A low-cost program assisting people with social needs: The Health Advocacy Program

As health systems increasingly screen for patients’ social needs, they are being challenged with how to address those needs while controlling costs. Most health systems have social workers and care managers who are able to connect patients to needed resources, however this can become very costly as more patients are identified with these social and economic needs. According to Maslow’s Hierarchy of Needs, basic needs must be satisfied before an individual can achieve full potential. These basic needs impact people’s well-being, serving as impediments to accessing health care and performing healthy behaviors. Often individuals lack self-efficacy in their ability to address their needs and therefore may not obtain the benefits to which they are eligible. The Health Advocacy Program (HAP) trains college students to serve as Health Advocates (HA) in a large health system. HAs perform in-depth social assessments and link clients to services. Among HAP clients, \u3e50% need assistance with housing and/or food, 40% have financial concerns, and \u3e30% need transportation. Clients who need civil legal assistance (30%) are referred to the health system’s medical-legal partnership. Over 450 clients have been referred to HAP and more than 1283 referrals have been made to community resources. HAs follow-up one week after making referrals to determine if needs were satisfied. Number of connections made and satisfaction with those connections are documented. Health outcomes include reductions in average number of emergency department visits (2.07 to 1.87); hospitalizations (1.36 to 1.25) and no-shows for clinic appointments (2.68 to 2.64) measured 6 months prior and 6 months after enrollment in HAP. Other outcome measures include changes in perceived stress and depression. Social needs can be addressed at a low annual cost (\u3c$30,000) by engaging college students as compared with community health workers (\u3e$60,000) or social workers (\u3e$90,000) when wages and benefits are considered. Colleges, health systems, and clinical practices should partner to better address patients’ social needs and limited self-efficacy

Prospective Validation of a Simple Risk Score to Predict Hospitalization during the Omicron Phase of COVID-19.

INTRODUCTION: We previously developed a simple risk score with 3 items (age, patient report of dyspnea, and any relevant comorbidity), and in this report validate it in a prospective sample of patients, stratified by vaccination status. METHODS: Data were abstracted from a structured electronic health record of primary care and urgent care 8 patients with COVID-19 in the Lehigh Valley Health Network from 11/21/2021 and 10/31/2022 9 (Omicron variant). Our previously derived risk score was calculated for each of 19,456 patients, 10 and the likelihood of hospitalization was determined. Area under the ROC curve was calculated. RESULTS: We were able to place 13,239 patients (68%) in a low-risk group with only a 0.16% risk of 13 hospitalization. The moderate risk group with 5622 patients had a 2.2% risk of hospitalization 14 and might benefit from close outpatient follow-up, whereas the high-risk group with only 574 15 patients (2.9% of all patients) had an 8.9% risk of hospitalization and may require further 16 evaluation. Area under the curve was 0.844. DISCUSSION: We prospectively validated a simple risk score for primary and urgent care patients with COVID1919 that can support outpatient triage decisions around COVID-19