P1002 - Cohorting patients at a community health center: in-person well care, telemedicine follow-ups, and on-site COVID-19 testing with social determinants screening

Program Goals: During the COVID-19 pandemic, anticipatory guidance, developmental surveillance and immunizations may be postponed. At Fair Haven Community Health Care (FHCHC), a multi-site community health center (CHC) in New Haven, CT, serving approximately 18,000 patients (9,000 children), we implemented cohorting during the period of greatest local impact of the pandemic. Our goals were to (1) prioritize well-child care for children due for immunizations, (2) increase the capacity for telemedicine for patients with chronic illness or acute complaints, and (3) implement on-site COVID-19 testing with social determinants screening.
Evaluation: We implemented cohorting for pediatric patients at FHCHC on March 12, 2020 (for reference, Connecticut’s stay-at-home order was signed March 23). Previously scheduled well child care (WCC) for key age groups – birth to 24 months and 4 to 5 years – were moved to a “clean” site where only WCC and prenatal care were offered. All other children received telemedicine visits, which could be converted to same-day in-person visits at the discretion of the clinician. School-based health center providers were re-purposed to call patients with asthma in need of follow-up using a chronic care model. On April 22, 2020, shortly after the neighborhood surrounding FHCHC’s main site was identified as a COVID-19 “hot-spot,” we implemented on-site testing regardless of symptoms, exposure, or prior use of FHCHC services. Patients tested on-site were seen prior to their test via telemedicine for symptom assessment and to be screened for social determinants using the Accountable Health Communities instrument. They were given locally-specific information to meet social needs generated by the NowPow platform. From March 12 through April 30, we completed 3,302 visits for children 0 through 22 years; 1,595 (48%) were via telemedicine. Younger children ages 0-5 years had a greater proportion of visits in-person (634, 60%) than children 6-12 years (438, 46%) or adolescents 12-22 years (635, 49%). Visit counts by time, stratified by visit-type, are shown in the Figure. From April 22 through 30, 2020, we have scheduled 317 visits for on-site testing, 243 (77%) of which were completed, 36 of whom were children, all of whom were screened for social determinants of health.

Discussion: CHCs can cohort children to ensure that preventive care and vaccinations happen in a timely fashion in the context of an epidemic. Responding to local epidemiologic data, CHCs can provide trusting environments for surveillance testing. Testing for COVID-19 represents a feasible opportunity to screen for social determinants of health and facilitate community linkages to meet social needs using electronic platforms. After the COVID-19 pandemic has subsided, CHCs can offer episodic telemedicine visits for children, and can screen for social determinants at various points of contact with families.