Table 2 Steps for Mi Puente in-hospital screening and consenting

Step 1 pre-screening

EMR and admission notes

Inclusion: (1) Hispanic ethnicity; (2) ≥ 18 years of age; (3) ≥ 2 cardiometabolic conditions

Exclusion: (1) pregnancy; (2) serious life-threatening condition with life expectancy ≤ 6 months; (3) psychiatric morbidity or neurological/cognitive impairment of sufficient severity to preclude consent or participation in the intervention; (4) discharging to location other than home (e.g., SNF); (5) does not speak Spanish or English

Medical information, including previous emergency department admission, chronic condition diagnoses, and LACE index

Patient identifying information including name, demographics, contact information, and medical record number

If pass step 1, Step 2 approach in person

Bedside nurse

Patient is available for screening.

Yes - approach patient

No - e.g., not currently in room or has already been discharged; document reasons and research assistant will return if applicable

New demographic information (e.g., language preference), screening status, qualitative enrollment data to facilitate future approaches/recruitment efforts

If pass step 2, step 3 in-person screening approach

Patient

Confirmation of patient name and language preference. Verbal consent to administer screener

No - declined

Yes - complete Behavioral Health Screener: ≥ 1 behavioral health concern(s) (i.e., related to mental health, life stressors, medication adherence, healthcare use); telephone access (see Table 3)

Reason(s) for patient eligibility/ineligibility

If pass step 3, step 4 consenting

Patient

Yes – agreed

No - declined

No - consent not obtained → study was introduced but no decision was made about participation

Complete consent form

Reasons for refusals and “hard” refusals (patient explicitly declined enrollment and will not be approached in the future) or “soft” refusals (patient may be approached in a future hospital readmission)

Reasons for no decision