Category: Health (page 1 of 2)

Overcoming Health Disparities – Edgecombe County

The Challenge 

Health outcomes vary by racial and ethnic background in North Carolina. Length and quality of life are worse for Native Americans and African Americans. Racial disparities begin early, as African American babies are more than twice as likely to die during childbirth than white or Hispanic babies in North Carolina. Additionally, a Black woman in North Carolina is three times more likely to die from childbirth than a white woman. These disparities also affect common chronic illnesses, like heart disease, diabetes, and cancer rates. A report by Dr. Caroline Ames, a urologist, underscores these health disparities. Dr. Ames found that not only does Edgecombe County have a prostate cancer mortality rate (41.9%) nearly twice the average in NC (23%), but also that low-income African American men are disproportionately affected.

Access to reliable primary care and early detection screenings can dramatically lower the odds of dying from prostate cancer, which is the second-leading cancer death cause in the nation. African Americans suffer a disproportionately high incidence of and mortality from prostate cancer compared to whites, according to this study in the NC Medical Journal. Multiple factors may prevent men, including African American men, from getting tested and treated for prostate cancer. Misconceptions exist about the effects of treatment on men’s bodies, including that prostate screenings are painful and emasculating and that treatment of an enlarged prostate can lead to sexual dysfunction or incontinence. African American men in eastern NC also may experience higher risk factors, including a diet lower in fruits and vegetables and higher in meats and fats, because of food deserts and other systemic food insecurity issues. Finally, access to healthcare in rural North Carolina compounds risks, as those who are un- or underinsured for health insurance, low-income, or have limited transportation are less likely to regularly attend medical appointments and receive necessary cancer screenings.

Racial and Ethnic Health Disparities in NC, from the NC Health Equity Report.

  

The Solution

To address this prostate cancer mortality disparity, Vidant Edgecombe Hospital, the Vidant Multispecialty Clinic, and local barbers in Edgecombe County joined together in the Edgecombe County Barbershop Partnership. The program works to increase prostate cancer awareness in African American men through their local barbers. Vidant Edgecombe Hospital hosts quarterly meetings and continually educates the participating barbers on early detection, screening, access to care, and other resources that they can share with their clients. Additionally, barbers are educated on myths, facts, and conversation-starters so they can best inform their clients.

As trusted members of the community, barbers are able to promote positive norms regarding screening and provide social support to their clients. Brandon Richardson, a barber who participates in the program, says that he has served some of his clients for five or more years, and knows their families, birthdays, and children’s names. He says that these long-standing relationships make it easy to ask what may seem like personal questions about a person’s family history of prostate cancer and other risk factors or symptoms, as well as direct them to resources for care.

Brandon Richardson, a barber at Master’s Barbershop in Rocky Mount, speaks about his participation in the Edgecombe County Barbershop Partnership.

 

The Players

This collaborative program is administered by Vidant Edgecombe Hospital and the Vidant Multispecialty Clinic, alongside the ten local barbers in nine shops that educate their clients about screening, access to care, early detection, and myths associated with prostate cancer. The hospital and clinic engage barbers via quarterly meetings and continuing education workshops that keep them informed and supported in their outreach work. Dr. Caroline Ames, who compiled the data on prostate cancer mortality in the county, helped found the program. Its funding comes from MultiPlan, a healthcare management company, who provided a Rural Health Outreach grant to the hospital to fund the partnership.

 

The Promise

Charles Williams, a prostate cancer survivor, says that when it comes to cancer, “it’s always going to shock you. But this isn’t a game. There’s no replay… you have to take control of your health.” For him, that included regular screenings starting in his 40s, which helped him catch his cancer early and get treatment. Programs like the Edgecombe County Barbershop Partnership lead to increased numbers of men getting reliable information about prostate cancer from trusted sources, including about free early detection testing at Vidant Hospital. As of the 2017 progress report, the barbers educated 533 African American men about prostate cancer testing and treatment. Similar barbershop models are being used in Wilson, NC, Maryland, and Arkansas.

Dr. Ronny Bell, associate director for the Center for Health Disparities at East Carolina University, identified poverty, discrimination, and lack of access to quality healthcare as factors in Edgecombe County and eastern North Carolina. He says collaborative partnerships in smaller communities are key for reducing instances of serious medical conditions like diabetes, stroke, and various cancers. Collaborations provide communities with trusted, local supports and information that can improve participants’ views of healthcare providers and encourage healthy behaviors like prostate cancer screenings. Communities interested in implementing similar programs should look to resources provided by the NC Office of Minority Health and Health Disparities, which created statewide health equity recommendations, as well as to local leaders who can help governments and healthcare providers with community outreach.

Team Spotlight: 8th Judicial District Opioid Crisis Team

Co-Author: Mary Parry

 

After a 2011 decision by the state of North Carolina to remove funding for drug court programs, communities and courts like North Carolina’s 8th Judicial District began collaborating to find another way. Advocates like Chief District Judge Elizabeth Heath were determined to keep drug courts open to help low-level offenders addicted to drugs receive treatment and avoid prison while on probation. “We began seeing an increase in use of opioids, heroin and meth around that time,” said Heath. “The commissioners and health departments from our three-county district immediately began looking at ways to collaborate and deal with the growing crisis.”

By 2017, the 8th District, comprised of Greene, Lenoir and Wayne counties, had formed an Opioid Task Force. The group was interested in working together on projects related to harm reduction and medication-assisted treatment. Judge Heath was invited to join the task force because of her experience and commitment in the drug courts. Funding was top of mind and the team lacked an experienced grant writer. “We were shooting in the dark,” said Heath. “It was in the process of trying to search for and find funding opportunities that we were connected with the Opioid Response Project at the UNC School of Government.”

 

Because of connections made through the Opioid Response Project, the 8th District Opioid Crisis Team found the support they need to collect data and apply for significant funding. The team has written and submitted two significant three-year grants that would go a long way in advancing their work. They hope to add an administration position to the task force, along with a peer support specialist who can help deliver the services and support needed in the community. “It’s so much more difficult for rural communities to seek funding,” said Heath. “We have fewer resources to pull from, including help with the nuances of grant writing. Being involved with the Opioid Response Project helped us find a grant writer – someone to stick with us and navigate the process until the application was submitted.”

Other ongoing needs in the counties involve transitional housing for women, transportation support, and training that came to a stop in 2011 along with the drug court funding. “We are hopeful that grant funding will help us address these growing needs,” said Heath. “These issues overlap with the interests of our entire community, whether you’re in drug court or you’re not.”

 

The 8th District’s community collaboration has been impressive, according to project manager Brandy Harrell, Behavioral Health Director of the Kinston Community Health Center. “The support we have had from our county commissioners, from the Department of Social Services, and the rehab community has really helped to increase understanding and awareness about the opioid epidemic,” said Harrell. “Being involved with the Opioid Response Project has strengthened our collaboration in a way that will benefit our community even after the project ends.”

To learn more about the Opioid Response Project coordinated by the ncIMPACT Initiative, please visit: https://www.sog.unc.edu/opioidresponseproject.

Improving Health Access in Rural Communities – McDowell County

The Challenge

North Carolina ranks as one of the ten most populous states in the nation. However, much of the growth since 2010 comes from just two counties, Wake and Mecklenburg. In 48 of the state’s 100 counties the population declined, and most are in rural areas. These disparate population trends contribute to starkly different stories about healthcare access.

Rural communities increasingly face a shortage of physicians, hospitals, and urgent care centers, which can result in patients having to be airlifted to other facilities for treatment. Read more from the Kaiser Family Foundation. Rural communities often struggle to access the resources needed to improve their quality of life. Less than 5 percent of physicians trained in North Carolina are currently practicing primary care in a rural county, according to the Cecil G. Sheps Center for Health Services Research.

“Almost any measure you look at in terms of health, rural areas are doing worse,” said Mark Holmes, director of the Sheps Center. “They’re older. They’re poorer. They’re more isolated. They have persistently higher mortality on just about every indicator you look at… from the prevalence of diabetes to opioid use.” Read more from NC Health News.

 

Source: Sheps Center. The community type is more rural as you move from left to right on the graph, dark blue is urban and dark green represents the most rural areas of NC.

 

The Solution

McDowell County connects practicing physicians with students who are patients, right at their schools. Using telemedicine connections in public schools, students can meet with physicians online for a diagnosis or consultation. This option helps parents gather professional healthcare information without missing work and removing children from school to go to a doctor’s office. The technology is based on high-definition video-conferencing using specially equipped stethoscopes and cameras so a centrally located health care provider can examine students at multiple schools without traveling, their website states. Students must enroll in the program to receive services. The program bills private insurance and Medicaid. If a student is uninsured or under insured, parents or guardians are billed on a sliding scale. Read more from McDowell News.

The McDowell County Community Care Paramedic Program began in 2013 with funding from the Kate B. Reynolds Charitable Trust. The program assists high utilizers of EMS and ER services in transitioning to primary care physicians to obtain care for non-emergent issues, which frees resources for acute emergencies. The program also works in partnership with McDowell Hospital to provide follow up care to discharged patients who are at high risk of being readmitted. Some patients are not eligible for home health after being discharged from the hospital and the program serves to bridge this gap. The team also provides wellness events in the community to raise awareness of uncontrolled high blood pressure, diabetes, and other conditions.

According to a UNC article, the UNC School of Medicine committed to improve the education and retention of rural physicians in 2013, when it launched the Kenan program, which collaborates with the UNC School of Medicine-Asheville Campus, Mission Hospital in Asheville, and MAHEC, the Mountain Area Health Education Center. Students attend the first two years of medical school at Chapel Hill, then commit to the program at the UNC School of Medicine-Asheville campus for their third and fourth years of medical school. They need to study one of the areas that the program classifies as “primary care”: family medicine, psychiatry, general surgery, internal medicine, obstetrics and gynecology, pediatrics or emergency medicine. 

 

The Players

The telemedicine program is available in every public school in McDowell County, as well as McDowell Technical Community College. The program receives funding from Duke Endowment and the Center for Rural Health Innovations. The McDowell Community Care Paramedic Program receives support from local government and philanthropies. Leaders in McDowell County convened a forum for residents to share their recommendations for improving the health of their community. One of the most popular solutions was a community garden to increase access to healthy foods. The NC Office of Rural Health provides technical assistance to small hospitals and community health centers in rural and medically underserved communities, recruits health care providers to work in rural and medically underserved communities, and provides grants for community health centers. 

 

The Promise

According to McDowell News, each student in McDowell County can receive care from a medical provider without leaving school. “This is the third year of the program, it’s growing and we have had great success,” said Christy Lewis, director of the program. “Over 90 percent of the patients we see get to go back to their classroom, which is amazing. That is our goal, to keep kids in school.” McDowell County is only one of four in the state that uses the telemedicine program in schools, according to the director, but many other counties may want to consider implementing a similar program.

In 2013, McDowell EMS was one of only three programs in North Carolina, and the first agency in a rural county, approved for funding for a Community Care Paramedic Program. In 2016, the program was selected as a pilot site for behavioral health diversions. When available, community paramedics respond to all behavioral health emergencies in McDowell, and utilize a rigorous medical clearance screening protocol. In three years, the program saved $1,262,009 in healthcare costs and prevented 1,154 EMS/emergency room visits and 79 hospital readmits. Read more from McDowell News. In January 2020, neighboring Caldwell County voted to create a community care paramedic program, citing the successful program in McDowell County as a model upon which they will base their efforts.

Adverse Childhood Experiences in Cumberland County

Co-Author Hallee Haygood

 

The Challenge

When children face extreme adversity at a young age, it impacts their well-being in the present and later on. It can create many social, physical, and psychological problems for children as they continue to age, as North Carolina Health News described. Most states define “adverse childhood experience” as neglect or abuse that results in harm, potential for harm, or threat of harm to a child. Data about adverse childhood experiences in North Carolina are available from the United Health Foundation.

Read more about adverse childhood experiences (ACES) from Prevent Child Abuse North Carolina, which offers support to interested community members who want to come together to build Community Child Abuse Prevention Plans. Cases of adverse childhood experience can lead to toxic stress and death. North Carolina has seen an increase in rates of children going into foster care after experiencing neglect or abuse. As such, Cumberland County felt that it was time to address these issues in a bold way.

 

The Solution

After the community endured the death of a child due to abuse, Cumberland County leaders decided the problem of adverse childhood experiences must be addressed. They were the first county in North Carolina to create a “Community Childhood Abuse Prevention Plan.” It focuses on promoting protective factors (like social and emotional competence, knowledge of parenting, and child development, resilience, connectedness, and concrete support) to foster community and family support that nurtures a child’s development. Read the plan adopted by the Cumberland County Board of Commissioners in 2017 at this link.

Research indicates that prevention plans at the local level are essential because the most change can occur within communities and families as personal investment increases. Additionally, such prevention plans bring different sectors together to address local issues. The CDC created a list of different approaches to improve quality of life for children and decrease abuse. As communities implement more prevention plans and strategies at the local level, more children are likely to avoid adverse experiences.

 

 The Players

Lead agencies in developing the Cumberland County plan included: Cumberland County Schools, Child Advocacy Center, Partnership for Children of Cumberland County, Cumberland County public health and social services officials, Fayetteville Police Department, and the local district attorney. The Cumberland plan incorporates research about protective factors, which are conditions in families and communities that increase the health and well-being of children and families. These attributes serve as buffers, helping parents find resources, support, or coping strategies that allow them to parent effectively, even under stress. Research has shown that the protective factors are linked to a lower incidence of child abuse and neglect.

Prevent Child Abuse provides information about the risk factors that increase the likelihood of child abuse and neglect, which include:

  • Young parents may lack experience with children or be unprepared for the responsibility of raising a child.
  • Unrealistic expectations. A lack of knowledge about normal child development or behavior may result in frustration and, ultimately, abusive discipline.
  • Families struggling with poverty, unstable housing, divorce, or unemployment may be at greater risk.
  • Substance use. The effects of substance use, as well as time, energy, and money spent obtaining drugs or alcohol, significantly impair parents’ abilities to care for their children.
  • Intergenerational trauma. Parents’ own experiences of childhood trauma impact their relationships with their children.
  • Effective parenting is more difficult when parents lack a supportive partner, family, or community.

The Promise

For communities who seek to address adverse childhood experiences, two determinants can make all the difference: funding and networks. Funding from diverse sources allowed Cumberland County to create the Community Childhood Abuse Prevention Plan that engaged 22 local public and nonprofit agencies in identifying strategies to reduce adverse childhood experiences 90 percent by 2030. Further, the network enabled these agencies with various missions and goals to collaborate on a common agenda. They are stronger and more effective together than they could be acting independently.

Opioid Response Project Team Focus: Onslow County

Co- Author: Mary Parry


Sparked by the UNC Opioid Response Project, a local effort formed in Onslow County and conversations about launching a collaboration began. Before long, around 30 agencies and partners were on board, eager to build a community team focused on solutions. “Because of the Opioid Response Project grant, we were able to launch our Strategic Opioid Advanced Response Team (SOAR),” said Sophia Hayes, project coordinator with the Onslow County Health Department. “We’re now partnering with physicians, mental health specialists, religious groups, and others, working with a shared purpose. It’s exciting!”

The team’s initial goal was increasing education and awareness. They began by offering a survey to find out how much the community knew about drug problems in the county. They also distributed educational materials, offering local statistics and resources for treatment to help more people seek help when they need it. The outreach response was strong. “We received 400 survey responses and handed out materials to 2,000 people,” said Hayes.  “We’re also working on a public service announcement to help this information spread further.”

The team hosts and participates in community events to broaden awareness in the county. One event featured a speaker on the long-term effects of opiates. Provider trainings are also planned, educating the medical community on alternatives to subscribing opioids, policies surrounding opioids, and other emerging topics like the use of CBD oil. These trainings are intended to help patients, too. “There are a lot of worries around prescribing and treatment that we can help alleviate by better educating our community,” said Victoria Reyes, community relations officer with the Onslow County Health Department.

Team leaders point to the Opioid Response Project grant as instrumental in helping them reach people in a targeted way. Becoming more strategic on social media and offering local content specific to Onslow County helped the community better understand the opioid epidemic and the resources available to people in need of support.

The SOAR Team’s initial work in the community has been well-received, but stigma creates a barrier for residents who need help but fear judgment. To help remove this barrier, the team started a Naloxone Take Home Program, allowing residents to pick up the opioid overdose reversal medication at the pharmacy for no cost. “Our EMS also leave take-home kits after cases involving overdose, trying to remove the barrier of stigma,” said Hayes. “This helps more people access Naloxone, but it does skew our data since this Naloxone use is underreported.”

Moving into 2020, Onslow’s SOAR Team works on turning survey results into new opportunities for education and collaboration. With help from the Onslow County Manager, a crisis continuum group joined the team and partners from Carteret County connected as well. Community partners share stories that convey the impact of the SOAR Team’s work, which helps spread the word and build momentum for their efforts.

Because of their early success as part of the Opioid Response Project, the City of Jacksonville received a Comprehensive Opioid Abuse Program grant (COAP) worth $900,000 over a 3-year period. “We’re starting to be able to look beyond the early stages of this work into next year, three years out, and into the future, which is very exciting,” said Hayes.

With continued funding in place, the SOAR Team hopes to provide peer support specialists in the community, who are people with lived experiences that offer valuable input to team leaders. They are also trusted messengers within the community, attending work groups and faith-based gatherings to broaden awareness. “This work is near and dear to their hearts and their impact is real,” said Reyes. “Funding for peer support specialists is needed so that we can provide resources like transportation. In a county like Onslow, where people are so spread out, a lot of travel is required to get to sober living and detox facilities.”

Providing equal access to treatment drives members of the SOAR Team. Coming together with this shared purpose, community leaders are thankful for the opportunity to do this work together. “The support we have received through the Opioid Response Project has been great, providing some structure and helping us uphold the collaboration so it can grow and reach further across our county,” said Reyes.

Learning and networking at forums through the Opioid Response Project has been extremely valuable to the learning and planning process, according to team leaders. “Even though we all live in different areas of the state, we’re all dealing with the same issue,” said Hayes. “Access to leaders in different counties has been both helpful and reassuring as we continue on this path, helping our community respond to the opioid epidemic.”

The team is excited to think about how far they have come because of their collaboration. “We have had tremendous attendance and participation by local leaders, which has been a terrific benefit to our team,” said Hayes. “It has made a tremendous difference in our progress. We look forward to continuing this important work.”

To learn more about the Opioid Response Project coordinated by the ncIMPACT Initiative, please visit: https://www.sog.unc.edu/opioidresponseproject

 

Opioid Response Project Team Focus: Cumberland County

Co-Author: Mary Parry


The Cumberland-Fayetteville Opioid Response Team (C-FORT) emerged from a task force first organized by former Fayetteville Mayor Nat Robinson. The task force brought stakeholders together to begin to discuss strategies for tackling the local opioid epidemic. When the UNC School of Government launched the Opioid Response Project, team members were eager and excited to participate in an opportunity to continue their work and expand their impact using the Collective Impact model.

“The C-FORT team is a pretty motivated group with quite an action plan,” said Melissia Larson, C-FORT Project Manager. “The team is made up of 90-100 community leaders, 25-35 of which are actively involved, working to address needs in the community.”

Improving post-overdose response is one of the focuses of the team. It was obvious to community leaders that more needed to be done, but there was not enough staff in place to collect all of the necessary data to take action. Because of the team’s work, a pocket guide is now being released to help patients who refuse transport. The guide, distributed by first responders, contains information to help patients understand where they can access services in the community.

Community education is another important component of C-FORT’s work. Committee members implemented a survey to better understand attitudes and awareness about the opioid epidemic in Cumberland County. The survey will gauge the community’s understanding of the availability and purpose of Naloxone, the medication used to counter the effects of an opioid overdose. The team will wrap up survey collection in January 2020, and results will inform the content and strategies behind an upcoming community education campaign.

“The roadblock initially keeping us back from collecting information and launching projects was funding,” said Larson. “We had an action plan and strategies that were great, but we needed the money.” C-FORT developed their action plan as part of the Opioid Response Project with support from the UNC School of Government.

As a result of their promising work, the C-FORT team was recently awarded a federal grant, offering the county $900,000 over a three-year period. The team will start receiving funding in early 2020 and will begin implementing its action plan, including a media campaign and hiring staff to help with the post-overdose response in the community.

“Because of our participation with the UNC Opioid Response Project, we have been able to really pull this team together and employ a community coordinator,” said Larson. “That has been critical to our success and will really help propel us going forward.”

The C-FORT team describes their involvement with the Opioid Response Project as educational and rewarding. After identifying early strategies, teams were encouraged to set goals and objectives, then move on to key performance indicators, helping them realize their goals. “The School of Government had a game plan, helping each team walk away with an action plan,” said Larson. “It’s exciting now to see those plans start coming together.”

Bringing together 10 teams from across North Carolina has made it easier for team members to share information and participate in networking that might not otherwise be possible. These discussions are helping local leaders save time and avoid reinventing the wheel as they work quickly to tackle similar issues in their communities.

“Thanks to the UNC Opioid Response Project, the C-FORT team now has a strong action plan that takes into consideration all of the different facets of the opioid problem,” said Larson. “We have learned about the importance of including workforce development in our action plan. We know that joblessness is a problem linked with opioid addiction, and now we have an opportunity to include that in our action plan.”

As the new year begins, the C-FORT team is excited to be hiring three full-time staff. “Being selected for funding was a big win for us,” said Larson. “Now, we’re looking forward to the many small wins along the way that will pave the way toward achievement of our goals.”

The C-FORT team is working hard to become the creative and recovery-ready community they see as necessary to tackle the opioid epidemic. Because of the team’s involvement in the Opioid Response Project, they are already seeing that start to happen. “One of our members with Methodist University recently reported the launch of recovery meetings on campus beginning in January 2020,” said Larson. “It’s exciting that our members can get the energy and inspiration they need to feel empowered to start a conversation with their chain of command, helping to launch projects that will become an important part of our community’s success.”

To learn more about the Opioid Response Project coordinated by the ncIMPACT Initiative, please visit: https://www.sog.unc.edu/opioidresponseproject

Opioid Response Project Team Focus: Wilkes County

Co-Author: Mary Parry


An early analysis of the local opioid crisis identified stigma reduction as an obvious need when the Healthy Wilkes: Community Opioid Prevention & Education Team first began working with the Opioid Response Project coordinated by the ncIMPACT Initiative at the UNC School of Government. “There is stigma around seeking treatment. There is stigma related to attitudes about joblessness,” said Heather Murphy, Executive Director of The Health Foundation in Wilkesboro. “Stigma is a major roadblock to connecting people who are struggling with the help they desperately need.”

Murphy leads a team of community advocates, first responders, and other professionals whose work is impacted by the opioid crisis. Together, with the help of UNC School of Government leaders, they are setting goals and adapting their own work to improve the community’s overall response to the epidemic. The team points to helpful trainings led by School of Government faculty as a primary reason for their early success working as a team to tackle local issues. “In the system of care, we have people with different roles trying to communicate and improve the system, like law enforcement, judicial, medical, and social workers,” said Murphy. “Collective impact is designed to change relationships among people and we’re benefitting from the expertise of the UNC School of Government, guiding us through our collective impact work.”

The ability to bring different community leaders together to discuss problems and solutions is invaluable, according to Murphy. Through their collaboration, the Wilkes team is helping staff at the local department of social services understand that medication assisted treatment shouldn’t necessarily be a barrier between parents and their children. They’re helping health care providers change the way they see the opioid crisis, through suggested readings, like “Dope Sick” by Beth Macy.

Another area of focus for the Wilkes team is adverse childhood experiences. According to a Stanford study on the impact of childhood trauma on life expectancy and overall health in adulthood, childhood trauma can shorten life expectancy by up to 20 years. Within the Wilkes team, a group of trained individuals help victims cope with childhood trauma. The “Reconnect for Resilience” group helps victims learn to regulate their own nervous systems. “It’s kind of like a ‘keep calm and carry on’ approach to dealing with stress,” said Murphy. “We need more professionals in the community to become trauma informed and trauma sensitive.”

The Wilkes team is also expanding the work of its harm reduction group, developing strategies to minimize impacts on people in the community while work to address the opioid crisis is underway. The team would like to see more businesses distribute Naloxone and hopes attorneys will soon be done parsing through language in North Carolina’s Good Samaritan Laws which sometimes prevents people from administering Naloxone. The Wilkes team also supports increased availability of syringe exchange programs. “When we started, Wilkes didn’t have a needle exchange program yet,” said Murphy. “We do now, and our hospital is expanding one at its Care Connection Pharmacy, too.”

Medication Assisted Treatment (MAT) is another option for addressing the opioid crisis, helping addicted patients with medication that blocks brain receptors expecting continued opioid use, paired with behavior therapy to help patients adapt. Doctors cannot prescribe MAT without special certification, which limits options for patients seeking care. While current medical school graduates from UNC-Chapel Hill are now certified, there are many physicians practicing across the state who are not yet certified. Murphy says some physicians worry that being certified to treat substance use disorder will impact how their general patient population views their practice, pointing back to the challenge of stigma reduction as a focus of the group’s work.

Leaders in Wilkes County attribute their work with the UNC Opioid Response Project to opening up new avenues of opportunity in their ongoing efforts to tackle the opioid crisis. “Because of this work, we’re more prepared to take advantage of a growing number of other offerings, said Murphy. “We have received a federal grant to help provide more treatment services for pregnant women. And we were in a position to participate in the Appalachian Regional Commission Listening Tour, which covers Work to Recovery programs in the vast Appalachian region, including Ohio and Kentucky.”

The Wilkes team is proud to have been selected for the UNC Opioid Response Project. While the long-term struggles of a community experiencing such a high incidence of opioid addiction is indeed challenging, Murphy says it’s an honor to have been chosen, knowing that UNC School of Government leaders see value in the county’s existing leadership and capacity to affect change. “Yes, our work is difficult,” said Murphy. “But, if you’re going to do the work and do it well, you can’t shy away from the difficult problems. Our team is excited by the progress we have already made, and about our ability make a difference.”

To learn more about the Opioid Response Project coordinated by the ncIMPACT Initiative, please visit: https://www.sog.unc.edu/opioidresponseproject

Accountable Care Communities Offer An Opportunity to Address Healthcare Disparities at the Systems Level

In a previous blog post, which you can find here, ncIMPACT shared information around NCCARE 360, an interdisciplinary referral tool being implemented in the state of North Carolina’s medical care systems. As we continue to research impacts of the health of a community, we find it increasingly important to look at the way data around how changes become integrated with existing cultural norms and daily lives of community members in North Carolina. NCCARE 360 is part of an effort to implement a model of Accountable Care Communities (ACCs).

ACCs

ACCs aim to address health at the community level through addressing the social drivers of health and looks at health on a systems level to better coordinate healthcare with a wide variety of stakeholders within a community. This coordination includes involving non-traditional partners in health initiatives, such as faith communities and academic researchers. ACCs have an underlying value of authentic community engagement. In the context of the ACC model, it is not enough to go into communities and give out information. Stakeholders must work alongside communities to create a power dynamic that gives community members agency and self-determination. Under the ACC model, the goal is to elevate the voices of community members who are most impacted by health disparities. For example, specific race groups are more likely to experience disparities within population health–those voices need to be amplified within this model.

 

 

Health Inequities by Race

In fact, the data suggests that many health initiatives have historically neglected or taken advantage of specific race populations, such as the Native American and African American communities (see Black-White Disparities in Health Care Report, released by the American Medical Association[1]). Racial disparities in health begin even at the stage of conception. African American babies are more than twice as likely to die during childbirth than white or Hispanic babies in North Carolina. While white babies die at a rate of 5.4% in North Carolina (comparable to the Hispanic rate of 5.5%), Black babies die at a rate of 12.4% (see figure below from NCDHHS).

 

 

Maternal mortality rates are alarming in general, but when analyzed by race, it is evident that Black mothers have a totally different experience during pregnancy and childbirth than their racial counterparts. In 2013, in the state of North Carolina, the maternal mortality rates for Black and white women was almost the same, with the white racial category making a large jump up in rates and the Black racial category briefly falling. However, since then, the numbers have since diverged once more. Today, a Black woman in North Carolina is 3x as likely to die from giving birth than a white woman. From 1999-2013, Black women accounted for 49% of the deaths due to childbirth in the state of North Carolina, while African Americans make up 22% of the state’s population (https://schs.dph.ncdhhs.gov/data/maternal/).

While working with the Kate B. Reynolds Charitable Trust on their targeted health strategies, our interviews with experts repeatedly brought up the importance of cultural competency at the systems level to address disparity. For example, one anonymous interviewee we spoke with mentions struggles with healthcare perceptions for older African American men:

“He grew up in a time where he knew studies were being done on Black people. Telling him he needs to go to the doctor brings up distrust for him. Entering into those large facilities, he’s not inclined to do that. He needs a provider that looks like him and be able to come to a place that feels safe.”

 

These disparities are alarming and to begin addressing these health inequalities, research and reports indicate that strategically culturally appropriate care, community capacity building, and homegrown community leader involvement will all need to be present as a start to making the state’s health system more culturally appropriate. These non-traditional partnerships implemented in Accountable Care Communities will require a breaking down of walls for everyone involved–silos will need to be removed for an integrated community care system.

For more guidance on implementing the ACC model, please see the following guide, provided by Kate B. Reynolds Charitable Trust and Duke Endowment, visit http://nciom.org/nc-health-data/guide-to-accountable-care-communities/

 

 

[1] https://www.ama-assn.org/about/ama-history/history-african-americans-and-organized-medicine

 

 

 

Drinking Water Incident Response Toolkit Now Available Online

Co-Author: Maddie Shea


On July 16, 2019, the ncIMPACT Initiative launched the North Carolina Drinking Water Incident Response Toolkit online and presented a webinar introducing the toolkit. You can view a recording of the webinar online. The toolkit includes a guide for pre-incident planning, customizable tools for local governments, information on mutual aid, communication tools, essential information on drinking water and its regulation, and an appendix of additional resources.

Drinking water incidents such as floods, infrastructure failures, or contaminations may create real or perceived threats to the safety of drinking water across North Carolina. One highlight from the toolkit is the section on pre-incident planning. Any local community can be vulnerable to experiencing a drinking water incident. As such, this guide was developed to help local governments be as prepared as possible to respond if and when incidents occur. The guide is based on the principles that preparation is crucial, that it should be inclusive and collaborative, and that local issues and needs vary.

The guide:

  • Highlights the need for a local champion,
  • Provides example invitation lists and letters,
  • Offers a sample tabletop exercise,
  • Includes sample discussion questions, and
  • Recommends a list of considerations for pre-incident planning meetings.

The ncIMPACT Initiative and the School of Government convened and staffed the Drinking Water Working Group with support from a grant from the North Carolina Policy Collaboratory. The Drinking Water Working Group guided development of this toolkit and resources to assist local governments when they must respond to drinking water incidents. We are grateful to the membership of the working group for their time and expertise.

The webinar was presented by:

For more information, please contact:

Jill Moore, Associate Professor, UNC School of Government moore@sog.unc.edu 

Emily Williamson Gangi, Policy Engagement Director, ncIMPACT Initiative emily.gangi@unc.edu

 

Decreasing Cost and Increasing Quality: Value-Based Care Could Improve Communities

Co-Author: David Brown


According to the America’s Health Rankings by United Healthcare, North Carolina ranks 33rd in the country. As the ncIMPACT Initiative works alongside North Carolina stakeholders to solve complex problems, we increasingly hear concerns about how the state’s health outcomes affect community economic vitality. It is important to fit these conversations into the context of the changing health systems around us. As a patient, citizen, and community member, you may hear a repetitive term in this context: value-based care. What is it? What solutions does it promise, and what potential problems could it cause?

 

What is Value-Based Care?

In a granular sense, value-based care refers to health care programs based on incentives: care providers should have a financial stake in basing their care on patient outcomes rather than the number of tests, procedures, or other interventions (sometimes called volume-based care). In the case of Medicare, where the transition to value-based care is occurring most prominently, the federal government hopes that aligning provider reimbursements more closely to health outcomes will ultimately result in better care for individuals, better health for populations, and lower costs for everyone. Other valued-based reimbursement programs administered by the federal government include the Skilled Nursing Facility Value- Based Purchasing Program and the Home Health Value-Based Purchasing Model. This is part of a steady transition toward value-based care at the national level.

 

The Challenge of Health Costs

Everyone knows – often from experience – that health care can be costly. Some drivers of health care costs are obvious: investments in highly trained personnel and highly specialized equipment; the chronic nature of some diseases; and the willingness to spend almost any amount to prolong life and avoid pain. Little can be done about these cost drivers in our current system. However, much can be done to control costs by incentivizing preventive care, minimizing complications from chronic diseases, modernizing medical record-keeping to avoid unnecessary tests and procedures, and treating diseases and other ailments that tend to occur together as a single health problem, rather than as multiple.

Transitioning to a system where health outcomes are prioritized over the number of appointments and procedures makes intuitive sense, but there are pitfalls to avoid on the road to value-based care. Measuring health outcomes is complicated and lacks an agreed-upon methodology across providers. Further, a system that dis-incentivizes proliferating appointments and tests runs the risk of denying aggressive care to patients for whom it may be appropriate. In addition, there may be a long learning curve as everyone from major hospitals and insurers to small private practices adjusts to the new world of value-based care. Finally, any change that increases reporting requirements is likely to divert providers’ time away from more patient-focused tasks.

Further, hand-offs between specialists as part of a comprehensive care plan are more likely to be successful than if the patient has to seek out each provider on his own. The ultimate goal of improved health means fewer hospital stays and, in the case of a Medicare or Medicaid recipient, lower costs for the government. And if provider reimbursements are tied to improved health, rather than the number of interventions, the incentives for the provider might be higher for patients with a higher likelihood of improved health outcomes.

 

The Potential for a Promising Response: NCCARE 360

Advanced medical record keeping will become increasingly important with the move to value-based care. NCCARE 360 is a new statewide coordinated care effort that will electronically track, connect, and refer patients through an accountable care  network. This is a person-centered approach in which community members and providers in North Carolina will have access to:

  • A statewide resource directory
  • A community resource repository
  • A referral platform

Experts have recently established that while around 20% of health determinants are around access to healthcare, the other 80% are referred to as the Social Determinants of Health (SDOH). NCCARE 360 will allow for a team of providers and social organizations to track health outcomes of a patient together, with a comprehensive care plan that works in real time. Not only will the patient be a part of an accountable care community, they will also have access to services not typically associated with medical care: housing services, access to healthy foods, domestic violence services, and other SDOH resources.

Image result for social determinants of health graphic

The promise of cost savings, greater efficiency, and better health outcomes will speed the adoption of value-based care in the coming years, as will legislation and regulations that require it. But providers and patients alike will need to be vigilant to ensure that the dollar-related outcomes are not prioritized over those related to patient health and well-being. NCCARE 360 gives an opportunity to impact health outcomes from a person-centered, community approach, creating accountability. NCCARE 360 will be implemented in every county in North Carolina by the end of 2020.

 

For more information, visit:

https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/nccare360

 

Image result for nccare 360

 

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