Enhanced Transitions of Care for Medically Complex Refugees

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.

     

The Health of Children in Immigrant Families: Key Drivers and Research Gaps Through an Equity Lens

ObjectiveThe United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity.MethodsThe literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps.ResultsThe initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks.ConclusionsBroad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes.