Health literature has widely accepted social determinants of health as having a fundamental role in health and wellness. Studies report that social determinants of heath account for roughly half of health outcomes. Mobile Outreach Clinic offers Care Coordination services alongside medical care to assist patients in the non-medical aspects of their lives. This program pairs patients with student volunteers (i.e. ‘Care Coordinators’) to collaboratively identify and address patients’ SDOH needs. In this program, Care Coordinators (CC’s) assess a patient’s SDOH needs through use of a screening questionnaire that evaluates a variety of domains including transportation, neighborhood, and financial stability among others. There are a few key goals for CC’s at MOC. First, CC’s serve as the liaison between MOC’s clinical team and the patient. This relationship allows for more comprehensive care due to the collaborative, interdisciplinary, and team-based approach to case management. Second, CC’s aim to be advocates, and empower patients to take charge of their own healthcare. The final goal of CC’s is to provide timely, relevant information about services or resources available to their patients to help address social determinants of health that are impacting the patient’s quality of life. While literature suggests that interventions such as MOC’s Care Coordination program should be effective in improving patient outcomes, evaluation of this novel program has been difficult. To overcome this barrier, Mobile Outreach Clinic has implemented a program evaluation that assesses patient satisfaction with Care Coordination services utilizing a validated inventory. Results of this program evaluation indicate a high degree of patient satisfaction including feelings of empowerment and patient-centeredness. This program evaluation provides MOC with valuable information about areas of programmatic growth while also displaying the effectiveness of this novel patient-centered, SDOH-informed approach to healthcare. Throughout this presentation covering advocacy, evaluation, innovation, and quality improvement, participants will (a) understand the importance of patient-centered, SDOH-informed care, (b) recognize methods of innovation in patient care coordination, and (c) identify potential applications of patient-centered and SDOH-informed approaches to their own organizations. Learning Objectives: Understand the importance of patient-centered, SDOH-informed care. Recognize methods of innovation in patient care coordination. Identify potential applications of patient-centered and SDOH-informed approaches to their own organizations.

Kelly Folsom, BPH, MPH, Program Volunteer Coordinator, University of Florida Mobile Outreach Clinic; Michelle Nall, MPH, ANC-BC, Nurse Practitioner, University of Florida Mobile Outreach Clinic