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- Title
Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study.
- Authors
Schickedanz, Adam; Sharp, Adam; Hu, Yi R.; Shah, Nirav R.; Adams, John L.; Francis, Damon; Rogers, Artair
- Abstract
<bold>Background: </bold>Programs addressing social determinants of health for high-utilizing patients are gaining interest among health systems as an avenue to promote health and decrease utilization.<bold>Objective: </bold>To evaluate impacts of a social needs screening and navigation program for adult predicted high utilizers on total medical visit utilization.<bold>Design: </bold>A prospective, quasi-experimental study using an intent-to-treat propensity-weighted difference-in-differences approach. Stratified analyses assessed intervention effects among three low-socioeconomic status sub-samples: patients in low-income areas, in low-education areas, and with Medicaid insurance.<bold>Participants: </bold>Predicted high utilizers-patients predicted to be in the highest 1% for total utilization in a large integrated health system.<bold>Intervention: </bold>A telephonic social needs screening and navigation program.<bold>Main Measures: </bold>Primary difference-in-difference analyses compared total visit count utilization, including outpatient, emergency department (ED), and inpatient utilization, between the intervention and control groups at both in-network and out-of-network facilities. Prevalence of social needs among sample patients and their connection rates to social needs resources are also described.<bold>Key Results: </bold>The study included 34,225 patients (7107 intervention, 27,118 control). Most (53%) patients screened reported social needs, but only a minority (10%) of those with a need were able to connect with resources to address these needs. Primary analysis found total utilization visits decreased 2.2% (95% CI - 4.5%, 0.1%; p = 0.058) in the intervention group. Stratified analyses showed decreases in total utilization for all low-socioeconomic status subgroups receiving the intervention compared with controls: - 7.0% (95% CI - 11.9%, - 1.9%; p = 0.008) in the low-income area group, - 11.5% (- 17.6%, 5.0%; p < 0.001) in the low-education area group, and - 12.1% (- 18.1%, - 5.6%; p < 0.001) in the Medicaid group.<bold>Conclusions: </bold>Social needs navigation programs for high-utilizing patients may have modest effects on utilization for the population overall. However, significant decreases in utilization were found among low-socioeconomic status patients more likely to experience social needs.
- Subjects
SOCIAL impact; HOSPITAL emergency services; SOCIAL services
- Publication
JGIM: Journal of General Internal Medicine, 2019, Vol 34, Issue 11, p2382
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-05123-2