P3.182: A Pilot Study of an Inpatient Community Health Worker Program for Children with Medical Complexity

Background: Community health workers (CHWs) are community members who link patients with social and medical resources to optimize their health. CHWs are a proven resource for social service navigation in the outpatient setting for children with medical complexity (CMC) and in the inpatient setting for children with asthma. Research around CHW programs targeting hospitalized children with medical and social complexity is limited. This pilot study aims to describe the patients enrolled in an inpatient CHW program and how CHWs addressed caregiver needs.

Methods: A retrospective chart review of all patients enrolled in the Pediatric CHW program during their hospitalization on the pediatric hospitalist service at a children’s hospital from 7/1/2020 to 7/17/2023 was conducted. Patients were referred by the hospitalist team if identified as having an unstable medical condition, or one involving multiple subspecialists, in addition to having potential social barriers. Data collected includes demographics, social determinants of health needs from assessment in the electronic health record (EHR), and diagnoses. Diagnoses were categorized based on the Complex Chronic Conditions grouping of the International Classification of Diseases. Data was analyzed using descriptive statistics.

Results: Thirty-six CMC enrolled in the CHW program, the majority of which identified as Hispanic (88%) and whose caregivers required language interpreter use (59%). 54% of patients had a community pediatrician, whereas 46% had an academic pediatrician. The most common primary diagnoses of the enrolled children included neurologic (45%), genetic (18%), and hematologic or immunologic (18%) (Figure 1). Most caregivers (62%) reported high levels of confidence in understanding their child’s health condition and care plan at baseline. Lack of access to transportation was the most common barrier for caregivers to engage with healthcare, care management, and support services (31%) (Figure 2). Food insecurity was uncovered in 44% and housing insecurity in 32% of patients. To address these barriers, CHWs supported 41% of caregivers in preparing for healthcare visits and 56% with appointment navigation. CHWs provided 73% of caregivers with referrals to food resources, 55% with referrals to housing resources, and 32% with referrals to education resources.

Conclusion: This pilot study demonstrates the immense needs that caregivers of CMC have in navigating the complex healthcare system and social services during the vulnerable period of a hospitalization. CHWs are key partners in identifying and addressing these needs; they have the opportunity to improve outcomes by connecting caregivers to support and referrals to social and medical resources.