Paige Kulie, MPH George Washington Medical Faculty Associates - - PowerPoint PPT Presentation

Paige Kulie, MPH

George Washington Medical Faculty Associates Department of Emergency Medicine June 26, 2018

• Large health inequalities exist within the Medicaid

population, largely due to social determinants of health (SDH)

• Previous pediatric studies found that SDH screening

and referral programs reduce unmet needs, though results are all based on self-report

• No study has yet examined a screening and referral

system in an emergency department

Background

• To measure the medical and social needs of adult

Medicaid beneficiaries during an ED visit and to determine whether referrals to community

• rganizations would result in assistance to address

their unmet needs

Objective

• We prospectively enrolled 505 ED patients with DC

Medicaid at an urban teaching hospital

• We administered a survey on sociodemographic

characteristics, social risk factors, and medical and social resource needs

• We referred subjects to up to three community

agencies using an online social services database to address the top three priority needs

Methods

• Patients referred to at least one agency were called a

month after index ED visit to determine whether they received assistance

• Community agencies reported back on patients who

received services within three months of referral

• Obtained Medicaid claims for one year prior to ED

enrollment and used to calculate Chronic Illness & Disability Payment System (CDPS)

Methods

• To establish the prevalence of various social needs in

the adult DC Medicaid population

• To determine the proportion of patients referred who

contact the referral agency and who ultimately receive a service from the referral agency

• To ascertain whether a referral program improved

patients’ well-being

Primary Outcomes

Results

Distribution of Patient Characteristics by Number of Referrals

Characteristic Overall Number of Referrals To Different Organizations 1 2 3 TOTAL 505 75 89 117 224 Age 18-34 46% 56% 47% 52% 39% 35-44 15% 16% 13% 15% 16% 44-54 21% 19% 13% 14% 29% ≥55 18% 9% 26% 20% 16% Female 69% 72% 75% 76% 61% Employed (full- or part-time) 57% 68% 69% 54% 50% High school diploma and above 82% 91% 83% 78% 82% Has a usual healthcare provider 73% 79% 78% 74% 68% Living in Poor Housing Conditions 40% 12% 16% 26% 25% Depression/Anxiety 53% 20% 34% 65% 65% Currently Smokes 36% 25% 31% 32% 44% Drinks Alcohol Daily 7% 5% 3% 6% 9% Has someone to help in an emotional crisis 82% 92% 88% 82% 72% Living with children 66% 44% 54% 46% 36% Food Insecure 54% 25% 29% 59% 71% Trouble paying bills in past 12 months 50% 16% 38% 55% 63%

Percent of Subjects Who Received Assistance From A Community- Based Organization

Service Agency Number Referred Agency Reported Helping Number Completed Follow Up Reported Receiving Agency Help Housing Counseling Services 344 1% 261 11% Food Pantries 149 5% 112 13% Neighborhood Legal Services 73 1% 57 11% Department of Behavioral Health 65 5% 47 9% AmeriHealth (MCO) 63 14% 50 28% Unity Health Care (FQHC) 113 19% 80 8% Medical transport (AmeriHealth) 16 0% 11 9% Our Door (Wellness Center) 52 0% 40 5% Job Training Program 109 0% 78 10%

• One: contacted agency
• Two: received help
• Variables:
• CDPS Score
• Demographics (age, gender, martial status, children)
• Major activity
• Social (food insecure, housing stability, paying bills, social

support, neighborhood safety)

• Medical (depression, substance abuse, smoking)
• No significant predictors found

Multivariate Logistic Regression Models

• Adult Medicaid patients treated in the ED report a

high prevalence of unmet medical and social needs

• Relatively few patients followed up and received

assistance, regardless of whether measured by self- report or the agency

• Passive referrals may not be effective in addressing

non-emergency social needs for the low-income population

Conclusions

Author/Year Design Intervention Population Results Gottlieb 2016 RCT Navigator –in clinic and up to 3 months post Pediatric primary and urgent care of 2 safety net hospitals (1) Significant decrease in number of social needs in intervention versus control (2) Significant increase in child’s health reported by caregiver Garg, 2015 Cluster RCT Providers identified and research staff made referrals at intervention clinics- RAs also called 1 month post- 8 community health centers, mothers of healthy infants (1) 12 months post-intervention greater enrollment in community service compared to controls (39% vs 24%) Self-reported outcomes (2) 9 month follow-up, intervention more likely to contact an agency than control (65% vs. 49%) Hassan 2015 Cohort Self-administered, web-based screening tool Youth aged 15 – 25 (1) 40% self-reported contacting agency; (2) No difference in problem resolution between those who contacted agency and those who did not Garg 2007 RCT We Care survey and residents made referrals Pediatric clinic, parents of children 2-10 years old (1) 20% of those referred in intervention group reported contacting agency vs 2% in control group 1 month post enrollment – self-report Fleegler 2007 Cohort Asked parents about needs; if they had a need whether anyone in past year had referred them to an agency; if they had, did they contact the agency 2 pediatric clinics, parents of 0-6 year

• lds

(1) 70% of those screened given ≥ 1 referral

Previous Studies