Complying with Joint Commission Health Equity Requirements: Medical-Legal Partnership Data and Health-Related Social Needs

Background

Medical-legal partnerships (MLPs) are a hospital-based resource for patients and families to address health-related legal needs, which often align closely with health-related social needs (HRSNs). For instance, patients and their families with housing insecurity or education, immigration, family law, or other legal needs, or who are having trouble accessing government benefits programs are referred by their health care provider to the MLP. Next, an intake process determines eligibility for MLP services that will result in connecting the patients and their families with resources or legal assistance to address the HRSNs. The Joint Commission's health equity requirements were established as a quality and safety imperative and focus on obtaining patient-specific data for HRSNs in the populations a hospital serves to address the root causes of disparities in patients’ health outcomes. The authors examined data for pediatric patients referred to the hospital's MLP as an example of using legal referral data to obtain HRSNs data to comply with these requirements.

Methods

The researchers collected and analyzed data on sociodemographic factors, clinical characteristics, and reason for referral of pediatric patients to a hospital-based MLP. Data were collected from January 1, 2019, to December 31, 2021, spanning the duration of the COVID-19 pandemic. The legal matters from January 1, 2019, to March 9, 2020, were classified as pre-COVID-19 pandemic legal matters, and the legal matters from March 10, 2020, to December 31, 2021, were classified as having occurred during the COVID-19 pandemic. These two time periods were analyzed to account for any pandemic-related effects.

Results

A total of 628 patients (median age 9.0 years; male 48.2%) were referred for 611 legal matters (referrals including more than 1 patient from a single household were counted once). Patients were more likely to be Hispanic/Latino, Black/African American, English-speaking, and publicly insured. Many had at least one complex chronic condition (44.4%). More than half of referrals were for housing insecurity (52.1%). This was consistent in the pre-COVID-19 pandemic period and during the COVID-19 period (52.0% vs. 52.2%, p = 0.95).

Conclusion

Most MLP referrals were for housing insecurity in children from medically underserved or marginalized populations. Aligning The Joint Commission's health equity requirements with legal referral data is a generalizable approach to improve the collection of HRSNs data for addressing disparities in health outcomes in the populations the hospital serves.