Implementation Experience Research Articles

A mixed methods study examining the impact of primary health care financing transitions on facility functioning and service delivery in Kenya: a study protocol.

Kenya has experienced several health financing changes that have implications for financing primary healthcare (PHC). These include transitions from funding by two key donors (the World Bank and the Danish International Development Agency (DANIDA)) and the abolishment of conditional grants that were earmarked for financing primary healthcare facilities. This protocol lays out study plans to evaluate the impact and implementation experience of these financing changes on PHC facility functioning and service delivery in Kenya. A sequential mixed methods design will be applied to address our research objectives. Firstly, we will perform a document review to understand the evolution of policy changes understudy. Second, we will conduct an interrupted time series analysis across all 47 counties in Kenya to assess these financing changes' impact on health service utilization in all public primary healthcare facilities (level 2 and 3 facilities). Data for this analysis will be obtained from the Kenya Health Information System (KHIS). Third, we will carry out in-depth interviews with health financing stakeholders at the national, county, and health facility levels to examine their perceptions of the experiences with these changes in health financing. This mixed methods study will contribute to evidence on the sustainability of financing primary healthcare in low and middle-income countries facing financing changes and donor transitions.

Approaches for supporting youth dually involved in child protection and youth justice systems: An international policy analysis

The high representation of children involved across both child protection and youth justice systems remains a pressing concern. Contributing factors include unnecessary police intervention for behavioural difficulties in residential care, and deficient systems integration particularly between child protection and youth justice. Policy reforms in the past 15–20 years have aimed to prevent and address this concern across jurisdictions such as Australia, New Zealand, Canada, the United Kingdom, and the United States. The study offers an updated review and analysis of these policies, targeting researchers, policymakers, and practitioners in the field. Examination of selected available policies identified four main strategies utilised: joint practice protocols, policies aimed at reducing the criminalisation of children in out-of-home care, crossover court lists, and specialised practice models like the Crossover Youth Practice Model (CYPM). There is promising evidence for some approaches, notably the CYPM, however, most suffer from a lack of implementation and outcomes evaluation, insufficient diversity considerations, and minimal inclusion of lived experience in design and implementation. Findings suggest future policy reforms should prioritise the development of whole-of-government strategies, involve children's perspectives, emphasise prevention, restorative and diversionary responses, multi-agency collaboration, ongoing support for implementation, and rigorous evaluation.

Review of participatory epidemiology application in human health and nutrition and future directions

Participatory Epidemiology (PE) developed as a branch of veterinary epidemiology and has been widely used in infectious disease control and early warning in resource-limited settings. In the beginning, Participatory Epidemiology was focused on linking the researcher’s communication skills with participatory methods to enable the participation of livestock owners and herders in the identification and assessment of livestock diseases as well as in the development, monitoring, and evaluation of the disease control strategies. In this respect, the use of participatory techniques gradually developed into Participatory Epidemiology with increased recognition by epidemiologists who have developed several tools which are being adapted in human health and nutrition. Relative to veterinary uses and human nutrition, Participatory Epidemiology has not been used in public health in Kenya or for studies on important human diseases, such as Kala-azar. However, in the recent past there have been growing interests from epidemiologists to extend the testing and piloting of the Participatory Epidemiology approach in the arid and semi-arid settings of Kenya geared at empowering communities to identify and solve their health needs. Additionally, there is ongoing debate about the ability of epidemiology to give results that can be better applied in public health practice besides its ability to identify disease risk factors. Scientific research has recommended that participatory research be applied in epidemiology to bridge this descriptive gap and action. This review describes the implementation experiences and lessons learnt in the use of Participatory Epidemiology in understanding human diseases, both communicable and non-communicable as well as human nutrition, a key factor in health and wellness. The reviewed articles provide an understanding into the application of PE approaches which have been limited in pastoralist areas, where zoonotic diseases are prone. The article establishes that as opposed to more conventional methods, using Participatory Epidemiology can generate precise and scientifically credible information within a relatively short period. Data generated from Participatory Epidemiology can be sustainably used to effectively find solutions to the common community health problems based on local preferences for control options.

First-line managers' experience of guideline implementation during the COVID-19 pandemic.

To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. A descriptive, qualitative study. Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.

Culture Internalization for AKHLAK BUMN: A Uniformized Core Values of All Indonesian State-Owned Enterprises

In today's business landscape, companies must be increasingly agile to meet the demands of developing business potential, changing customer needs, and rising competition. This includes State-Owned Enterprises (SOEs) that aim to deliver social and economic value. Internalization of core values is crucial in creating a culture that drives the company's performance. Therefore, the activation program and measurement methods for culture are key to the success of the transformation. Through the implementation experience, this practitioner study aims to identify the necessary infrastructure for managing the uniformized culture, activation programs, and measurement methods in companies. The core value set by the Ministry of SOEs or AKHLAK BUMN, guides the behavior of employees to support company performance. Implementing core values in each SOE company will facilitate talent mobility and ensure that the transformation process aligns with the ministry's objectives.

Chatbot Design and Implementation: Towards an Operational Model for Chatbots

The recent past has witnessed a growing interest in technologies for creating chatbots. Advances in Large Language Models for natural language processing are underpinning rapid progress in chatbot development, and experts predict revolutionary changes in the labour market as many manual tasks are replaced by virtual assistants in a range of business functions. As the new technology becomes more accessible and advanced, more companies are exploring the possibilities of implementing virtual assistants to automate routine tasks and improve service. This article reports on qualitative inductive research undertaken within a chatbot development team operating in a major international enterprise. The findings identify critical success factors for chatbot projects, and a model is developed and validated to support the planning and implementation of chatbot projects. The presented model can serve as an exemplary guide for researchers and practitioners working in this field. It is flexible and applicable in a wide range of business contexts, linking strategic business goals with execution steps. It is particularly applicable for teams with no experience in chatbot implementation, reducing uncertainty and managing decisions and risks throughout the project lifecycle, thereby increasing the likelihood of project success.

Prevention of sexual violence and domestic abuse through a university bystander intervention programme: learning from a UK feasibility study

In response to evidence documenting the scale and impact of sexual violence (SV) and domestic abuse (DA) in universities, Universities UK (2016) recommend implementation of a UK based bystander programme, The Intervention Initiative (TII), as a key prevention strategy. However, a recent UK review (Gaffney et al, 2023) concluded that no studies have addressed implementation issues for university-based bystander programmes. Our study explored what is required for implementation of the TII in a UK university, rather than intervention effectiveness. The intervention was delivered to undergraduate students across three school cohorts: medicine, social work and sports coaching. The study draws on pre- and post-intervention surveys to explore SV and DA knowledge, attitudes, and bystander skills. Focus groups or individual interviews with students (n=11) and staff facilitators (n=10) explored experiences of implementation, delivery and participation. Students reported positive changes across several areas and some evidence of immediate impact on behaviours, suggesting potential for wider implementation across university contexts. Barriers included professionalisation of the application of the bystander intervention, resistance to an underpinning gendered evidence base and a lack of diversity and relatability in programme materials.

Artificial intelligence in accounting

Artificial Intelligence (AI) technologies open up broad horizons for enhancing business efficiency and advancing various professional domains, boosting their productivity and compe­titiveness. There is an active exploration of approaches to incorporating AI technologies in the accounting sphere, promising a seamless transition from human to machine involvement. The aim of this article is to summarize the acquired experience, identify perspectives, constraints, and risks associated with the use of AI technologies in the professional activities of accountants. The research is based on the hypothesis that widespread use of AI in the professional activity of an accountant with an insufficient level of professional skepticism and caution carries significant threats and risks for both the accountant and the business as a whole. Scientific search methods, comparative and critical analysis, theoretical generalization, and synthesis were used. A prerequisite for imple­menting AI technologies in accounting is expert information systems and ERP systems. The analysis of AI technology implementation experience in various industries demonstrates their relevance in the accounting field for performing routine tasks (automated recognition of primary documents, processing incoming signals, and other standard operations with a simultaneous reduction in the probability of errors), analyzing large datasets, and providing information support for decision-making (pro­ces­sing business data and regulatory docu­ments), training professionals, and organi­zing internal and external communication (parti­cularly between humans and machines). Identi­fied potential risks include breaches of privacy and data security, misinterpretation of output data, and the disregard of activity context, external and internal environments, especially due to the absence of emotional intelligence, which influences the trust level in integrated information systems. The requirement for the application of professional assessments and judgments, mandated by regulatory documents, limits the scope of AI technology utilization in accounting. Future research should focus on exploring the possibilities of widespread integ­ration of AI technologies in information systems for accounting and improving legislation based on the principle of risk assessment.

Implementation barriers and facilitators of Moyo foetal heart rate monitor during labour in public hospitals in Nepal

ABSTRACT Background Globally, every year, approximately 1 million foetal deaths take place during the intrapartum period, fetal heart monitoring (FHRM) and timely intervention can reduce these deaths. Objective This study evaluates the implementation barriers and facilitators of a device, Moyo for FHRM. Methods The study adopted a qualitative study design in four hospitals in Nepal where Moyo was implemented for HRM. The study participants were labour room nurses and convenience sampling was used to select them. A total of 20 interviews were done to reach the data saturation. The interview transcripts were translated to English, and qualitative content analysis using deductive approach was applied. Results Using the deductive approach, the data were organised into three categories i) changes in practice of FHRM, ii) barriers to implementing Moyo and iii) facilitators of implementing Moyo. Moyo improved adherence to intermittent FHRM as the device could handle higher caseloads compared to the previous devices. The implementation of Moyo was hindered by difficulty to organise training ondevice during non-working hours, technical issue of the device, nurse mistrust towards the device and previous experience of poor implementation to similar innovations. Facilitators for implementation included effective training on how to use Moyo, improvement in intrapartum foetal monitoring and improvement in staff morale, ease of using the device, Plan Do Study Act (PDSA) meetings to improve use of Moyo and supportive leadership. Conclusion The change in FHRM practice suggests that the implementation of innovative solution such as Moyo was successful with adequate facilitation, supportive staff attitude and leadership.

Holacracy as a flexible technology for managing IT companies

The paper considers the features of holacratic structure as one of the forms of flexible organization management. The aim of the paper is to investigate the possibilities of integrating this tool into the management of Russian IT companies, as well as to analyze the consequences of such an implementation. The author solved the following tasks: the main features of holacracy in the context of Agile philosophy are outlined, the features of holacratic and traditional hierarchical structures are compared from the point of view of the system approach to organizational management, the statistics of the use of this technology in the activities of domestic IT companies is studied, the most significant results of the implementation experience of recent years are given, the arguments in favor of the use of holacracy as an organizational management tool in IT companies are substantiated. Based on the analysis of the scientific literature on project management and a number of Internet sources, the authors have identified the readiness attributes that an organization should possess for successful transition to a holacratic structure. The risks and difficulties of such a transition are considered, taking into account the advantages and disadvantages of this management method. The application of flexible management methods, including holacracy, seems to be the most expedient for those Russian IT market participants, whose activity implies the presence of cross-functional teams and microservice architecture. As a conclusion, the authors emphasize the decisive role of the personal factor in ensuring the proper level of self-organization of the company and its readiness for holacracy,and recommend a compromise variant of using holacratic principles for Russian IT.

Reducing the cognitive abstractness of climate change through an “engineering fiction” learning experience: A natural language processing study

The lackluster societal response to the climate crisis is partially attributed to the abstractness of people's mental construals of climate change given its vast spatial and temporal dimensions, which fail to evoke urgency to act. Prior efforts to measure mental construal levels of climate change are inconsistent, insufficient, and labor-intensive. This study developed and implemented learning experiences for integrating engineering design and climate fiction writing to engage 48 high school students in concrete climate change thinking. A novel measure of cognitive abstractness overcomes previous methodological shortcomings by automatically quantifying the linguistic abstractness of participant-authored stories using natural language processing. Comparing participant stories written at the beginning and end of the intervention reveals a significant decrease in linguistic abstractness (Cohen's d = 1.01, p = 0.03). This study contributes to the nascent movement for greater use of narratives as data sources in environmental psychology research, which may uncover new insights into human behavior and decision making.

Corporate culture: institutional regulation and practical implementation experience

The article presents a theoretical analysis of the sociological discourse on corporate culture. The role of corporate culture in the practical activities of the enterprise and its institutional features are discussed. The subject of the study is corporate culture, in particular, the specifics of the use of the term and the components of corporate culture are clarified. It is shown that culture is based on a value component, the development of which in the context of the company should form the value of work and the value of belonging to one's company, which, in turn, should be congruent with the company's strategy and development goals. The article reveals the differences between a developed corporate culture, such as educating and motivating employees to perceive work in the company as a way of life, ensuring staff commitment to the ideas and values of the organization. The article used a theoretical review of scientific literature in the field of sociology of culture and personnel management. The novelty of the research is the translation of the experience of a medical organization (Mayo clinic), which has a highly developed corporate culture based on the ideas of customer orientation, as well as the identification of the principles of its work and the features of building a culture. The importance of compatibility of corporate culture and strategy is also emphasized. It is noted that at the material level, corporate culture can be observed through visible signs (branded clothing, corporate symbols, organizational ceremonies and attributes, work environment, etc.), and at the level of spiritual culture – values and norms that define and regulate the behavior of employees in the company. At the same time, values closely related to visual samples reflect the internal philosophy of the company. It is emphasized that norms, patterns of corporate behavior, through corporate culture are tools for personnel management, and corporate culture acts as an institutional management tool. The article concludes that it is necessary to purposefully form and develop a corporate culture in the process of which the primary should be the creation of a value component related to the company's development strategy.

Performance Analysis of Internet Enterprises From the Perspective of ESG: A Case Study of NetEase

In recent years, corporate performance evaluation has been mainly focused on financial performance, and there are few studies on the construction of performance evaluation system containing non-financial indicators. Especially since the concept of ESG was put forward by the Financial Action Agency of the United Nations Environment Program in 1992, environmental, social and corporate governance have gradually attracted the attention of social investors. Internet technology has helped the rapid development of domestic economy. Taking NetEase as an example, this paper aims to combine the concept of ESG with the financial performance of enterprises, establish an ESG performance evaluation system of Internet enterprises, and evaluate the system. It is found that the ESG performance evaluation system is more effective than the traditional performance evaluation, and finally summarizes the experience and enlightenment of ESG performance implementation.

Телемедицинские технологии в гепатологии: время идти вперед?

The article considers the possibility of using telemedicine technologies in providing specialized medical care to patients with chronic hepatitis C and nonalcoholic fatty liver disease. Foreign experience of implementation of this direction of work and our own results are presented.

A database for oncological research and quality assurance: implementation and first experiences with the University Clinical Cancer Registry Regensburg

Legal requirements, certification specifications, as well as the demand for real world data on cancer research and treatment led to the decision to establish the University Clinical Cancer Registry Regensburg. The first organizational step in the implementation process of this oncological data registry was the evaluation and acquisition of suitable tumor documentation and database software. For this purpose, an evaluation matrix comprising required database software criteria was designed and consented by a multidisciplinary group of experts. Next, a yearly report of the Institute for Cancer Center Certification (OnkoZert 2019) was considered to identify database software already in use. The identified systems were rated according to the established criteria matrix and other relevant aspects. Onkostar was the system considered most suited for building up an oncological data repository. In the second step, the central IT department implemented Onkostar on-premise and migrated digitally available data after an adaptation and verification process. In parallel, a uniformed process for handling emerging oncological research questions was established. For research requirements, a data analysis concept was established comprising a proposal for data extraction, procedural instructions, and statistical training materials. In the final step, the implemented software and the process for handling research requirements in practice were evaluated by using two exemplary use cases with the focus on clinic-wide analyses and currently relevant scientific topics. A 2-month test phase conducted by various user groups showed a preference for Onkostar tumor documentation software from IT-Choice, mainly because of its adjustability to support research and treatment. Newly added and migrated data can be used for certification and research purposes. This software also provides support in current tumor documentation by displaying the course of cancer disease for individual patients over time. Such oncological data registries can be a powerful tool for legally required cancer registration, the certification of medical centers, as well as for additional oncological research. Tumor databases can be helpful in projects on cancer treatment and scientific aims. The experiences made at the University Hospital Regensburg may be used as a guidance for implementing clinical databases in similar settings with interdisciplinary responsibilities.

A scoping review of continuing education models and statutory requirements for pharmacists globally

BackgroundIn the dynamic field of pharmacy amongst a diverse array of countries with disparate income levels, pharmacists play a pivotal role in integrating emerging scientific knowledge into their practice while adapting to evolving therapeutic interventions and expanding service delivery responsibilities. Lifelong Learning (LLL) is cultivated through continuing professional education (CPE) and continuing professional development (CPD), indispensable components ensuring sustained professional competence and heightened patient care quality. The global landscape witnesses diverse LLL activities tailored to pharmacists’ learning needs and preferences. This scoping review maps and synthesises a comprehensive global perspective on the existing knowledge regarding CPE/CPD models, statutory requirements, and pharmacists’ preferences for LLL activities.ObjectiveTo comprehensively investigate global models of CPE/CPD for pharmacists’ and examine the statutory requirements governing pharmacists’ registration and licensure.MethodA literature search of PubMed, Google Scholar, Web of Science, and the University of KwaZulu-Natal library search engine was undertaken for studies between January 2012 and February 2023. The article selection and reporting followed the recommendations made by PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) guidelines. The articles were tabulated based on their respective country’s income level, continuing education models employed, country-specific statutory requirements, and pharmacists’ preferences for LLL activities.ResultsOf the initial 3974 publications identified through the database search, 24 studies met the review criteria. The majority of the articles originated from high-income countries (HICs) (14/24, 58.3%), and most employed the mandatory CPD points system (21/24, 87.5%). However, in some HICs and upper-middle income countries (UMICs), the CPE/CPD is non-mandatory. While most countries (19/24, 79.2%) offer various LLL formats, the preference of pharmacists remains primarily face-to-face learning (13/24, 54.2%). However, workplace learning (3/24, 12.5%) and blended learning (7/24, 29.1%) are mentioned in some studies.ConclusionDiverse models of CPE/CPD alongside statutory requirements persist globally and evolve, shaped by varied implementation experiences. HICs lead in CPD models, while the implementation in low- and middle-income countries (LMICs) and low-income countries (LICs) requires further exploration for inclusivity and effectiveness. A few UMICs are either initiating or in early stages of implementing the CPD models. Structured planning for LLL activities is increasingly a global requirement for pharmacists’ licensure. The essential progression of pharmacy practice in developing healthcare systems necessitates a mandatory CPD model. Ongoing research is crucial to fortify the implementation, align and unify the CPD model with evolving pharmacy profession needs.

Reflection of Pre-Service Physics Teacher on The Implementation of The New Indonesia Curriculum

This study aims to explore the pre-service of physics teachers in implementing the Merdeka Curriculum in the Samarinda region. The Curriculum Merdeka is a learning approach that gives teachers freedom in choosing methods and approaches that use a descriptive method to collect data from prospective physics teachers in Samarinda. The results indicated that most pre-service physics teachers were ready to implement the Merdeka curriculum (76.13%) and acknowledged its effectiveness (73.40%), but some still faced difficulties (64.40%) due to limited direct implementation experience. The study employed a qualitative research approach with a descriptive analysis, used questionnaires as data collection instruments, and employed data analysis techniques such as transcribing, coding, and inference or verification for those who had difficulty implementing the Merdeka Curriculum. This is because pre-service physics teachers have not directly implemented the Merdeka Curriculum. These results indicate that socialization and training on the Merdeka Curriculum alone are not enough; a consistent support program is needed, as are in-depth courses on the Merdeka curriculum as well as apprenticeship programs in schools that implement the Merdeka curriculum for prospective teachers.

Community School Implementation in Rural Vermont

This study highlights the Community Schools (CS) implementation experience of five rural Vermont schools. Principals and CS coordinators participating in a state-funded program aimed at CS establishment were interviewed to understand better their experience with implementing a school/district-wide policy and reform effort. Findings suggest several elements play a critical role in the successful implementation of rural CSs, including leveraging already-present community engagement practices, school leader embodiment of CS values/mentality, as well as collaborative leadership practices that broaden participation and level the field for all parties involved. Implications for community school implementation within rural contexts are discussed.

Mixed method evaluation of a learning from excellence programme for community health workers in Neno, Malawi

BackgroundCommunity Health Workers (CHWs) play an essential role in linking communities to facility-based healthcare. However, CHW programmes have often been hampered by low levels of staff motivation, and new tools aimed at improving staff motivation and work environment are needed. One such intervention is the “Learning from Excellence” (LfE) programme. We aimed to assess feasibility, outputs, and impact of a co-designed LfE programme on CHW motivation, in Neno District.MethodsWe conducted a convergent mixed-method evaluation of the LfE programme. Co-design of the programme and forms took place between October 2019 and January 2020. LfE forms submitted between September and November 2020 were analysed using descriptive statistics and memos summarising answers to the open-ended question. To investigate experiences with LfE we conducted in-depth semi-structured interviews with key stakeholders, CHWs, and site supervisors, which were analysed thematically. A pre-post intervention questionnaire was developed to assess the impact of the co-designed LfE intervention on CHW motivation and perceived supervision. Outcomes were triangulated into a logic model.ResultsIn total 555 LfE forms were submitted, with 34.4% of CHWs in Neno District submitting at least one LfE report. Four themes were identified in the interviews: LfE implementation processes, experience, consequences, and recommendations. A total of 50 CHWs participated in the questionnaire in January 2020 and 46 of them completed the questionnaire in December 2020. No statistically significant differences were identified between pre-and post-LfE measurements for both motivation (Site F: p = 0.86; Site G: p = 0.31) and perceived supervision (Site F: p = 0.95; Site G: p = 0.45). A logic model, explaining how the LfE programme could impact CHWs was developed.ConclusionsMany CHWs participated in the LfE intervention between September 2020 and November 2020. LfE was welcomed by CHWs and stakeholders as it allowed them to appreciate excellent work in absence of other opportunities to do so. However, no statistically significant differences in CHW motivation and perceived supervision were identified. While the intervention was feasible in Neno District, we identified several barriers and facilitators for implementation. We developed a logic model to explain contextual factors, and mechanisms that could lead to LfE outcomes for CHWs in Neno District. The developed logic model can be used by those designing and implementing interventions like LfE for health workers.

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.

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. 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. 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. The examination of referral rates is observational and may not generalize to other contexts. 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.