina.     

The future of nursing and the health of North Carolinians: The North Carolina summit

Nurse leaders in North Carolina convened the Statewide Summit for Creating the Future of Nursing and Health Care in North Carolina on April 11, 2011. This article summarizes the summit and lays out the way ahead for implementing, in North Carolina, recommendations from the report on the future of nursing recently published by the Institute of Medicine of the National Academies (IOM). A synopsis of the commentaries composing the policy forum of this issue of the NCMJ follows, linking them to the IOM report.     

Psych NP-NC: a benchmark graduate nurse practitioner program for meeting the mental health needs in North Carolina

UNC-Chapel Hill's Psych NP-NC program prepares clinically and culturally proficient nurse practitioners to provide psychiatric and mental health care in North Carolina areas that are medically underserved and have a greater number of health disparities. This article reviews the program and the role of its graduates and makes policy recommendations for improving mental health care in the state.     

An update on Community Care of North Carolina's Medicare demonstrations

To enhance the impact of Community Care of North Carolina (CCNC)'s population health initiatives, CCNC partnered with the US Centers for Medicare and Medicaid Services to bring persons who are dually eligible for both Medicaid and Medicare, as well as Medicare beneficiaries, into CCNC's system of medical homes and community-based care management supports.     

Escalating the pathway from the associate's degree in nursing to the bachelor of science in nursing and/or the master of science in nursing: what is standing in the way?

For more than 25 years, promoting higher levels of education for registered nurses (RNs) has been a strategic theme in national reports. Yet, only 42.2% of RNs in North Carolina hold a bachelor of science in nursing, a master of science in nursing, or a doctorate in nursing. Creating a seamless educational pathway for RNs is essential for achieving this goal.     

Linking primary care with adult care homes

This commentary describes a pilot program wherein a community health center is partnering with Community Care of North Carolina to create a system of integrated care management and "treatment-in-place" visits for aged residents and disabled residents of adult care homes, with the goal of improving the quality of care and reducing unnecessary visits to emergency departments.     

Contribution of nursing education programs to the implementation of the Affordable Care Act in North Carolina

Registered nurses play an important role in ensuring the delivery of quality health care, and their education is one key to achieving the goals of the Affordable Care Act. This article explores the contributions that nursing education programs in North Carolina can make in helping this legislation achieve its objectives.     

Regionally increasing baccalaureate-prepared nurses in North Carolina: the RIBN Project

A more highly educated nursing workforce is needed to address the increasingly complex health care needs of our citizens and to expand the pool for future faculty and advanced practice nurses. North Carolina must create new partnerships between community colleges and universities to support seamless progression toward a baccalaureate degree. The RIBN model provides one option to meet this goal.     

Research for North Carolina: The University Cancer Research Fund

In 2008 an estimated 40,000 North Carolinians will be diagnosed with cancer. This disease is the number one cause of death in our state and will claim more than 17,000 lives this year. North Carolina is swimming against a demographic tide of growth and aging that will bring 80,000 new cancer cases by 2050, despite continued improvements in cancer prevention, early detection, and treatment. By establishing the University Cancer Research Fund, North Carolina has taken a bold, nation-leading step forward toward improving the future health and well-being of its citizens. Research that creates new knowledge, turns that knowledge into advances in treatment, screening, and prevention, and then ensures delivery of those advances across the state-that research is the key that unlocks the doors to a new and better future. The Fund will make that research possible. As has often been the case, North Carolina was ahead of the national curve by creating the UCRF in July 2007. In November 2007, Texas passed a $3 billion bond referendum to provide $300 million annually to support cancer research over the next decade. In 2005, California passed a $3 billion bond referendum to support stem cell research. Perhaps noting the downturn in federal funding for biomedical research, other states are watching these states' investments to see if they improve their citizens' health and make researchers nationally competitive. We will rigorously evaluate the UCRF to show the nation that North Carolina has taken a bold and wise step. The North Carolina General Assembly and the people of North Carolina have presented the University of North Carolina at Chapel Hill, the UNC Lineberger Comprehensive Cancer Center, the North Carolina Cancer Hospital, and UNC Health Care with an astounding opportunity and responsibility. We embrace that opportunity and that responsibility and pledge ourselves to our shared vision of a better future for the citizens of North Carolina.     

North Carolina's preparedness to respond to on-farm emergencies

North Carolina farm families, emergency services, and fire departments do not always have sufficient training to respond to on-farm emergencies. The main barrier to preparedness is lack of awareness of these needs. We recommend improved emergency response through collaborative education using AgriSafe of North Carolina and Certified Safe Farm North Carolina, two programs geared toward safety training.     

Honoring their service: behavioral health services in North Carolina for military service members, veterans, and their families

The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic brain injury), and substance abuse that are currently available in North Carolina to military service members, veterans, and their families. The task force determined that there are several gaps in services and made 13 recommendations related to federal, state, and local community resources. This article reviews the work of the task force and current efforts to improve services in North Carolina.     

Injury prevention: North Carolina's challenge and capacity to respond

North Carolina has worked to develop an infrastructure and identify priorities to reduce the high morbidity and mortality from injuries. Findings of the North Carolina Institute of Medicine (NCIOM) Task Force on Adolescent Health and the NCIOM Task Force on Prevention, combined with the North Carolina Division of Public Health strategic plan and the Injury and Violence Prevention State Advisory Council, have laid the path toward this goal.     

158名应届护理本科毕业生就业情况及影响因素调查

目的：了解护理本科毕业生就业情况及其影响因素,探求就业指导工作的新思路。方法：采用自行设计的问卷对158名应届护理本科毕业生的就业情况及其影响因素进行调查。结果：91．8％应届护理本科毕业生已基本落实就业单住,其中95．2％的护生从事临床护理工作;二本护生与三本护生就业率和就业单位比较,差别均无统计学意义（P〉0．05）;80％以上的护生认为专业知识和操作技能、仪表外貌、沟通能力是影响就业的前三位因素。结论：我校应届护理本科毕业生的就业形势相对较好;护理专业毕业生就业单位主要是医院,就业面较窄;学校需要帮助学生正确认识就业影响因素,提高护生的就业竞争力。     

Health and safety on North Carolina farms

Many rural areas in North Carolina do not receive the professional health care they deserve. North Carolina Farm Bureau recognized this unfilled need and implemented its Healthy Living for a Lifetime program in 2010. This initiative is one way to help improve the health of the state's 52,000 family farmers.     

Addressing the escalating public health issue of falls among older adults

The rate of older adult falls has increased dramatically in North Carolina. With screening and intervention, many falls can be prevented. To improve best practices, the Carolina Geriatric Education Consortium and other members of the North Carolina Falls Prevention Coalition have committed resources to train health care professionals in screening and assessment and to develop infrastructure to disseminate evidence-based interventions.     

We're not keeping up with the Joneses: North Carolina has fewer dentists per capita than neighboring (and most other) states

This commentary provides a data-driven analysis that shows that North Carolina faces a geographically maldistributed dentist workforce that is inadequate in supply. Not only has North Carolina consistently lagged behind other states in dentists per capita for over 10 years, but projections of future workforce supply do not show improvement.     

Newborn screening in North Carolina: the evolution of policy and practice

Newborn screening policies in North Carolina are due to the efforts of skilled and knowledgeable state officials, clinicians, and scientists who are able to develop effective newborn screening procedures. A newborn screening that was developed in North Carolina is the first automated method for diagnosing phenylketonuria. This process was later adopted in many other states. The use of tandem mass spectrometry in newborn screening was also pioneered in North Carolina, and it is being used in an increasing number of states. Newborn screening is more than testing, however; follow-up and specialized care are essential. State-level policies should recognize the multiple links necessary to make newborn screening effective and efficient.     

Reducing North Carolina's health care costs through environmental disease prevention

At a time of unprecedented pressure on the North Carolina state budget, reducing environmental risks to health may provide opportunities for substantial savings in the proportion of the state budget (24%) that is allocated for medical assistance. Recently, the Research Triangle Environmental Health Collaborative held a summit to identify options for increasing attention to environmental impacts on health in the ongoing health care and budget debates. Summit participants included not only public health and environmental experts, but also individuals (such as transportation planners, developers, and industry representatives) whose decisions can have a significant impact on environmental quality. This article summarizes key recommendations from the summit, as well as commentaries in the policy forum of this issue that further elaborate on why environmental quality matters for public health in North Carolina. Key recommendations from the summit include requiring formal health impact assessments (similar to environmental impact assessments but with an emphasis on health) in state and local transportation and land use planning processes, quantifying the total disease burden attributable to environmental hazards in North Carolina, prioritizing environmental risks to health in North Carolina, providing state technical assistance for communities disproportionately affected by poor environmental quality, establishing a new database system to link existing environmental and public health data by geographic location, undertaking North Carolina case studies to test the hypothesis that improving environmental quality also reduces medical care costs, and developing "environment matters to your health" public awareness campaigns.     

Economic impacts of Medicaid in North Carolina

OBJECTIVE: The purpose of this study is to provide estimates of the economic impacts of Medicaid program expenditures in North Carolina in state fiscal year (SFY) 2003. STUDY DESIGN: The study uses input-output analysis to estimate the economic impacts of Medicaid expenditures. DATA SOURCES/STUDY SETTING: The study uses North Carolina Medicaid program expenditure data for SFY 2003 as submitted by the North Carolina Division of Medical Assistance to the federal Centers for Medicare and Medicaid Services (CMS). Industry structure data from 2002 that are part of the IMPLAN input-output modeling software database are also used in the analysis. PRINCIPAL FINDINGS: In SFY 2003 $6.307 billion in Medicaid program expenditures occurred within the state of North Carolina-$3.941 billion federal dollars, $2.014 billion state dollars, and $351 million in local government funds. Each dollar of state and local government expenditures brought $1.67 in federal Medicaid cost-share to the state. The economic impacts within North Carolina of the 2003 Medicaid expenditures included the following: 182,000 jobs supported (including both full-time and some part-time jobs); $6.1 billion in labor income (wages, salaries, sole proprietorship/partnership profits); and $1.9 billion in capital income (rents, interest payments, corporate dividend payments). If the Medicaid program were shut down and the funds returned to taxpayers who saved/spent the funds according to typical consumer expenditure patterns, employment in North Carolina would fall by an estimated 67,400 jobs, and labor income would fall by $2.83 billion, due to the labor-intensive nature of Medicaid expenditures. LIMITATIONS: Medicaid expenditure and economic impact results do not capture the economic value of the improved health and well-being of Medicaid recipients. Furthermore, the results do not capture the savings to society from increased preventive care and reduced uncompensated care resulting from Medicaid. ConclusionS: State and local government expenditures do not fully capture the economic consequences of Medicaid in North Carolina. This study finds that Medicaid makes a large contribution to state and local economic activity by creating jobs, income, and profit in North Carolina. Any changes to the Medicaid program should be made with caution. RELEVANCE: The rising costs of health care and the appropriate role of government health insurance programs are the object of current policy debates. Informed discussion of these issues requires good information on the economic and health consequences of alternative policy choices. This is the first systematic study of the broader economic impacts of Medicaid expenditures in North Carolina.