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

Abstract

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.

Utilizing Mobile Health Units for Mass Hypertension Screening in Socially Vulnerable Communities Across Detroit

“…The Wayne Health Mobile Unit program, launched March 2020, comprises a fleet of up-fitted Ford Transit vans staffed with multiple personnel 4 . The initial focus on coronavirus disease 2019 (COVID-19) testing was rapidly expanded to additional health care capabilities given community needs.…”

“…Five to 7 mobile health units deploy 5 to 6 days per week to 376 available community partner locations covering the Detroit area targeting locations with higher social vulnerability using specialized geocoding methodologies. 4 …”

“…Five to 7 mobile health units deploy 5 to 6 days per week to 376 available community partner locations covering the Detroit area targeting locations with higher social vulnerability using specialized geocoding methodologies. 4 Given the large population serviced (while also ensuring resiliency of the program during cold weather and COVID restrictions), we developed a high-throughput method to offer screening for high BP (defined as ≥120/80 mm Hg) beginning in November 2020. Those driving to a site (≈90%) rested inside their parked car for ≥5 minutes.…”

“…3 We here describe the first-year results using our novel Wayne Health Mobile Unit program developed in collaboration with Wayne State University to address health disparities in Detroit. 4 …”

Influenza vaccination coverage among an urban pediatric asthma population: Implications for population health

“…Furthermore, a recent systematic review highlighted transportation as a common issue with accessing care but noted that transportation-only interventions may not be sufficient for improving health outcomes [53]. As improved health care access has been positively associated with influenza vaccination coverage, the opportunity to improve vaccine administration in non-traditional settings-such as at the hospital, pharmacy, or mobile health unit-may be an appealing alternative in an urban population [54][55][56]. Paired with education and communication interventions in schools and community health centers, "non-traditional" healthcare interactions serve as an added piece for building "reminder systems" in urban settings [35].…”