Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA, USA.
Department of Internal Medicine, Highland Hospital - Alameda Health System, Oakland, CA, USA.
Emerg Med J. 2017 Sep;34(9):599-605. doi: 10.1136/emermed-2015-205662. Epub 2017 Jun 22.
Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a 'medical home' (defined as a consistent, primary source of medical care such as a primary care doctor or clinic).
ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1 and 6 months. Primary outcomes were linkages for the primary identified need and to a medical home within 1 month. Other outcomes at 6 months included whether a patient (1) felt helped; 2) had a decreased number of ED visits; (3) had the primary identified need met; (4) had a primary doctor; and (5) had a change in self-reported health status.
We enrolled 459 subjects (intervention=154, control=305). Housing (41%), employment (23%) and inability to pay bills (22%) were participants' top identified needs. At baseline, 32% reported the ED as their medical home, with the intervention cohort having higher ED utilisation (>1 ED visit in the prior month: 49% vs 24%). At 1 month, 185 (40%) subjects were reached for follow-up, with more HHA subjects linked to a resource (59% vs 37%) and a medical home (92% vs 76%). At 6 months, 75% of subjects felt HHA was helpful and more subjects in the HHA group had a doctor (93% v 69%). No difference was found in ED utilisation, primary need resolution or self-reported health status.
Health-related social needs are common in this US safety net ED. Our help desk is one possible model for addressing social needs.
患者通常因社会需求前往急诊部（ED）。为此，我们创建了 Highland Health Advocates（HHA），这是一个基于 ED 的服务台和医疗法律伙伴关系，利用本科生志愿者帮助患者了解公共资源，并提供现场法律和社会工作转介。我们能够提供英语和西班牙语服务。我们旨在确定向我们 ED 就诊的患者的社会需求，以及该计划在解决这些需求并将他们与“医疗之家”（定义为一致的主要医疗保健来源，如初级保健医生或诊所）相关联方面的潜在影响。
美国安全网医院的 ED 患者以 1:2 的比例参与了一项准实验，将接受 HHA 在有限访问期间的干预与在没有服务台的日子接受常规护理的对照组进行比较。我们收集了基线社会需求评估，并在 1 个月和 6 个月时进行了随访评估。主要结果是在 1 个月内确定的主要需求的联系和医疗之家的联系。6 个月时的其他结果包括患者是否（1）感到有所帮助；（2）就诊 ED 的次数减少；（3）满足主要需求；（4）有主治医生；以及（5）自我报告的健康状况发生变化。
我们共纳入了 459 名患者（干预组 154 名，对照组 305 名）。住房（41%）、就业（23%）和无力支付账单（22%）是参与者最需要的需求。在基线时，32%的患者将 ED 作为他们的医疗之家，干预组的 ED 就诊率更高（过去一个月内就诊超过 1 次：49% vs 24%）。在 1 个月时，185 名（40%）患者接受了随访，HHA 组有更多的患者与资源（59% vs 37%）和医疗之家（92% vs 76%）建立了联系。在 6 个月时，75%的患者认为 HHA 很有帮助，HHA 组有更多的患者有医生（93% v 69%）。ED 就诊次数、主要需求的解决或自我报告的健康状况没有差异。
美国安全网 ED 中常见与健康相关的社会需求。我们的服务台是解决社会需求的一种可能模式。
