A HOSPITAL-BASED COMMUNITY HEALTH WORKER PILOT PROGRAM FOR THE LATINX COMMUNITY DURING THE COVID-19 PANDEMIC

ABSTRACT

STATEMENT OF PROBLEM/QUESTION Despite accounting for only 34% of the population in Austin, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized patients, 40% had never seen a primary care physician (PCP), had high rates of previously undiagnosed health conditions and significant health-related social needs (HRSNs). DESCRIPTION OF PROGRAM/INTERVENTION We implemented an interdisciplinary pilot program at a local academic teaching hospital to improve community outcomes and address HRSNs. The intervention is led by a bilingual community health worker (CHW), and includes discharge follow-up with patients hospitalized with COVID-19. As the pandemic ebbed and flowed across multiple surges, we expanded the intervention to Latinx patients with other complex health conditions. The full sample was included in the analysis. MEASURES OF SUCCESS This is a mixed-method evaluation, which includes quantitative patient data (n=96), as well as qualitative data from hospital-based, healthcare professionals (n=26) that collaborated with the CHW. Quantitative data includes patient demographics (age, gender, race, education & insurance), HRSNs, community referrals and primary care followup. Qualitative data was collected via focus groups with case managers, hospitalists, residents and palliative care team members. Focus groups were approximately 60 minutes long, and we used content analysis to identify themes. FINDINGS TO DATE The majority of patients were hospitalized for COVID-19 (n= 67, 70%) while the rest were diagnosed with other acute conditions. Average length of stay (LOS) was 13.8 days and the median LOS was 8 days. Mean age was 50.6 years, 66% of patients were male and 79% spoke Spanish. Half of the patients had less than a high school education, while 20% had more than a high school education. One-third of patients were employed while the rest were either seeking employment (16%) or nonworking (50%). The majority of patients were either uninsured (42%) or had county-based health coverage for the uninsured (30%). The top HRSNs included food (47%), rental assistance (36%) and utility assistance (36%). Almost half of patients attended a follow up with a PCP. Initial qualitative themes fall into three categories 1) the role of a CHW, 2) the benefits of a CHW in the hospital and 3) growth opportunities. KEY LESSONS FOR DISSEMINATION This pilot program demonstrated the capacity for CHWs to raise the hospital scope of care, particularly within the context of COVID-19. CHWs are experts in assessing and addressing HRSNs and can provide complementary services to inpatient care teams. CHWs provide culturally appropriate, transitional care to patients with chronic illnesses, which directly addresses the socioeconomic barriers to receiving continuity of care. Additional and diverse funding mechanism are needed to expand the presence of CHWs in hospital settings and increase the capacity to serve more patients.