The case for integrating medical-legal partnerships into trauma care

Introduction: Medical-legal needs are health-harming adverse social conditions with a legal remedy. Medical-legal partnerships in primary care settings have been proposed to address these needs for at-risk patients already seeking medical care. Our hypothesis is that trauma patients represent a unique population that may be more likely to have baseline medical-legal needs. Methods: A trauma-specific medical-legal needs survey was developed. Adult trauma patients who were able to give consent and were admitted to our urban Level I hospital were surveyed. Medical-legal needs were tabulated from the surveys. Those patients in the top decile of medical-legal needs were categorized as having a High Burden of medical-legal needs. Multivariate logistic regression was used to identify those independent risk factors for having a High Burden of medical-legal needs. Results: A total of 566 participants completed the survey (78.2% response rate). The mean number of medical-legal needs for our population was 2.5 (SD = 3.1). 73% of our respondents had at least one medical-legal need. The most common needs were Housing (n = 229, 40%) and Education/Employment (n = 223, 39%). Older age (aOR = 3.01, 95% CI 1.2-8.1, P = 0.02), being separated or divorced (aOR = 4.25, 95% CI 1.2-14.0, P = 0.02), self perceived poor health (aOR = 8.4, 95% CI 2.61-26.86, P < 0.001), penetrating mechanism of injury (aOR = 2.52, 95% CI 1.22-5.2, P = 0.01), and having been admitted to the hospital for a longer period of time (aOR = 5.48, 95% CI 1.55-19.4, P = 0.008) were all independently associated with a High Burden of medical-legal needs. Conclusions: Trauma patients have a high baseline burden of medical-legal needs. Medical-legal partnerships embedded in trauma teams may offer an innovative strategy to help address long-term health outcomes in a highly vulnerable population that would not otherwise have contact with the healthcare system.