Presenters
- Sarah Hemeida, MD, MPH, Scholar, Farley Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Stephanie Kirchner, MSPH, RD, Director of Practice Transformation, Farley Health Policy Center and Practice Innovation Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Sirikit Benja-Athonsirikul, JD, Attorney, Colorado Legal Services, Denver, Colorado
- Emma Gilchrist, MPH, Deputy Director, Farley Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Shale Wong, MD, MSPH, Executive Director, Farley Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Summary
Background: Medical legal partnerships (MLP) provide legal services in medical settings to address legal needs adversely impacting patients’ health. MLPs help identify unmet legal needs (e.g., housing code violations, threats to personal safety, or access to public benefits) and allow health care providers to address and act upon social determinants impacting and exacerbating health problems. MLPs are particularly beneficial to vulnerable populations for whom addressing social inequities can help achieve higher quality and more equitable health outcomes. Description: The Colorado Tele-Legal Partnership is a 2-year demonstration project to provide free legal services to patients in two urban primary care medical homes with progressive models of integrated care. This pilot is a partnership between an academic policy center, practice transformation team, primary care clinics, and a non-profit legal aid organization. Study design: Telelegal services will be implemented at two primary care practices, with services starting in January 2021 and in June 2021. A social and legal needs screener was developed, pretested among patients, and integrated into the EHR and workflow, using practice transformation techniques with the assistance of clinical champions and iterative staff engagement throughout the workflow development. Primary care providers and staff will participate in health equity and implicit bias training. Patient focus groups aim to solicit feedback and better understand patient trust and satisfaction with the legal services in the context of their personal health goals. Data collection: Partnered with IT teams for EHR adaptation to include screener and accommodate external referrals to legal team, granting EHR access. Monthly queries of patients screened, positive screening results, referrals, and declined services. Patient demographic data are being collected to determine levels of patient needs and rates of successful connection to services. Analysis will include trends among patients who have been missed for screening, and individuals who screen positive and decline services. Patient focus groups will explore these scenarios as well as patient experiences, level of trust with the medical system, improved sense of health equity, mental and physical wellbeing. Key results: The project is in its first year and preliminary findings will be available for the fall conferences. The analytic plan will provide an evaluation framework for MLPs that could be adopted broadly, measuring success in operations, improved patient equity, and demonstration of value. Conclusion: We anticipate that delivery of tele-legal services in two primary care medical homes will have a positive impact on patients and families served. This evaluation will contribute to evidence-based policy recommendations to implement expansion among primary care clinical homes and sustain MLPs, addressing social and legal needs to promote equity for individuals and families.
Objectives
- Describe the types of legal issues addressed in medical-legal partnerships.
- Discuss strategies for implementing new tele-legal services in primary care practices.
- Assess whether MLP services improve health outcomes and reduce health inequities.
