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 andimmunizations may be postponed At Fair Haven Community Health Care (FHCHC), a multi-site communityhealth center (CHC) in New Haven, CT, serving approximately 18,000 patients (9,000 children), weimplemented 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 forpatients with chronic illness or acute complaints, and (3) implement on-site COVID-19 testing with socialdeterminants 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 childcare (WCC) for key age groups - birth to 24 months and 4 to 5 years - were moved to a “clean” site where onlyWCC 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 identied as a COVID-19 “hot-spot,” weimplemented on-site testing regardless of symptoms, exposure, or prior use of FHCHC services Patientstested on-site were seen prior to their test via telemedicine for symptom assessment and to be screened forsocial determinants using the Accountable Health Communities instrument They were given locally-specicinformation to meet social needs generated by the NowPow platform From March 12 through April 30, wecompleted 3,302 visits for children 0 through 22 years;1,595 (48%) were via telemedicine Younger childrenages 0-5 years had a greater proportion of visits in-person (634, 60%) than children 6-12 years (438, 46%) oradolescents 12-22 years (635, 49%) Visit counts by time, stratied by visit-type, are shown in the Figure FromApril 22 through 30, 2020, we have scheduled 317 visits for on-site testing, 243 (77%) of which werecompleted, 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 timelyfashion in the context of an epidemic Responding to local epidemiologic data, CHCs can provide trustingenvironments for surveillance testing Testing for COVID-19 represents a feasible opportunity to screen forsocial determinants of health and facilitate community linkages to meet social needs using electronicplatforms 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