Taylor Phillips & Linda Wu
THE PATIENT DISCHARGE INITIATIVE
Tagline: The Patient Discharge Initiative is a health advocacy organization composed of undergraduate students from Rice University and the University of Houston that aims to understand and address health disparities faced by underserved patients seen at Ben Taub Hospital.
Index Keywords: health disparities, social determinants of health, health advocacy, Houston, Rice University, University of Houston
In Houston, one of the most diverse cities in the nation, limits to medical access, or social determinants of health (SDoH), present immediate barriers to careby Black and Latinx Americans. In 2019, 78.7% of Black residents and 75.7% of Hispanic residents were overweight or obese, reflecting how almost half a million residents live in food deserts with little to no access to healthy foods (Harris County Public Health, 2021). Additionally, one-third of Hispanic adults reported that they have not been able to seek out needed medical services due to financial constraints. This lack of routine medical care often leads to overuse of the emergency room putting significant strain on the city’s healthcare system.
Over one million ER visits were made in Harris County Hospitals annually and over 40% of these visits were primary care-related which include non-urgent, primary treatable, and primary care preventable visits. Over two-thirds of these visits were by people who are Black or Hispanic, and 40% are primary care related. Even if the patients who cross the ED doors are treated for their physical conditions, the social determinants still exist and act on their health (UTHealth SPH, 2012). One of the hospitals that experiences this major strain on its emergency department is Ben Taub Hospital, – Houston’s largest county hospital. At Ben Taub the Patient Discharge Initiative (PDI) works to address the social determinants of health to decrease the number of primary care-related visits.
In 2011, the Patient Discharge Initiative was established by Baylor College of Medicine students Dennis Shung ‘14 and John Lin ‘14 through the prestigious national Albert Schweitzer Fellowship that funds service projects to meet the health needs of underserved populations. Today, the Patient Discharge Initiative boasts over 90 members from Rice University and the University of Houston to improve post-hospital quality of life for Ben Taub patients through connecting them to resources that seek to decrease societal inequalities that affect health.
PDI volunteers work in the emergency department to ensure that patients understand their prescribed treatment, increase medication adherence, and support patients’ needs after discharge. Through a screening process, PDI also helps patients utilize community resources to address the SDoH that may lead to certain health disparities. The screening process, developed by the Centers for Medicare & Medicaid Services (CMS), surveys a patient’s housing situations, access to transportation, food insecurity, educational or employment needs, as well as insurance and ability to pay for medical costs. From the screening, volunteers are able to connect patients to Houston-area resources to address their needs. These resources include ESL education, legal assistance, and housing or food access.
During the COVID-19 pandemic, PDI could not continue their usual volunteering at Ben Taub’s emergency department. The organization took the past year as an opportunity to strengthen the education of their volunteers through internal committee projects and assisting the Mayor’s Office of Education with public health curriculums. These committee projects have included a panel inviting healthcare leaders to speak about their experiences addressing social determinants of health, writing thank you notes to local front-line healthcare workers, hosting a health policy hack-a-thon for college students in Houston, and partnering with their organizations’ emergency physician mentors to research and learn more about factors impacting eligible patients from attaining insurance. They are also working to bring their service to a virtual SMS to continue engaging with patients and connecting them with community resources. Through this system, PDI hopes it will allow the organization to increase reach to serve more of Houston’s underserved residents beyond Ben Taub Hospital.
More recently, PDI has also been working to form meaningful and synergetic community partnerships within Harris County. Since 2019, the organization has expanded its initiative and has been supporting the newly established PDI chapter at the University of Houston. Further, over the past two years, PDI has fostered a partnership with the Harris Health Population Health Department to strategically expand its reach and integrate its work into the health system to directly improve the care of all patients seen at Harris Health. Relationship-building continues to be a critical theme for PDI to optimize collective efforts to address social determinants of health and contribute to a healthier, more equitable community.
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Sahana Prabhu and Daniel Wang, interview by Taylor Phillips, March 10, 2021, interview, transcript, and recording, Medicine, Race, and Democracy Lab Collection
Harris County Medical Society. “Social Determinants of Health,” February, 21 2021, https://www.hcms.org/tmaimis/HARRIS/Practice_Resources/Tools_and_Resources/Social_Determinants_of_Health.aspx?WebsiteKey=0a784a46-1152-4b41-8e5d-3545a059ff7f
University of Texas Health Science Center at Houston School of Public Health (UT Health SPH). “Houston Hospitals Emergency Department Use Study,” June 2012, https://sph.uth.edu/content/uploads/2013/06/Final2011ER.pdf