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The Highland Health Advocates: a preliminary evaluation of a novel programme addressing the social needs of emergency department patients
  1. Lia Ilona Losonczy1,
  2. Dennis Hsieh1,
  3. Michael Wang2,
  4. Christopher Hahn1,
  5. Tarak Trivedi1,
  6. Marcela Rodriguez1,
  7. Jahan Fahimi3,
  8. Harrison Alter1
  1. 1 Department of Emergency Medicine, Highland Hospital – Alameda Health System, Oakland, CA, USA
  2. 2 Department of Internal Medicine, Highland Hospital – Alameda Health System, Oakland, CA, USA
  3. 3 Department of Emergency Medicine, University of California at San Francisco, San Francisco, CA, USA
  1. Correspondence to Dr Lia Ilona Losonczy, Department of Emergency Medicine, Highland Hospital – Alameda Health System, 1411 E. 31st Street Oakland, CA 94602, United States; lia.losonczy{at}


Objectives Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a ‘medical home’ (defined as a consistent, primary source of medical care such as a primary care doctor or clinic).

Methods ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1 and 6 months. Primary outcomes were linkages for the primary identified need and to a medical home within 1 month. Other outcomes at 6 months included whether a patient (1) felt helped; 2) had a decreased number of ED visits; (3) had the primary identified need met; (4) had a primary doctor; and (5) had a change in self-reported health status.

Results We enrolled 459 subjects (intervention=154, control=305). Housing (41%), employment (23%) and inability to pay bills (22%) were participants’ top identified needs. At baseline, 32% reported the ED as their medical home, with the intervention cohort having higher ED utilisation (>1 ED visit in the prior month: 49% vs 24%). At 1 month, 185 (40%) subjects were reached for follow-up, with more HHA subjects linked to a resource (59% vs 37%) and a medical home (92% vs 76%). At 6 months, 75% of subjects felt HHA was helpful and more subjects in the HHA group had a doctor (93% v 69%). No difference was found in ED utilisation, primary need resolution or self-reported health status.

Conclusions Health-related social needs are common in this US safety net ED. Our help desk is one possible model for addressing social needs.

  • Access to Care
  • Emergency Department Utilization
  • Law
  • Medico-Legal
  • Patient Support

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  • Contributors Each author made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; LL, DH, CH and HA conceived the study, designed the tria, and obtained research funding. MR collected data. LL, TT, MW, JF and HA provided statistical advice on study design and analysed the data; LL, DH, CH, MR, TT, JF and HA drafted the manuscript or revised it critically for important intellectual content; and all authors contributed substantially to its revision and approved the final version to be published. LL takes responsibility for the paper as a whole.

  • Competing interests None declared.

  • Ethics approval IRB at Alameda County Medical Center, now Alameda Health System.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.