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Addressing Social Determinants of Health Through Mobile Medical Van in Miami-Dade, County

CP39 - Addressing Social Determinants of Health Through Mobile Medical Van in Miami-Dade, County

Poster Type: Innovation

Category: Social Determinants of Health

Issue or Challenge: The purpose of the Mobile Medical Van (MMV) is to improve access to early, comprehensive primary care services among South Florida’s most vulnerable populations by addressing social determinants of health (SDOH) including transportation, food insecurity, housing, insurance coverage and other barriers that contribute to health inequities. Though Miami-Dade County has nearly 20% of all individuals below the federal poverty line, people experiencing homelessness and those living in public housing have even greater needs. Community Health of South Florida’s (CHI) MMV initiative was designed to serve these populations through comprehensive primary and behavioral health care and by addressing SDOH.

Description of Innovation: The mobile medical van (MMV) is the only comprehensive full-service mobile clinic in the area serving the population (public housing, early childcare centers and homeless encampments) through a lens of addressing social determinants of health through a care management model. The MMV provides full-service primary care and behavioral health services, an SDOH assessment integrating the PRAPARE Assessment tool, laboratory services, immunizations, cancer and STD screening, EKG, telehealth (to link with other providers), support with insurance, linkages to community resources and support with accessing public benefits. The van operates in close partnership with community organizations and the public housing authority. MMV patients become part of the CHI network and have access to all CHI support services, as appropriate, including referrals for ongoing care, comprehensive disease management and care reminders. Comprehensive evaluation of the MMV supports a deeper understanding of SDOH among this population and how addressing SDOH at the point-of-care can lead to improvement in core clinical measures. The MMV population is regularly assessed for SDOH, support follow-through and UDS clinical quality measures.

Impact or Result: We assessed results from the first eight months of MMV implementation, which took place at the height of COVID-19 cases in South Florida (July to February, 2021.) Overall, 178 people received care at MMV and were assessed for SDOH. In terms of SDOH, 48% of our patients indicated they had one or more barriers to care including transportation (21%), housing stability (19%) and food insecurity (15%). Over 49% of clients reported that if the MMV was not available, they would have gone to an urgent care or emergency department, and 25% said they would have remained sick and not received healthcare. In terms of clinical measures, data suggests that MMV clients have poorer diabetes control (48%) and cervical cancer screening (50%), but higher 1st trimester entry into prenatal care (100%), screening for depression (79%) and statin therapy for prevention of CVD (85%), compared to the 2030 HRSA target.

Replicating this Innovation: MMVs can be adapted by other Health Centers and clinical settings, provided they have community need and sufficient funding for staffing and sustainability. It is important to recognize the role of building trust within the communities and to use the skills of trained outreach workers to reinforce linkages within, and across, clinical and social service settings. MMVs can reach the vulnerable populations by delivering health services curbside in communities of need and addressing not just medical and behavioral health conditions but also SDOH at the community level.

Author(s):

Tony Amofah, MD, MBA, FACP, Chief Medical Officer, Community Health of South Florida, Inc.

Peter Wood, VP Planning and Government Affairs, Community Health of South Florida, Inc

Eunice Hines, MPH, CCHW, CHC, Director for Migrant Health & Outreach Services, Community Health of South Florida, Inc

Rachna Patel, OMS_IV, MPH candidate, Nova Southeastern University - KPCOM MPH program

Nicole Cook, PhD, MPA, Associate Professor, OCHIN