CP31 - Improving Health Outcomes in Vulnerable Populations: The Medical-Legal-Partnership Colorados (MLP-CO’s) Experience
Poster Type: Innovation
Category: Patient and Community Engagement; Social Determinants of Health
Issue or Challenge: Social determinants of health(SDH) may have a greater effect on health outcomes than medical interventions, yet healthcare providers are not adequately equipped to address them. Medical legal partnerships (MLPs) add legal professionals, trained specifically to tackle these issues, to the healthcare team. The latest reviews of the evidence document how the MLP addresses the quadruple aim (patient and provider experience, costs, health outcomes). However, evaluations on health outcomes and healthcare utilization remain scarce hampering the wide adoption of this strategy. We describe the pre and post evaluation of the MLP-CO’s impact on health outcomes, healthcare utilization, legal needs and satisfaction.
Description of Innovation: Unlike other civil legal aid organizations MLP Colorado operates on-site and in coordination with Salud Family Health Center in Commerce City, CO. Under this fully-integrated model, MLP attorneys act as one piece of the care team alongside services like primary care, behavioral health, dental, pharmacy, and care management. Patients are then screened by the MLP-CO lawyers for I-HELP legal needs (Income, Housing, Employment, Legal status, Personal needs). Clients with needs other than I-HELP are referred to local organizations providing legal aid. From 2015-2020, the MLP-CO completed 223 legal cases while 185 cases remained open (average 68 clients/year). Since its inception, evaluation of health outcomes and healthcare utilization (especially emergency department visits) of the MLP-CO clients was a priority. Upon MLP-CO enrollment (BASELINE), clients are assessed for: 1)overall mental and physical health, using validated questions from SF-36; 2)healthcare utilization; 3)legal needs. Six months post-enrollment (FOLLOW-UP), clients are contacted by phone to assess the same items, as well as satisfaction with MLP-CO services, and perception of the MLP-CO’s impact on their healthcare experience. Interviews were conducted in the client’s preferred language.
Impact or Result: Overall, 115 clients (115/193, 59.6%) responded the surveys. Most were low-income women. Reasons for legal assistance were: immigration status(48.7%), income/benefits(28.7%), personal/family stability(16.7%), housing(5.3%), and education(0.7%). Legal success rate was 84.5%. Over 86% of clients reported that their lawyer explained well, listened carefully, treated them with respect and spent enough time with them, and rated their lawyer as 4-5 (scale 0-5, 5=best lawyer).Sixty-nine (69/193, 35.7%) clients had complete data on health outcomes at the BASELINE and FOLLOW-UP periods to allow a paired analysis (Table).Days with poor physical/mental health in the past month, as well as in feelings of stress and worry in the past 2 weeks improved significantly. Self-reported overall health and days with no usual activities due to poor physical or mental health in the past month also improved, albeit not significantly. Missed appointments reduced significantly. There were also reductions, albeit not significant, in the emergency department.
Replicating this Innovation: According to data from the National Center for Medical Legal Partnerships, MLPs have expanded across the nation, with programs in 450 health centers and hospitals, which has increased by over 100 locations from 2019.
Marc Scanlon, JD, Executive Direct, Salud Family Health Centers