Abstracts

Rationale:
People with epilepsy face cognitive impairment, complex medication regimens, lifestyle adjustments, symptom management, emotional struggles, co-morbid depression, disability, under- or unemployment, limited access to transportation, and stigma (1). Dartmouth-Hitchcock Health is a health system that serves a rural patient population in Northern New England. Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH is the only Level 4 epilepsy center north of Boston. To address the complex medical, psychosocial, and economic challenges faced by our epilepsy patients, the DHMC Epilepsy Center developed a pilot project to assess the feasibility and impact of integrating a community health worker (CHW) into the epilepsy care team to help patients address social determinants of health (SDOH).
Method:
The CHW was trained using the CDC Community Health Worker’s Training Curriculum for Epilepsy Self-Management. The CHW worked with patients 1:1 to address SDOH by setting individualized goals to improve transportation access, reduce food insecurity, address insurance problems, connect with behavioral health services, identify employment opportunities, and more. The evidence-based Pathways Community HUB was used for standardized data collection and completion time points. Patients were eligible for this intervention if they were an adult DHMC epilepsy patient and expressed one or more needs related to SDOH. Providers, associate providers, and other clinic staff were educated on the role of the CHW and how to make appropriate referrals Data collected includes number and types of SDOH pathways initiated, referral sources, open and closure dates, and patient demographics.
Results:
From August 2019 to March 31, 2020, 53 patients were referred and a total of 24 patients completed the program (the remaining 29 patients are still actively working with the CHW). Patients were 52.8% female and 69.8% were unemployed. 56.6% of patients were single, and the average age was 47.4 years. Most patients (73.5%) were enrolled in some form of public insurance (Medicaid and/or Medicare). RNs in the epilepsy clinic initiated the majority of referrals (47.2%); 28.3% of referrals were from APRNs, 13.2% from epileptologists, and the rest (11.3%) from a combination of secretaries, research staff, and family members of patients. A total of 66 SDOH pathways were opened by the cohort. The most frequent patient needs were transportation (34.8%), health insurance (16.7%), and financial assistance (16.7%). The average time from initiation to closure for these pathways was: 64.5 days, 61 days, and 119.8 days, respectively.
Conclusion:
This project demonstrated the feasibility of a CHW working with epilepsy patients. Clinic staff have recognized the benefits of the program, as evidenced by the number of referrals in a short time frame. More data is needed to determine long-term effectiveness of the program in reducing SDOH. Future directions for this project include implementing a standardized screening tool to automatically identify and refer patients who screen positive for SDOH, and making the program sustainable by identifying a permanent funding source. References:   •Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64-78. Epub 2002/01/31. doi: 10.1377/hlthaff.20.6.64. PubMed PMID: 11816692.
Funding:
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Funding:
was provided by Harvard Pilgrim Health's Quality Grants Program.