This article explores the correlates of intimate partner violence (IPV) among rural, southern Latinas. A sample of 1,212 women in blue-collar work sites in rural North Carolina completed a questionnaire assessing IPV and other social, demographic, and health-related variables. Social and demographic correlates of IPV were examined. Adult lifetime prevalence of IPV in Latinas was 19.5%, similar to that of non-Latinas. As compared to Latinas who did not experience IPV and non-Latinas who experienced IPV, Latinas who experienced IPV were more likely to lack social support and to have children in the home. Agencies that provide services to victims of IPV in the rural South need to be prepared to meet the unique needs of Latina immigrants.

The United States leads the world in health care costs but ranks far below many developed countries in health outcomes. Finding ways to narrow this gap remains elusive. This article describes the response of one state to establish community health networks to achieve quality, utilization, and cost objectives for the care of its Medicaid recipients. The program, known as Community Care of North Carolina, is an innovative effort organized and operated by practicing community physicians. In partnership with hospitals, health departments, and departments of social services, these community networks have improved quality and reduced cost since their inception a decade ago. The program is now saving the State of North Carolina at least $160 million annually. A description of this experience and the lessons learned from it can inform others seeking to implement effective systems of care for patients with chronic illness. 1 Despite these high expenditures, the quality of care remains unsatisfactory. For example, only 27% of patients with hypertension have adequate blood pressure control, and only 17% of patients with coronary artery disease have cholesterol at levels suggested by national guidelines. 2 The United States ranks last in preventable deaths among 19 Organization for Economic Cooperation and Development (OECD) countries. 3 One reason for this quality gap is that, although the prevalence of chronic disease is increasing, our health care delivery system is based on a model that is best suited to episodic care for acute illnesses. Optimal delivery of chronic care and preventive services requires restructuring our health care system. In recent years, much research and discussion have focused on how best to adapt our system to chronic care and prevention. For example, the Chronic Care Model lays out several key elements of high-quality care for chronic diseases, including community resources, health care organization, self-management support, delivery system design, decision support, and clinical information systems. 4 More recently the concept of the patient-centered medical home has received widespread attention as a model to improve care. 5 Seven key principles outline the characteristics of the patient-centered medical home: a personal physician, physician-directed medical practice, a whole-person orientation, coordinated care, quality and safety, enhanced access, and a system of payment that refl ects the added value of a patient-centered medical home.Although these models have shown promise in controlled research settings and small demonstration projects, they have been diffi cult to disseminate widely. 6 One problem with implementation of models in indi- 362 CO M MUNI T Y C A R E O F NOR T H C A ROL INAvidual practices is that the current funding structure of health care is based on acute care. When practices are reimbursed on a fee-for-service basis for episodic care, fi nding the resources to redesign a practice, develop systems of care, and implement the elements of these new models of care can ...

A false-positive mammogram that leads to open surgical biopsy does not inhibit most women from undergoing subsequent screening mammography. In fact, such an experience may increase their intentions to undergo regular screening.

Physicians seek connections to their communities. Some health care and academic leaders believe that facilitating the creation of more such community connections is one way to reverse the trend of waning social and political legitimacy for the U.S. medical profession. For academic health centers (AHCs), such connections can maintain local and state support crucial to their long-term success. Multiple barriers exist to such involvement, especially for physicians in AHCs, where work done beyond direct patient care, administration, and research rarely contributes to the tenure and promotion process. The authors present a case study to show how one department in an AHC, beginning in the late 1990s, has been overcoming these barriers to incorporate the scholarship of community engagement into its mission and structure. The case study incorporates theoretical underpinnings to crystallize the following lessons that the department has learned so far: (1) If academic departments wish community service to be a central part of their mission, they need ways to institutionalize community engagement within organizational structures. (2) Community engagement can be scholarly. (3) If faculty members are to be recognized for their service activities, measures are necessary to determine what constitutes "excellence" and "scholarship" in community service. (4) Scholarship of community engagement goes beyond performing service activities in the community.

Community-based education and service learning are becoming increasingly common in health and human services education. As students enter the community, several ethical dilemmas arise regarding the university's interaction with the community. This article explores clinical, agency, and community placements in terms of the relationships they engender between the university and the community. The article then outlines some ethical obligations of universities and faculty members and ethical dilemmas that arise in different placements. Finally, a fundamental ethical framework that may guide universities and faculty members in planning community-based educational experiences is proposed.