High touch, high trust: Using community health advocates and lawyers to address ED high utilizers

ElsevierVolume 60, October 2022, Pages 171-176The American Journal of Emergency MedicineHighlights•

Why is this topic important? ED high utilizers represent a costly group of individuals who are often high have social needs that prevent them from caring for themselves and address their medical needs.

What does this study attempt to show? Partnering with community health advocates and legal services can be beneficial to the system in reducing costs and to the patient in addressing their social needs.

What are the key findings? While ED, admission and total costs did not differ significantly overall, costs were lower in those who had less ED visits in the pre-enrollment period and many social needs were addressed but not fully mitigated or resolved.

How is patient care impacted? Hospitals can benefit from partnering with community health advocates and legal services in addressing many social needs that prevent patients from addressing their medical needs.

AbstractBackground

Emergency department (ED) high utilizers are a costly group of patients due to their higher utilzation of acute care costs. At a safety-net hospital, we enrolled patients in a program which partnered with lawyers and community health advocates (CHAs) to navigate patients' social, medical and legal needs. Our aim was to decrease costs and utilization and address the patient's social determinants of heath (SDOH).

Methods

We enrolled patients with 4 or more ED visits in the prior 6 months and gave them SDOH and medical questionnaires. Patients were followed for 6 months on a weekly, then bi-monthly basis. All utilization and cost data were obtained through an internal data warehouse and evaluated using a pre-post analysis and broken down into quartiles.

Results

ED, admission, and total costs did not differ significantly between the 12 months pre-enrollment and the 12 months post-enrollment. Outpatient costs did increase ($2182 increase, p < 0.005). ED visits declined significantly in the post-enrollment period (IRR = 0.84, p = 0.048), with the highest impact on those with <7 ED visits. Total admissions did not decline (IRR 0.84, p = 0.059). But, among those with 4 or 5 ED visits, admission costs and visits decreased. On average, six SDOH issues were identified. Of these, approximately 30.3% were mitigated with up to 17% requiring legal help.

Conclusion

While outpatient costs did increase, total costs did not decrease in this program. This type of non-clinical intervention may be best served for patients who are less clinically complex but significant social needs.

Keywords

Social determinants of health

Legal intervention

Homelessness

Cost challenge

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