North Carolina's Maternal and Child Health Trends, Contributing Factors, and the Demonstrated Benefit of Public Investments

The North Carolina Division of Public Health reported that, in 2016, African American infants died at more than 2.5 times the rate of white infants, a ratio that has worsened from ten years ago. This and others disparities are indicative of poor maternal and infant health outcomes that affect many North Carolinians and reflect the many systems and policies that impose barriers to health and prosperity. Many of the factors that influence maternal and child health are beyond the influence of individual mothers and their families. Public policies can address disparities, improve quality of life for North Carolina’s communities, and ultimately improve outcomes. However, they require a commitment to providing equitable opportunities and public investments that support those strategies. Targeted efforts to remove barriers that lead to racial and ethnic health disparities and economic injustice are necessary, particularly due to the persistent and growing disparities across many measures of health and wellbeing in the state. This paper provides an analysis of the factors that drive maternal and child health outcomes, as well as family economic conditions, and describes their connections to public policies. Examining disparities and the many systems that influence them can inform policies that improve health and economic and social wellbeing. Through smart investment of public dollars into strategies that are known to work, all North Carolinians can lead healthy and prosperous lives.Master of Public Healt

Aligning Medical Student Curriculum with Practice Quality Goals: Impacts on Quality Metrics and Practice Capacity for Students

The practice of medicine occurs primarily in the ambulatory environment where providers have many competing demands, including health record documentation and patient volume expectations. Subsequently, medical student education has not been a priority for providers, health systems, or community practices. Yet, accrediting and professional organizations, such as the Association of American Medical Colleges, American Academy of Family Physicians, Ambulatory Pediatric Association, Society of General Internal Medicine, and the Liaison Committee on Medical Education, recommend education in ambulatory settings

Students Adding Value: Improving Patient Care Measures While Learning Valuable Population Health Skills

Medical students are potential resources for ambulatory primary care practices if learning goals can align with clinical needs. The authors introduced a quality improvement (QI) curriculum in the ambulatory clinical rotation that matched student learning expectations with practice needs. In 2016-2017, 128 students were assigned to academic, university affiliated, community health, and private practices. Student project measures were matched with appropriate outcome measures on monthly practice dashboards. Binomial mixed effects models were used to model QI measures. For university collaborative practices with student involvement, the estimated odds of a patient being screened for breast cancer in March 2017 was approximately 2 times greater than in 2016. This odds ratio was 36.2% greater than the comparable odds ratio for collaborative practices without student involvement (95% confidence interval = 22.7% to 51.2% greater). When student curriculum and assignments align with practice needs, practice metrics improve and students contribute to improvements in real-world settings