Medical-Legal Partnerships Facilitate Patient-Provider Cost of Care Conversations: A Multisite Qualitative Study in the U.S.
Jean S Edward, Kimberly D Northrip, Andrea Welker and 1 others
PMID 36113114WHAT IT FOUND
Clinicians were described as lacking time, knowledge, and training to have patient-provider cost conversations and address health-harming legal needs at 10 medical-legal partnership sites.
Teamwork, co-located lawyers, and ongoing training were reported to help staff identify needs and make referrals.
Key findings
01Clinicians were described as prioritizing medical care, leaving inadequate time to assess or discuss social determinants and health-harming legal needs; limited knowledge and lack of formal training also hindered cost-of-care conversations.
02Interdisciplinary teamwork, including lawyers physically present in healthcare settings, and ongoing training were reported as facilitating cost-of-care conversations and referrals.
03One theme was that participants described access to housing, utilities, public and health benefits as improved through medical-legal partnership services.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a qualitative interview study, so it describes participants' views and reported experiences; it does not test whether medical-legal partnerships improve clinical outcomes. Only 18 patients were interviewed, compared with 78 partnership personnel. Participants came from 10 established sites chosen for pediatric and oncology strengths, so the findings may not apply to other clinical settings. The study was designed before COVID-19 but conducted early in the pandemic, which may have shaped discussions about needs and workflows. Financial and health benefits, including return on investment, were reported by participants and sites, not independently measured, and respondents noted challenges quantifying outcomes. Only three participants were registered nurses, so the nursing role is suggested by the authors' implications more than by a large nursing sample.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the Robert Wood Johnson Foundation (#77293) and supported by the University of Kentucky Markey Cancer Center Shared Resource Facilities (P30 CA177558).
The easy way to misread this
Do not read the reported improvements or return on investment as proof that medical-legal partnerships work. The paper reports themes from interviews, not measured effects.