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Enhanced Transitions of Care for Medically Complex Refugees

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Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Background

Between 2015 and 2019, 261,091 refugees were resettled through the U.S. Refugee Admissions Program. Few are chronically ill, but previously these went to emergency rooms upon arrival. We designed a pilot program to anticipate, assess, and safely assume care of chronic health needs and stabilize sick and medically complex refugees upon arrival.

Clinical Operations

Academic internal medicine and pediatrics clinics are linked to the Washington State Refugee Health Program and Refugee Resettlement Agencies. Arriving refugees deemed medically complex through overseas medical evaluation or post-arrival were selected for the program.

Metrics

We reviewed biodata of 2,947 refugees deemed medically complex. We referred five hundred and sixty one (19%) of these for evaluation, and 257 (46%) of referrals received care.

Discussion

Safe transitions of care are standard practice in medical systems. This innovation in Seattle is one example of a system for the safe and cost-effective relocation of refugees with complex illnesses.

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References

  1. Transitions of Care. Content last reviewed June 2018. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/reasearch/findings/nhqrdr/carecoordination/measure1.html.

  2. Snow V, Beck D, Budnitz T, et al. Transitions of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine. J Hosp Med. 2009;4(6):364–70.

    Article  Google Scholar 

  3. Report to Congress on Proposed Refugee Admissions for FY2020. U.S. Department of State, Policy Issues. Available at: https://www.state.gov/reports/report-to-congress-on-proposed-refugee-admissions-for-fy-2020. Accessed 12 Jun 2020.

  4. Migration Policy Institute (MPI) analysis of WRAPS data from the State Department Bureau of Population, Refugees, and Migration. Available at: www.wrapsnet.org/admissions-and-arrivals/

  5. Migration Health Assessments and Travel Assistance, IOM UN Migration. Available at: https://www.iom.int/migration-health-assessments-travel-health-assistance. Accessed 12 Jun 2020.

  6. Technical Instructions for Panel Physicians, Immigrant and Refugee Health, Center for Disease Control and Prevention. Available at: https://www.cdc.gov/panelphysicians/technical-instructions.html, Accessed 12 Jun 2020.

  7. Tuberculosis Technical Instructions for Panel Physicians, Technical Instructions for Panel Physicians, Immigrant and Refugee Health, Center for Disease Control and Prevention. Available at: https://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/tuberculosis-panel-technical-instructions.html. Accessed 12 Jun 2020.

  8. Mitchell T, Weinberg M, Posey DL, Cetron M. Immigrant and refugee health: a center for disease control and prevention perspective on protecting the health and health security of individuals and communities during planned migrations. Pediatr Clin North Am. 2019;66(3):549–60.

    Article  Google Scholar 

  9. Overseas Medical Exam, Refugee Health Technical Assistance Center. Available at: https://refugeehealthta.org/physical-mental-health/health-assessments/overseas-medical-exam. Accessed 12 Jun 2020.

  10. Public Health and Promoting Interoperability Programs, Center for Disease Control and Prevention. Available at: https://www.cdc.gov/ehrmeaningfuluse/index.html. Accessed 12 Jun 2020.

  11. DiVenere L. The affordable care act and the drive for electronic health records: are small practices being squeezed? OBG Manag. 2013;25(7):36–44.

    Google Scholar 

  12. Jackson JC, Haider M, Wilson Owens C et al. Healthcare recommendations for recently arrived refugees: observations from EthnoMed, Harvard Public Health Review, vol 7; 2016.

  13. Worcester J, D’Afflitti J, Pace CA, et al. Achieving productivity expectations among general internal medicine clinicians at an Urban Safety-Net Academic Medical Center. J Med Pract Manag. 2018;34(3):190.

    Google Scholar 

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Acknowledgements

We gratefully acknowledge Cathy Vue, MPH, Jennifer Malloy and Jasmine Matheson, MPH for their support.

Funding

Authors Jackson, Ahrenholz, Burkhalter, and Haider received funding for this work through Contract Number 1865-37851 from the Office of Refugee and Immigrant Affairs in the Washington State Department of Social and Health Services.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Box 359780, Seattle, WA, 98104, USA

    J. Carey Jackson, Nicole Chow Ahrenholz & Mahri Haider

  2. International Medicine Clinic/Refugee Health Promotion Program, Harborview Medical Center, Seattle, WA, USA

    Heather Burkhalter

  3. Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Elizabeth Dawson-Hahn, Anisa Ibrahim & Suzinne Pak-Gorstein

Authors
  1. J. Carey Jackson
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  2. Nicole Chow Ahrenholz
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  3. Heather Burkhalter
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  4. Elizabeth Dawson-Hahn
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  5. Anisa Ibrahim
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  6. Suzinne Pak-Gorstein
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  7. Mahri Haider
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Corresponding author

Correspondence to J. Carey Jackson.

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Animals and Human Rights

This project is in compliance with the policy of the Human Subjects Division of the University of Washington and received a Human Subjects exemption, since the intervention is a quality improvement effort with aggregated data and no individual identifiers.

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Jackson, J.C., Ahrenholz, N.C., Burkhalter, H. et al. Enhanced Transitions of Care for Medically Complex Refugees. J Immigrant Minority Health 23, 1359–1363 (2021). https://doi.org/10.1007/s10903-021-01200-z

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  • DOI: https://doi.org/10.1007/s10903-021-01200-z

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