The core groundwork of equity is to understand the key underlying socioeconomic determinants of health that bring about unequal outcomes.

In Main Line Health's geographic area, the Lankenau Medical Center serves one of Pennsylvania's healthiest counties—Montgomery County, ranked fourth—and also the unhealthiest county, Philadelphia County. This presents big challenges to providing high-quality, equitable care to our patients.

This fundamental understanding has led to several initiatives:

  • Creation of a Center for Population Health Research
  • Leveraging the land surrounding the Lankenau Medical Center campus to create the Delema G. Deaver Wellness Farm to promote a focus on healthy food access for our patients
  • Main Line Health appointed a system director of “health equity”
  • Community Health Services was transformed to Community Health and Equity
  • A program administrator was appointed to Main Line Health's medical student advocacy program
  • A role was created for a fellow in Health Care Disparities
  • A special team was formed to address the health needs of the community's most complex and vulnerable patients

  • The establishment of our Healthcare Disparities Colloquium

    Healthcare Disparities Colloquium

    For the past 8 years, Main Line Health has hosted an annual system-wide Health Care Disparities Colloquium intended to identify disparities in healthcare processes and practices as they might exist—unknown to us—within our system.

    The interest in research into social determinants of health through the work of collaborative interprofessional teams of faculty, residents and nurses has been significantly enhanced in our system since the opportunity to present such research projects has been afforded by the annual colloquium.

    Since 2012, Main Line Health physicians and interprofessional teams have presented more than 70 research studies focusing on a variety of important topics such as:

    • Health literacy
    • Transportation barriers to primary care
    • Food access and nutritional health
    • Unconscious bias
    • Disparities in stroke rehabilitation
    • Disparities in outcomes of breast cancer and mother/baby mortality in the African American population

  • Creation of the Medical Student Advocate Program

    Medical Student Advocate Program

    The uncovering of disparate outcomes revealed in the early Healthcare Disparities Colloquium stimulated the creation and development of the Main Line Health Medical Student Advocate (MSA) Program, now in its sixth year. The MSA program uses volunteer medical students from Philadelphia College of Osteopathic Medicine to help identify nonmedical barriers to care and connect patients to established resources in order to address their needs.

    The MSA program provides future physicians with a unique educational opportunity that allows them to develop skills in establishing doctor-patient relationships, understanding the psychosocial factors shaping health outcomes and engaging with other healthcare professionals.

    MSAs are embedded in patient-centered medical home teams at Lankenau Medical Associates, an internal medicine and subspecialty residency practice at the Lankenau Medical Center, which serves many of our most vulnerable patients.

    Patient-centered medical home teams comprise nurses, social workers, nurse practitioners, health educators, physicians and medical assistants. Through a social need survey screening tool, MSAs identify a range of nonmedical patient needs, including transportation, child care, food access and utility assistance.

    Patient surveys are reviewed at a patient-centered medical home team meeting dedicated specifically to addressing psychosocial needs. Subject to survey outcomes and patient willingness, patients are triaged to social workers, health educators, case managers or an MSA for follow-up. This interprofessional team-based care incorporated into a weekly interprofessional forum provides for improved care coordination and population health management.

    The program has expanded to include five clinical sites, including Main Line Health's Lankenau Medical Center Emergency Department (a level II trauma center) and Spectrum Health Services, a federally qualified health center in West Philadelphia. Since 2012, at Main Line Health, a total of 102 MSAs have served 1,513 patients, identified 3,688 nonmedical needs and provided 1,535 referrals to community resources for patients.

  • Development of an Emergency Room High Utilizer Analysis

    ED High Utilizer Study

    Integrated with the efforts of the MSA program, Lankenau Medical Center initiated a project to analyze the underlying nonmedical needs (such as transportation, utilities, food insecurity and housing) that might lead to the high frequency of ED visits by members of the vulnerable populations who have become known as “ED superutilizers.”

    In this pilot project, an interprofessional team-based approach was used to identify and address the medical and psychosocial needs of patients who had been “treated and released” from the Lankenau Medical Center Emergency Department more than three times over a 15-month period.

    An interprofessional team was established including a nurse case manager, primary care physician, nurse practice manager, social worker, clinical psychologist, hospital administrator, MSA, ED nurse, nurse manager and medical assistants.