Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Am J Emerg Med. 2022 Apr;54:323.e1-323.e4. doi: 10.1016/j.ajem.2021.09.071. Epub 2021 Oct 1.
We sought to evaluate a screening and referral program for health-related social needs (HRSN) in our ED. Our goals were to (1) quantify successful screenings prior to and during the initial peak of the pandemic, and (2) describe the HRSNs identified.
We performed an observational analysis of ED-based screening for HRSN in Medicare and Medicaid patients at our large urban safety-net hospital. Screening was performed by patient navigators utilizing the ten question, validated Accountable Health Communities (AHC) Screening Tool, which screens for food insecurity, housing instability, transportation needs and utility assistance and interpersonal safety. Patients who screened positive for HRSN were provided with handouts listing community resources. For patients with two or more self-reported ED visits in the last 12 months and any identified HRSN, ongoing navigation after discharge was provided utilizing community resource referrals. During the pre-pandemic period from November 1, 2019 - January 31, 2020, screening occurred in-person. Screening during the pandemic from March 1, 2020 - May 31, 2020 occurred remotely via telephone. Descriptive statistics including frequency rates and percentages were calculated. Successful screening was defined as completing the screening survey with a navigator and being triaged to either no assistance, resource handouts, or navigation services.
Among the adult and pediatric patients screened for HRSN, 158 (16%) qualified for community resource handouts and 440 (44.4%) qualified for patient navigator services. The proportion of patients receiving both resources and care navigation remained similar in the pre- and post-periods of the study, at 227 (45%) and 213 (43.9%) respectively. However, the proportion of ED patients with a HRSN need doubled from 56 (11.1%) in the pre-period to 102 (21%) in the post-period. Food insecurity was the most identified HRSN in both the pre-pandemic period (27.3%) and during the pandemic (35.8%).
We found that remote HRSN screening for ED patients during the COVID-19 pandemic resulted in similar proportions of successfully completed screenings compared to pre-pandemic efforts. This demonstrates the feasibility of utilizing alternative methods of screening and referral to community resources from the ED, which could facilitate this type of intervention in other EDs. During the pandemic HRSN increased, likely reflecting the economic impact of the pandemic.
我们试图评估我们急诊部（ED）的健康相关社会需求（HRSN）筛查和转介计划。我们的目标是：（1）量化大流行初期之前和期间成功的筛查数量，（2）描述确定的 HRSN。
我们对我们大型城市安全网医院的医疗保险和医疗补助患者进行了基于 ED 的 HRSN 筛查的观察性分析。筛查由患者导航员利用经过验证的负责任健康社区（AHC）筛查工具进行，该工具可筛查食品无保障、住房不稳定、交通需求和公用事业援助以及人际安全。对 HRSN 筛查呈阳性的患者提供了列出社区资源的传单。对于在过去 12 个月内有两次或更多次自我报告的 ED 就诊且有任何确定的 HRSN 的患者，在出院后提供了利用社区资源转介的持续导航。在 2019 年 11 月 1 日至 2020 年 1 月 31 日的大流行前期间，筛查是亲自进行的。2020 年 3 月 1 日至 5 月 31 日大流行期间，通过电话远程进行筛查。计算了频率率和百分比等描述性统计数据。成功筛查定义为与导航员一起完成筛查调查，并被分诊至无需帮助、资源传单或导航服务。
在筛查 HRSN 的成年和儿科患者中，有 158 人（16%）有资格获得社区资源传单，有 440 人（44.4%）有资格获得患者导航服务。在研究的前后两个时期，接受资源和护理导航的患者比例相似，分别为 227 人（45%）和 213 人（43.9%）。然而，ED 患者有 HRSN 需要的比例从大流行前的 56 人（11.1%）增加到大流行后的 102 人（21%）。在大流行前时期（27.3%）和大流行期间（35.8%），食品无保障都是最确定的 HRSN。
我们发现，在 COVID-19 大流行期间，对 ED 患者进行远程 HRSN 筛查与大流行前相比，成功完成筛查的比例相似。这表明可以利用 ED 从社区资源进行替代筛查和转介方法，这可以促进其他 ED 进行此类干预。在大流行期间，HRSN 增加了，可能反映了大流行的经济影响。
