Dr. Doyle CummingsDavis, Breyana D.2025-06-052025-06-052025-05May 2025May 2025http://hdl.handle.net/10342/14016Given the integral role community-based organizations (CBOs) play in connecting individuals to essential resources and services, understanding how CBOs engage with NCCARE360 is essential to enhancing adoption, sustainability, and impact of the platform. This study explored how CBOs in the Piedmont Triad Region use NCCARE360, North Carolina’s statewide coordinated care referral platform, to address food insecurity. A mixed methods approach was used to address the study’s objectives. Focus groups explored the barriers to onboarding and retention that CBOs experience as well as the facilitators that keep CBOs active and engaged with NCCARE360. Aggregated CBO-level referral data from July 2023 – June 2024 was analyzed using logistic and negative binomial regression components to evaluate and interpret trends in referral patterns, workflows, service subtypes, and acceptance rates across CBOs to understand referral success. Training and capacity building and resource constraints were commonly reported onboarding and retention barriers of NCCARE360. Facilitators of onboarding and retention emphasized increased exposure for CBOs and the value of using NCCARE360 to connect patients to resources, improve coordinated care, and strengthen care management. The number of referrals received and accepted increased for certain service types, such as emergency food, food pantries, and prepared meals. County-level differences were also noted, with Alamance County showing significant variations in referral acceptance rates, offering insights for best practices to improve NCCARE360 utilization in other counties. Results indicated that CBOs with consistent referral intake also accepted referrals more effectively, and that different CBOs and service subtypes played a crucial role in improving referral acceptance. Further research is needed to understand the specific challenges lower-performing CBOs face in delivering food security services through NCCARE360.application/pdfDoctoral Dissertation2025-05-22