Providing Legal and Social Services to Address the Needs of Health Care Super-Utilizers: Thinking Outside the Box

Project Summary

The project team is assessing the impact of legal services provided to health care super-utilizers through a medical-legal partnership (MLP) on their health and health care use. The team is conducting a randomized controlled trial to examine whether the provision of social and/or legal services through MLP to address the social and legal needs of these healthcare super-utilizers will improve their health outcomes and reduce medical care utilization and expenditure.

Research Question(s)

  • Compared to those receiving no social or legal services provision through Nebraska Medicine (NM) MLP, will super-utilizers (a) assessed and provided with social and legal services through NM MLP or (b) assessed and provided with only social services have fewer ED visits and inpatient admissions, lower annual medical care expenditure, better access to care, and better overall health?
  • Compared to those receiving social services only, will ED super-utilizers receiving both social and legal services have fewer ED visits and inpatient admission, lower annual medical care expenditure, better access to care, and better overall health?


  • Inform organizational decision-making regarding integration of health and legal services by providing evidence about the impacts of a holistic and interdisciplinary approach to alleviating inequality in health and health care for underserved and low-income patients.


Main: Emergency department visits, annual medical expenditure

Other: Annual medical expenditure, patients’ access to care, alternative measures of medical services utilization, financial barriers to care


All analyses are conducted from an intent-to-treat perspective. A generalized linear mixed effects model or generalized estimating equation is used to examine the association between use of social and legal services and medical care visits, total medical expenditure, and health outcomes after controlling for demographic and socioeconomic indicators and within-subject correlation.

Doctor and patient shaking hands
Grantee and Partner organizations

Legal Aid of Nebraska
Nebraska Medical Center
University of Nebraska Medical Center

Grant status
Principal investigators
Hongmei Wang, PhD
Ann Mangiameli, JD
Start date
Award amount
36 months

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