ABSTRACT
Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.
Subject(s)
Quality Improvement , HumansABSTRACT
Medical-legal partnerships integrate legal advocates into health care settings to address health-related social needs. However, their effect on health outcomes is unclear. This retrospective cohort study examined the effect of referral to a medical-legal partnership on hospitalization rates among urban, low-income children in Greater Cincinnati, Ohio, between 2012 and 2017. We compared 2,203 children referred to a pediatric primary care-based medical-legal partnership with 100 randomly selected control cohorts drawn from 34,235 children seen concurrently but not referred. We found that the median predicted hospitalization rate for children in the year after referral was 37.9 percent lower if children received the legal intervention than if they did not. We suspect that this decrease in hospitalizations was driven by the ability of legal advocates to address acute legal needs (for example, threat of eviction and public benefit denial) and, when possible, to confront root causes of ill health (for example, unhealthy housing conditions). Interventions such as those provided through a medical-legal partnership may be important components of integrated, value-based service delivery models.
Subject(s)
Poverty , Referral and Consultation , Child , Hospitalization , Humans , Primary Health Care , Retrospective StudiesABSTRACT
BACKGROUND: Clear associations exist between socioeconomic risks and health, and these risks are often amenable to legal interventions. METHODS: This is a case study of an implementation of a medical-legal partnership (MLP) in three pediatric primary care centers that serve a predominantly high-risk population. Referral circumstances and outcomes over the first three years are described. RESULTS: During the three-year study period, 1,808 MLP referrals were made for 1,614 patients by all levels of provider. Those referred were more likely to have asthma (p<.0001) and developmental delay/behavioral disorder (p<.0001) than the general clinic population. Housing (37%) and income/health benefit (33%) problems were the most common reasons for referral. Referrals led to 1,742 (89%) positive legal outcomes affecting nearly 6,000 cohabitating children and adults and translating into nearly $200,000 in recovered back benefits. CONCLUSION: Successful MLP implementation enabled pediatric providers to address social determinants of health potentially improving health and reducing disparities.
Subject(s)
Cooperative Behavior , Lawyers , Pediatrics , Physicians, Primary Care , Child , Child, Preschool , Chronic Disease , Humans , Male , Medically Underserved Area , Ohio , Organizational Case Studies , Outcome Assessment, Health Care , Program Development/methods , Referral and Consultation/statistics & numerical dataABSTRACT
OBJECTIVE: The aim of this study was to examine the effects of a new social determinants of health curriculum on pediatric interns' attitudes, knowledge, documentation, and clinical practice. METHODS: A nonrandomized mixed-methods study of an educational intervention conducted over a 1-year period was performed. The 2008-2009 pediatric interns (intervention group) participated in a new social determinants of health curriculum; prior year interns were controls. An anonymous online survey at the end of internship to both groups (post-tests) and the beginning of internship to the intervention group (pretest) assessed attitudes and knowledge. Documentation from the electronic medical record of social history questions was audited during the same 3-month period in successive years. Medical-legal partnership (MLP) referrals from both groups were compared. RESULTS: Intervention interns (n = 20) were more comfortable discussing issues (100% vs. 71%; P < .01) and felt more knowledgeable regarding issues (100% vs. 64%; P = .005), community resources (94% vs. 29%; P < .001), and housing (39% vs. 6%; P = .04) than control group interns (n = 18). No differences regarding the importance of social hardships or screening for food security or education issues were found. Knowledge was greater in the intervention group post-test in all domains: benefits (72% vs. 52%), housing (48% vs. 21%), and education (52% vs. 33%; P < .001 for all). Intervention interns were more likely to document each issue (benefits 98% vs. 60%, housing 93% vs. 57%, food 74% vs. 56%; P < .001 for all). The intervention group had a slightly higher rate of referral to MLP, although the difference did not reach statistical significance. CONCLUSION: The educational intervention increased interns' comfort and knowledge of social determinants of health and community resources. Documentation of social questions also increased.
