Transforming Interprofessional Education Through Student Hotspotting Addressing Social Determinants of Health Among High-need, High-cost Patients at Grady Health System

Background: Atlanta Interprofessional Student Hotspotting (AISH) is a student-run volunteer organization that partners with Grady Health System (Grady) to enable multidisciplinary student teams to engage in non-clinical care for high-need, high-cost (HNHC) patients. HNHC patients have had greater than or equal to 5 emergency department visits or greater than or equal to 2 inpatient admissions at Grady in the previous 12 months due to greater than or equal to 2 decompensated chronic conditions. Nationally, these medically and socially complex individuals comprise only 5% of the U.S. population but constitute 50% of healthcare expenditures. We aim to improve patients’ health outcomes, decrease healthcare costs, and train students to provide team-based, patient-centered care by integrating real-world, service-learning opportunities into graduate-level interprofessional curricula.

Design/Methodology: Student volunteers pursuing careers in six distinct health professions were organized into interdisciplinary teams. In coordination with Grady’s Chronic Care Clinic (CCC), teams identified and interviewed patients to recruit into the 6-month program to help patients identify root causes of their frequent hospital admissions, determine health goals, develop personalized care plans, and navigate barriers. Assessment of civic learning among AISH volunteers was performed using the Public Affairs Scale - Short Survey (PAS-SS) and student reflections.

Results: The most commonly reported root causes of readmission were unstable housing (n=7, 35%), stolen medication (n=4, 20%), and lack of transportation (n=4, 20%). Analysis of student reflections and PAS-SS submissions revealed increased drive to participate in service work in the future and greater understanding of how such volunteer opportunities will translate to more success in their professional careers.

Conclusion: Students developed a complex understanding of the relationship between individual patients and their community-level social needs, all while learning how to leverage the perspectives and skill sets of various health professionals. By helping to improve patient self-efficacy and access to appropriate, high-quality care, AISH students are better prepared to succeed in the interprofessional, team-based environments within healthcare.

Reflections/Implications: Moving forward, student hotspotters will work collaboratively to develop, pilot, and evaluate novel community-level intervention(s) that address the most common root causes of readmission identified. In addition to direct patient support, community-level project(s) will require coordination across disciplines to identify innovative yet feasible interventions. AISH’s success will highlight how health professional students are currently an untapped resource, and how collaborative, service-learning opportunities can revamp both interprofessional education and efforts to improve both health disparities and healthcare utilization.

Supported by The National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378.