Spotlight on Research at COPH – Medical care expenditures are highly concentrated in the U.S. with 5% of the population responsible for nearly half of all health care expenses. Patients with high medical utilization often have frequent emergency department visits. There is an increasing interest in studying the characteristics and underlying needs of the frequent users of emergency department (ED) to help understand the causes of poor health and high utilization. Research shows that these patients may have complex health-harming needs that cannot be addressed by medical services alone, especially for those low-income population. Research shows that low-income persons each have one to three unmet social or civil legal needs. Unaddressed social and legal needs can create barriers for patients to seek appropriate medical care, lower patient compliance with medical treatments or medication regimens, and exacerbate symptoms of their illness. A holistic approach to health care is needed to address factors that affect health care utilization beyond the hospital walls. Medical-Legal Partnerships (MLP) take a multidisciplinary approach in a clinical setting to address the social and legal problems intertwined with patient health by providing access to social workers and attorneys to resolve unmet needs. Studies are needed to understand whether the innovative MLP model offers a solution to address the causes of high utilization and poor health of these ED patients.
Dr. Hongmei Wang has recently received funding from Robert Wood Johnson Foundation Evidence for Action grant mechanism to conduct a three-year study to examine the causes of high medical expenditure of the frequent users of emergency department and the impact of assessing and addressing patients’ unmet needs by providing integrated services through MLP. Dr. Hongmei Wang is a health economist and an assistant professor in the College of Public Health (CoPH) Department of Health Services Research and Administration. Her research interests include socioeconomic determinants of health and health-related behaviors, obesity and cancer prevention in particular. Dr. Wang also conducts evaluation and economic analysis of medical care and policy intervention programs. The interdisciplinary research team includes co-investigators Dr. Li-Wu Chen and Dr. Jiangtao Luo from UNMC CoPH, Ann Mangiameli from Legal Aid of Nebraska, and Dr. Kerry Rodabaugh from Nebraska Medicine and support research staff from all three organizations. Building upon the established Nebraska Medicine MLP, a collaboration between Legal Aid of Nebraska’s Health Education and Law Project and Nebraska Medicine, the study will examine whether providing integrated services to address the unmet needs of the ED patients will help increase access to care, reduce unnecessary utilization of ED, reduce costs, and improve health outcomes.
Dr. Wang’s research team is currently working on recruiting participants for the study in Nebraska Medicine and will continue the work for the next three years. The study will assess patients’ unmet needs which include issues related to income and public benefits, housing and utilities, education and employment, personal and family stability. This study will be the first to use rigorous research design to examine the effects of addressing patients’ needs through MLP. The study results will help establish ways to meet the needs of vulnerable populations and reduce unnecessary medical care utilization and expenditure by addressing the causes of poor health. The study findings will provide evidence for a holistic and interdisciplinary approach to alleviate inequality in health and health care for underserved and low-income patients, strengthen the integration of health services and systems, and make health a shared value in the community.
This article was written by Hongmei Wang, Ph.D., Assistant Professor, Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center.