P-2058. Healthcare Utilization Before and After Enrollment in the New York City Health + Hospitals/Bellevue Health Equity Action Team, 2022-2024

TL;DR

A health equity program at NYC Bellevue Hospital increased outpatient visits for patients with HIV and substance use disorders without increasing emergency or hospital use.

Contribution

The study presents preliminary evidence that the HEAT program improves outpatient engagement among marginalized patients with HIV and substance use disorders.

Findings

Outpatient visits increased significantly after HEAT intervention (from 0.4 to 3.1 per patient).

Emergency department and hospital admissions remained stable before and after HEAT.

Most participants were Black, Latinx, and experiencing homelessness with high rates of substance use and HIV.

Abstract

Patients hospitalized with HIV-related complications and substance use-related infections (e.g., endocarditis) often face sociostructural inequities that lead to poor health outcomes. Hospitalization is a key opportunity to address health-related social needs (HRSN) and reduce avoidable emergency department (ED) visits and readmissions. The Health Equity Action Team (HEAT), launched in July 2023 at NYC Health + Hospitals/Bellevue, provides inpatient consult and post-discharge navigation for patients with complex HRSN. HEAT leverages HRSN screening, trauma-informed care, peer support, and community partnerships to promote primary care utilization over ED or hospital-based care. We explored HEAT’s preliminary healthcare utilization outcomes before and after HEAT intervention.

We conducted a retrospective pre-post analysis of 35 patients who received the HEAT intervention (Figure 1) between January 1, 2022 and December 31, 2024. Manual chart review captured patient demographics, co-morbidities, and healthcare utilization six months pre- and post-HEAT consult. Outcomes included outpatient visits, ED visits, hospital admissions, and readmissions. We calculated means, standard deviations (SDs), and compared pre- and post-HEAT outcomes using paired t-tests at p < 0.05 as significant.

Participants were majority male (74%), Black (40%) or Latinx (49%), on Medicaid (83%), and experiencing homelessness (77%) (Table 1). Most (80%) had substance use disorder (SUD), 54% had HIV, 34% had both SUD and HIV, and 49% had hepatitis C. Substance use included primarily cocaine and opioids (Table 2). Mean outpatient visits from pre- to post-HEAT increased significantly (0.4 [SD 0.9] to 3.1 [SD 4.5], p < 0.01). ED visits remained stable (3.7 [SD 5.0] vs. 3.2 [SD 3.7], p = 0.61), as did hospital admissions (1.1 [SD 1.8] vs. 1.7 [SD 2.3], p = 0.20) and readmissions (1.0 [SD 1.8] vs. 1.1 [SD 2.1], p = 0.84).

HEAT intervention was associated with increased outpatient follow-up among patients with HIV and SUD with historically low engagement in post-discharge primary care. Hospital and ED use remained stable. Future studies will assess HEAT’s long-term impact on healthcare utilization, quality, and safety.

Ofole Mgbako, MD, MS, Gilead Sciences: Advisor/Consultant

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