From pandemic response to portable population health: A formative evaluation of the Detroit mobile health unit program

This article describes our experience developing a novel mobile health unit (MHU) program in the Detroit, Michigan, metropolitan area. Our main objectives were to improve healthcare accessibility, quality and equity in our community during the novel coronavirus pandemic. While initially focused on SARS-CoV-2 testing, our program quickly evolved to include preventive health services. The MHU program began as a location-based SARS-CoV-2 testing strategy coordinated with local and state public health agencies. Community needs motivated further program expansion to include additional preventive healthcare and social services. MHU deployment was targeted to disease “hotspots” based on publicly available SARS-CoV-2 testing data and community-level information about social vulnerability. This formative evaluation explores whether our MHU deployment strategy enabled us to reach patients from communities with heightened social vulnerability as intended. From 3/20/20-3/24/21, the Detroit MHU program reached a total of 32,523 people. The proportion of patients who resided in communities with top quartile Centers for Disease Control and Prevention Social Vulnerability Index rankings increased from 25% during location-based “drive-through” SARS-CoV-2 testing (3/20/20-4/13/20) to 27% after pivoting to a mobile platform (4/13/20-to-8/31/20; p = 0.01). The adoption of a data-driven deployment strategy resulted in further improvement; 41% of the patients who sought MHU services from 9/1/20-to-3/24/21 lived in vulnerable communities (Cochrane Armitage test for trend, p<0.001). Since 10/1/21, 1,837 people received social service referrals and, as of 3/15/21, 4,603 were administered at least one dose of COVID-19 vaccine. Our MHU program demonstrates the capacity to provide needed healthcare and social services to difficult-to-reach populations from areas with heightened social vulnerability. This model can be expanded to meet emerging pandemic needs, but it is also uniquely capable of improving health equity by addressing longstanding gaps in primary care and social services in vulnerable communities.

423. Implementation of a Hierarchy of Controls in a Mobile Health Unit to Safely Care for Inpatients with COVID-19 during Healthcare System Surge

Background In April 2021, Sunnybrook Health Sciences Centre opened a Mobile Health Unit (MHU, i.e. medical tents) under the direction of the Ontario Ministry of Health and Long Term Care in response to a surge in hospitalized patients with COVID-19 during wave three of the pandemic. Providing care to patients in non-conventional spaces is not new, however, experience in safely caring for COVID-19 patients in these settings is lacking. Our aim is to describe the implementation of our MHU and associated outcomes of these COVID-19 patients. Methods A multidisciplinary clinical and operations team was created to plan, execute and operate a safe environment for COVID-19 patients and healthcare workers within the MHU. Patient selection was restricted to patients with COVID-19 who were clinically recovering from severe COVID-19 pneumonia. Ventilation was optimized with air flow directed away from patient areas, velocity reduced to below 0.25 meters per second, and air exchanges of 24-28 per hour. All healthcare workers working in the MHU were offered COVID-19 vaccine and required to complete mandatory education if they declined (vaccination rate of 87% was achieved among dedicated staff). Universal masking and eye protection was used throughout the MHU with designated areas for donning and doffing personal protective equipment. Results In total, 32 patients with COVID-19 were managed in the MHU between 26 April and 21 May, 2021. Table 1 provides the summary of patient characteristics. All patients had a median of one-day of transmission-based precautions remaining in their course and were infected with Alpha variant with exception of one patient with the Gamma variant. Among those patients with genotyping available, all were infected with SARS-CoV-2 carrying the N501Y mutation. Four of the 32 patients required transfer to the main hospital for medical indication while the others were discharged home or to rehabilitation. None of the healthcare workers who worked within the MHU developed COVID-19 infection. Conclusion We safely cared for patients recovering from COVID-19 infection in an MHU to support system healthcare capacity. Our experience, including the specific hierarchy of controls implemented, may be helpful for future pandemic planning. Disclosures All Authors: No reported disclosures

Lymphoedema care in the mobile unit: a service evaluation of patient experience and attendance rates

Background/aims Lymphoedema can be a life-long burden to patients. Value-based lymphoedema services should aim to empower patients and meet expectations of care. This study evaluated the attendance rates and experiences of patients accessing a mobile health unit for lymphoedema care. Methods A questionnaire was shared with all adult patients with lymphoedema at 16 mobile unit clinics in south Wales over 3 months in 2019. Attendance rates and questionnaire data were explored descriptively. Results Out of 417 patients, 175 (37%) participated in the study. Of these, a considerable majority (132/148, 89%) expressed a preference for the mobile unit compared to hospital-based services. Reasons for this preference included ease of access, excellent staff and parking facilities. Non-attendance rates of 8% were observed at the mobile unit. Conclusions Patients favoured attending the mobile unit, suggesting that mobile care is a key aspect of value-based healthcare, allowing services to be planned around patient needs. However, this did not fully resolve the issue of non-attendance. The impact of such community-based services on health outcomes, costs and staff experiences should be explored before widespread adoption is implemented.

A University-Community Problem Based Mobile Health Unit Solution: Indirect and Direct Measures of the Impact of Rural Health in the Central Valley

The development of a medical home is an integral component in decreasing health disparities among disenfranchised communities. Mobile health clinics contribute to increasing access to health services, promoting health education, and improving care coordination especially among low income rural patients. This problem based solution, case study describes the experience of a University-community based partnership in the development of a mobile clinic model within ambulatory Community Medical Health. In 2014, a university based, nursing program initiated, mobile health unit was created to offer basic medical care to rural health areas in the Central Valley. The following case describes how this was accomplished, what outcomes were tracked and what lessons were gleamed as a means of improving the process for future endeavors or as a model to others looking to develop a similar project. Over the past two years the mobile health unit has shown the increased need for medical services as evident by an increase of patient visits in these areas. In addition, implementation results and considerations are discussed including key process indicators, limitations and future model directions.

Exploring Business Models: A Case Study of the Commercialization of a Mobile Health Unit

The case study examines how commercial value for new ideas is created through business model design. More specifically, the study is concerned with the commercialization process of a ‘dental care on wheels’ prototype called Suupirssi, which was originally manufactured for teaching and training purposes. It was later considered that mobile dental care services, and perhaps other types of mobile health care services, could have a wider business potential in both domestic and global markets. The case study elaborates on the process of designing and testing multiple business models that could be used either separately or simultaneously.

Accessibility applied to ships, case study Riverine Ambulatory Care Center (RACC)

Accessibility as a design concept is generally applied in land constructions; however, the medical character of the case study requires it to be considered in the design process as of its conceptual stage. The riverine ambulatory care center (RACC) is a mobile health unit to carry out medical missions in populations located on the riverbanks; given the RACC dimensions, these have limited medical services to primary care and health brigades. Physical barriers1 are the causes for an environment being inaccessible; to eliminate them, from the RACC, an analysis and redesign was performed of the conceptual proposal, based on standards for accessibility, medical spaces, and ships. Two basic moments were taken for intervention, access and interior circulation, yielding as a result the design of an integrated system of products that eliminate the physical barriers from the environment, permitting boarding and offering medical services under equal, comfortable, and safe conditions. Accessibility as modifier of the environment to improve the quality of life of users should not only be applied in medical ships, this study opens an opportunity for industry to optimize the physical environment of other types of ships by applying this concept.