When the COVID-19 pandemic began to hit Brooklyn, N.Y., in March, association member SUNY Downstate Health Sciences University canceled in-person clinical rotations, leaving medical students with time on their hands and a desire to act.
“When coronavirus really broke, I knew I had to do something,” one student wrote. “I couldn’t just sit on my hands while I was supposed to be studying for [United States Medical Licensing Examinations], watching the news as the death counts continued to rise.”
The medical school’s neighborhood of East Flatbush, Brooklyn, was among the hardest hit by COVID-19. Trends in hospitalizations and mortality rates highlighted striking health disparities and unmet social needs. To survey and meet those needs, SUNY students and faculty designed a social determinants of health (SDOH) screening tool tailored to the needs of Central Brooklyn patients at four of the health system’s ambulatory care clinics.
Based on the National Association of Community Health Centers’ Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool and the Centers for Medicare & Medicaid Services Accountable Health Communities screening tool, the SUNY tool surveyed patients about COVID-19 symptoms, living situations, chronic conditions, medication needs, food security, economic needs, and child care requirements.
“The students are the brains behind this,” says Crystal Marquez, MD, a faculty member in the Family and Community Medicine Department at SUNY Downstate Health Sciences University. “They’re the ones who did all the work.”
Students developed a patient spreadsheet and phone call script with an algorithm that directed callers to ask follow-up questions or refer patients to resources based on their responses. Community partners included Mutual Aid Flatbush; Equality for Flatbush’s Mutual Aid Project; CAMBA Inc., which operates an emergency food pantry and shelters and provides family, economic, and legal services; and God’s Love We Deliver, which delivers food to individuals with chronic conditions.
Students also helped patients file for unemployment; search for jobs; register for the Supplemental Nutrition Assistance Program; and access needs like free Wi-Fi, diapers, and formula. When patients reported loneliness or mental health needs, students offered check-in phone calls and, when necessary, contacted the patient’s primary care provider and a social worker for follow-up.
“During this time, a lot of patients found it difficult to get ahold of our office. Since patients were being talked with on a regular basis, or called on a regular basis, they found it very nice to go through students,” Marquez says. “They were able to get refills on their medications that maybe they wouldn’t have been able to get if the students didn’t call them … One student helped a mother get diapers … Some people stayed on the phone for two hours with patients and went through the unemployment website or food stamp website to be able to get all that done.”
While some students were volunteers, others enrolled in a family medicine and telemedicine elective. Each week, these students completed 12 hours of patient outreach, read and analyzed research studies focused on SDOH, and participated in a reflection session.
“This experience has humbled me, made me realize my privilege, and challenged me to continue to contribute to this cause as much as I can,” one student wrote.
“Telehealth is not something I am immediately drawn to,” wrote another. “But being able to connect with patients, many of whom are scared, many of whom do not know exactly what to do if they indeed do start to feel sick, many of whom do not have access to resources such as food and medicine, is uplifting.”
In the program’s first eight weeks, 29 students called 1,408 patients and completed 761 surveys, with 420 calls resulting in at least one positive trigger identified. The calls resulted in:
- 32 social work referrals;
- 185 medication refill requests;
- 154 appointment requests within the family medicine department;
- 67 appointment requests with other departments;
- 94 referrals to food insecurity resources;
- 44 referrals to housing instability resources;
- 80 referrals to resources for inability to pay bills;
- 10 referrals to resources for baby diapers or formula; and
- 18 referrals to resources for social isolation.
Program results were published in “Integrating Social Determinants of Health Into Clinical Training During the COVID-19 Pandemic” and the companion article “Medical Students Screen for Social Determinants of Health: A Service Learning Model to Improve Health Equity” in PRiMER: Peer-Reviewed Reports in Medical Education Research. SUNY also integrated the needs assessment into its women’s health clerkship curriculum and prenatal care plans.
While students resumed clinical rotations and ended the family medicine elective in July, Marquez and her team now are training volunteers and work-study students to conduct six-month follow-up calls with the patients the program originally surveyed, as well as reach out to patients who were never contacted. Her ultimate goal is to create a program linking medical students to ambulatory clinic patients, in which the students would follow the patients for four years, provide SDOH resources, and improve patient satisfaction.
How is your hospital targeting SDOH during the COVID-19 pandemic? Share your story at firstname.lastname@example.org.