Background: In the acute care environment, healthcare workers interface with patients who have limited access to medical care and a high prevalence of social determinants of health (SDoH) barriers.1 The inpatient setting presents a key intervention point where the social needs of vulnerable populations might be addressed. Standard inpatient medicine care teams, however, lack the time and expertise needed to address complex social needs. Community Health Workers (CHW), defined as “frontline public health worker[s] who [are] trusted member[s] of and/or [have] an unusually close understanding of the community served,”3 have been shown to positively impact SDoH barriers in multiple settings.2-5Sidney Kimmel Medical College offers a unique learning experience in which CHWs precept pre-clerkship medical students as they screen patients for SDoH barriers, affording students the opportunity of early patient interaction. CHWs then connect patients with positive screens to needed resources, thus benefiting learners and patients. This course has traditionally been offered in the Ambulatory or Emergency Department setting. In August 2021, Thomas Jefferson University Hospital’s Hospital Medicine (HM) Division partnered with this program.

Purpose: By extending the student experience to the inpatient setting and integrating a CHW into an interprofessional unit-based care team, our purpose was to better characterize and address the SDoH barriers in the HM patient population. We also explored whether there was a difference between the prevalence of SDoH barriers identified by administering a screening questionnaire versus those identified by providers who referred patients to the CHW.

Description: A CHW was incorporated into an inpatient HM unit’s interprofessional care team in August 2021. Students joined in September 2021. Early integration priorities included role clarification between CHWs, social workers, and case managers; operationalizing processes related to unit-based SDoH screening versus direct referrals from care teams; and developing a data collection strategy. If patients were found to have significant SDoH barriers within their scope, CHWs addressed these during hospitalization, and followed up after discharge if necessary.Of 419 patients on HM services screened based on unit from September 2021 to July 2022, 156 patients (37.2%) screened positive for at least one SDoH barrier. 97 additional patients were directly referred by care team members during this time. 91 patients (93.8%) screened positive for at least one SDoH barrier. Comparing these two groups, we found an increased prevalence of utility and food insecurity barriers in the unit-based screening group and an increased prevalence of housing insecurity in the direct referral group (Figure 1).

Conclusions: This partnership demonstrates the feasibility of incorporating CHWs in the inpatient setting by leveraging existing interprofessional structures and processes. It also confirmed the high prevalence of SDoH barriers in our hospitalized patient population and suggests that a screening program may identify SDoH barriers not identified by traditional care teams. Finally, it indicated that CHW integration may be a mechanism to address SDoH barriers identified in this environment. For next steps, we are working to improve the partnership with social work, expand the screening process to other units, and focus on housing issues and lack of primary care which were highly prevalent in this patient population.

IMAGE 1: Figure 1. Prevalence of Social Determinants of Health Barriers from Unit-Based Student screenings versus Care Team Direct Referrals from September 2021 to July 2022