Abstracts

Rationale: About 3 million U.S. adults live with current or active epilepsy. Despite advances in treatment, people with epilepsy face many barriers accessing different types of health care and community-based services that result in significant disparities in health and social outcomes. People with epilepsy are more likely to report cost as a barrier to care; higher levels of fair or poor health; social participation limitations, and reduced life opportunities. People with epilepsy face the added burden of comorbidity and unique challenges associated with stigma and transportation restrictions. The 2012 IOM Report on Epilepsy noted nontraditional health providers, including CHWs offer untapped opportunities for improving outcomes in epilepsy, specifically to address SDOH and bridge the gap between communities and health care teams.

Methods: A CHW was recruited, trained and integrated into the adult outpatient Neurology clinic at Dartmouth-Hitchcock Medical Center (DHMC) to address the SDOH needs of patients living with neurologic disease.  Five subspecialty (Epilepsy, Movement Disorders, Memory, Headache, Stroke) and a general neurology clinic were included in CHW integration. A validated Dartmouth Population Health SDoH screener was presented to patients on a tablet in the outpatient clinic setting or via DHMC patient portal for telehealth visits. Positive screens from patients who indicated they wished to involve a CHW in their care were directly forwarded to the clinic CHW via the EMR. CHW outreach to address SDoH needs and track progress was recorded securely in REDCap.  

Results: In total the number of patients assigned SDoH screeners was 2650 during the period from November 1, 2021, through May 31, 2022. About 31% (n=826) of screeners were returned completed with 13.1% screening positive for patients from all neurology clinics (n=6). In non-epilepsy clinics (movement disorders, stroke, memory, headache, general) positive screens were returned in 12% of patients compared to a positive screen rate of 32% for epilepsy clinic patients. In epilepsy clinic patients who were identified (32%) to have SDOH need by screening, plus via direct provider referral to CHW (6%), SDoH needs that were most frequently seen were transportation (25%), financial assistance (18%), and behavioral health (14%). Among epilepsy patients, 51.8% had their needs met with median time from intake to complete being 13 days (range same day to 27 days), with more complex needs like housing requiring ongoing assistance from the CHW.

Conclusions: The integration of a trained CHW in a neurology clinic setting provides opportunity to systematically screen patients for SDoH utilizing the EMR to facilitate screener dissemination. Epilepsy patients screened positively for SDoH needs three times more frequently when compared to a cohort of patients seen in the general neurology or other subspecialty clinics. The ability for a CHW to address needs has thus far proven to be effective and efficient. _x000D_
Funding: Harvard Pilgrim Health Care QI15602