Impact of a Housing and Health Focused Residency Curriculum on Community Health Worker Utilization for Unmet Housing Needs.

Abstract

Stable housing is a well-recognized health-related social need (HRSN) with little attention in medical training. This study examined the efficacy of a resident housing curriculum on referrals to a Community Health Worker (CHW) intervention to assist patients with unmet housing needs. This was a retrospective cohort study conducted on Internal Medicine residents at a large urban residency program in Bronx, NY. We utilized multivariate mixed-effects logistic regression to determine whether clinician curriculum exposure increased CHW referrals among patients who self-reported housing needs in a HRSN screening tool between July 2021 and August 2024. Nine hundred six unique patients screened positive for unmet housing needs, and 303 (33.4%) patients were referred to CHWs by eligible clinicians (n = 118). Clinician exposure to the curriculum was not a significant predictor of CHW referrals (aOR = 1.03, 95% CI = 0.69-1.54), adjusting for covariates. Patient age (aOR = 0.98, 95% CI = 0.97-0.99), Spanish language (aOR = 1.65, 95% CI = 1.09-2.51), and Medicaid coverage (aOR = 1.61, 95% CI = 1.03-2.51) were associated with likelihood of referral. Our findings demonstrate that the curriculum did not increase CHW referrals. Multimodal educational and systemic interventions that support the use of existing workflows may be needed to increase uptake of interventions to address HRSNs.