Expand the Patient Services Department: In Personnel, and In Scope to Address More Social Determinants of Health: 3

The expansion of the Patient Services Department is important because Mobile Care is expanding. Mobile Care is expanding its reach, in terms of the services we provide, the regions we serve, and our patient population. By doing this we are able to offer our services to a greater number of families and address a greater need. Patient Services has hired additional staff and added indoor air quality monitoring to our home assessments. We’ve expanded our home assessment and physicals/immunizations programs, we’ve partnered with other organizations to address the COVID-19 pandemic and the opioid crisis. We’ve added additional school sites in the south suburbs and assisted with providing much-needed specialty care that had not been available in the area previously. Mobile Care is always looking for opportunities to meet the needs of our communities and to do whatever we can to improve health equity. As we expand, we will hopefully provide the best care for not only asthma, allergies and dental but also for primary care, mental health, violence prevention, etc. Perhaps one day, the name Mobile Care will ring bells throughout our region, because we created access regardless of financial status, social status, race, or geographic location. We paved new roads to quality care.

-Kamari Thompson, Director of Patient Services

When we speak in public health conversations about the Social Determinants of Health (SDOH), because it has become a buzzword for so many different things, I fear that we tend to abstract them into the realm of mystical complexity where they remain acknowledged but unaddressed, present in discussion but too all-consuming to affect. Healthy People 2030 lists five different sub-groups of SDOH, and any one of these categories would require us to up-end our present social structure to comprehensively address. Yet, at the heart of SDOH is a simple and urgent syllogism: 

• In our society, a lot of people don’t have enough money to meet their basic needs
• As a result, they are forced to make concessions on many or all of their basic needs
• Keeping people, and families in particular, in an economic position where their basic needs cannot be met is not free or economically responsible because, ultimately, there is a massive social cost that must be paid, through our healthcare spending and in other areas; far higher than if people had been given the funds to meet their needs in the first place
• Because the social cost is so high, we as a society need to document all of the areas where low-income people have had to concede their basic needs partially or fully so that we can understand and try to remediate the price we, collectively, are paying
• In doing this accounting, we are documenting a road: once people are set upon this road it leads to poor health, dramatically increased risk of chronic health conditions, huge unpaid hospital bills, and untimely death. We may not see where this road leads in each individual step, when the end is not yet on the horizon, but we know where it goes because people have walked this road before and are now in the process of walking it, everyday.

Mobile Care Chicago is a very small charitable organization that specializes in delivering medical care to people with chronic conditions, and the question might naturally arise what meaningful role an organization like ours can play in creating systemic change, the likes of which would move the needle on mortality rates, healthcare spending, and the prevalence of chronic health issues.

The answer, which may surprise you, is that a small organization can do an awful lot, and we are committed to doing even more. Our approach to social determinants starts with people and their specific needs. Not every family experiences all social determinants of health in the same way or to the same degree. One issue, like housing, might be at a crisis level, while something else, like access to nutritious foods, might not be an issue at that time. Addressing needs, then, starts by listening to specific people, and developing unique plans. The reason we emphasize an expansion of the community health workers in our Patient Services Department when discussing SDOH, is because building capacity allows us to ask more questions and resolve a greater set of issues.

Based on the answers our families gave us last year, we know that these are the social determinants that we mitigate currently:

Transportation – over 70% of MCC patients report that a significant barrier to receiving consistent medical care is an inability to take time off work to travel to distant clinics that accept public insurance or will grant appointments without charge for uninsured patients. By driving high-quality medical care within blocks of patients’ homes, and offering all services free of charge, MCC removes a substantial barrier. The organization also offers telehealth appointments so that parents do not have to take off work and travel in order to be present at medical appointments.

Health Behaviors – Effective preventative care is not necessarily about how often one sees a doctor, it’s about strong, intentional health habits that promote wellness. All of MCC’s medical appointments have a substantial focus on education and empowerment, teaching and reinforcing for families the specific actions, like regular tooth brushing, use asthma control medications, allergy trigger avoidance/reduction, that will aid them in their goal of overall wellness. MCC’s Patient Services department continues to provide education with regular case management calls between regularly scheduled patient appointments. 

Safe Housing – Mobile Care Chicago offers Home Environmental Assessments, in partnership with the EPA Region 5 and the American Lung Association’s Illinois Chapter. These assessments proactively identify and remove allergy triggers that make a home potentially dangerous for a person with severe allergic reactions. These assessments also feed back into reinforcement of positive health habits, giving Patient Services staff a better idea of what they can emphasize through education.

Equal Access to Education – Asthma and tooth pain are the two most common causes of school absenteeism, according to the CPS Office of Student Health and Wellness. Over 50% of new MCC patients had missed days of school for a chronic medical condition in the year before enrollment in their mobile clinic. One year later, 96% of those same patients had not missed any days of school.

Access to nutritious foods and physical activity opportunities – MCC tries to partner directly with local food distribution points to ensure that families who need both resources do not have to make multiple trips to receive the assistance that they need. Physical activity is a major indicator of asthma control, and through providing sport physicals so that students can participate in athletics, and by offering comprehensive asthma management, MCC allows children who would have significant barriers to athletics and healthy play to participate in those activities.

Polluted air and water – MCC frequently collaborates on research that can measure and address potential causes of harm in air and water. Most recently, MCC and UIC partnered on a study of particulate matter and airborne heavy metals in Chicago’s Southeast side. The findings are being presented to community groups presently, and are published in the International Journal of Environmental Research and Public Health under the title “Assessment of Metal Concentrations and Associations with Pulmonary Function among Children with Asthma in Chicago, Illinois.” Other publications on other aspects of metal exposure are planned in 2022.

Language barriers – All of MCC’s clinics are bi-lingual (Eng/Spn) so that the portion of MCC’s patient population that feels more comfortable speaking Spanish, which is over 60% of current patients, can receive education and support in their native language.

Is this a comprehensive methodology to address all Social Determinants of Health? No. It’s not even close. We’re frequently in discussions with our patients and community partners to understand how we can do more. 

Through addressing these substantial health barriers, however, there’s no doubt that Mobile Care Chicago has helped change the trajectory of patient families. We’ve shared stories publicly in the past about patients who were able to focus more in school, participate in athletics, go on to college, or were inspired to pursue jobs in healthcare because of their experience on the mobile units. We’ve also shared stories of families who had close brushes with death and found their health completely transformed through regular access to a specialist aboard our Asthma Vans. Indeed, if every child had the same access to medical providers as our patients, it would save the City of Chicago over $11.7 million dollars annually in decreased hospitalizations, and another $24.9 million in decreased ER utilization. Sometimes resolving health barriers for families doesn’t require a place that can do a little of everything, but rather a place that can do some things really, really well. Expanding our Patient Services Department translates into expanded capacity to listen to what our patient families need and, ultimately, to adapt our organization to resolve their most urgent issues.

–Matt Siemer, Executive Director