For my health policy MPH capstone, I wrote a 10-page memo describing policy options for preserving rural obstetric services in North Carolina. Options were moving to a patient-centered payment model for rural hospitals, increasing Medicaid fees for bundled obstetric services, and providing financial incentives for physicians to obtain additional obstetrics training. I recommended the patient-centered payment model, which is a model proposed by the Center for Healthcare Quality and Payment Reform in which hospitals receive funds based on the number of providers needed to serve the number of residents in their service area as well as service-based fees. I calculated these standby capacity fees by using state population data, Dartmouth Health Atlas Health Service Areas, and physician and nurse salaries from the Bureau of Labor Statistics and adjusting for what proportion of these costs would be paid by Medicaid. To estimate how many more births would occur in rural hospitals under this model, I used births at hospitals enrolled in the Pennsylvania Rural Health Model as a comparison.

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While working at the Social Mission Alliance based at GW's Fitzhugh Mullan Institute for Health Workforce Equity, I developed a resource repository for health professions schools to implement the social mission. The social mission is a series of objectives relating to health equity and equity within health professions schools and the health workforce. I compiled peer-reviewed and gray literature as well as public-facing websites to find evidence supporting specific policies or practices; real-world examples of schools implementing the social mission; and tools for schools to conduct community needs assessments, develop mission statements, alter their admissions practices and more. I presented an overview of common themes in the library at the 2024 Social Mission Alliance conference as well as demonstrated the functionality to conference attendees.

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In May 2022, I began collecting and analyzing data on social determinants of health to guide Duke Health's approach to addressing health-related social needs in its primary service area: Alamance, Durham, Granville, Orange, Person, Wake, and Vance Counties in North Carolina. I pulled data from local sources such as county databases, Durham Neighborhood Compass and the State Center for Health Statistics, as well as national sources such as the Centers for Disease Control and Prevention and the U.S. Census Bureau. This data was maintained in an Excel spreadsheet where I also performed calculations, such as correlations between smoking and poor mental or physical health days. I combined geographic shapefiles with data files to produce Tableau visualizations of local trends, including Social Vulnerability Indices. I produced a preliminary written report and later a full presentation on my findings. I eventually shifted to a consulting role in which I reviewed practices at other health systems related to housing, faith communities, food security and community engagement to guide Duke's practices.

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While working on a literature review about musculoskeletal health with the Duke-Margolis Center for Health Policy, I considered how occupation could contribute to musculoskeletal disorders and injury. This led me to consider farmworkers, who are often subject to injury and are generally an underserved population. I would eventually develop an independent study looking at care utilization by farmworkers, particularly telehealth. This independent study was supported by the Duke Global Health Institute and the Duke-Margolis Center. After an initial literature review, I drafted a blog post summarizing my findings that would eventually evolve into a Health Affairs Forefront piece. Initial results were also presented at a 2022 Margolis Seminar. Eventually, I decided to pursue a full thesis examining policies that fostered access to care and telehealth utilization. I defended my thesis in April 2023 and later presented the findings at the 2023 North Carolina Public Health Association Fall Educational Conference.

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Global health majors at Duke University were required to complete a team-based capstone project with a community partner in their senior year. My group worked with HeartWorks, Inc., a nonprofit providing after school activities and psychological support for students in Bayboro, North Carolina. We developed a prototype mental health screening questionnaire for the students using questions from validated pediatric instruments. I completed the literature review on validated tools and identified questions for the questionnaire in consultation with my team and HeartWorks leadership. We also completed a site visit and identified grants for HeartWorks to apply for. My team was awarded the 2022-2023 Outstanding Capstone Award.

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While interning at The Charlotte Observer in 2022, I looked into the accuracy of provider directories offered by insurance companies. I manually verified about 50 listings in Blue Cross and Blue Shield's directory; spoke with the insurance company, researchers, providers and residents; and requested complaints from the N.C. Department of Insurance to show the scope of the issue. The results from my initial report were presented at the 2022 Duke-Margolis student and staff retreat. See more about this work on my writing page.

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As a summer 2021 Duke-Margolis intern, I worked with the Exploring Equitable Access to Care and Outcomes Using Telehealth in the Transition to Medicaid Managed Care team. I conducted a literature review on the use of telehealth for musculoskeletal conditions and for Medicaid beneficiaries in preparation for a series of quantitative and qualitative studies on telehealth use among North Carolina Medicaid beneficiaries during the COVID-19 pandemic. The findings from that literature review and future steps were presented at the end-of-summer symposium. I also identified potential stakeholders and drafted an IRB protocol for stakeholder engagement in collaboration with other interns. I co-authored "Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions: Insights From the COVID-19 Pandemic", published in Medical Care in November 2023. During the internship I also wrote a data brief to submit to NC Medicaid.

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In spring 2021, I was part of a Revaluing Care in the Global Economy team that developed policy recommendations for COVID-19 vaccine distribution from a feminist perspective based on historical case studies. I reviewed journal articles, websites, and government documents in English and Spanish to chronicle vaccine distribution during the 2009-2010 H1N1 pandemic, particularly for pregnant women. I also maintained a spreadsheet with a comprehensive timeline of Mexico's pandemic response.

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As part of the Medical Cognition Lab, I reviewed prescription drug ads to understand how the presentation of information impacted viewer comprehension. This involved writing summaries of each advertisement watched and maintaining a spreadsheet with information about drug side effects and how they were presented in the ad. In summer 2020, I completed a practicum in which I reviewed previous research on drug ads and wrote a report on the use of "explicit" and "implicit" language. I requested funding from Duke's Undergraduate Research Support office to support the development of an experiment in which participants would view ads with pre-determined amounts of explicit or implicit language and perform recall tasks.

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