Differences in healthcare utilization across 2 social health support modalities: Results from a randomized pilot evaluation

INTRODUCTION: The aim of this study was to assess differences in utilization outcomes among patients with social needs as part of a pilot social health integration program in 2 clinics in an integrated health system in the Pacific Northwest. 

METHODS: Patients who reported social needs between October 2022 and January 2023 were randomized to receive support from either local, clinic-based community resource specialists or a centralized Connections Call Center. The authors used administrative and claims data for 534 participants to compare the following utilization outcomes between arms over 9 months after randomization: primary care encounters, specialty care encounters, behavioral health encounters, emergency department encounters, inpatient admissions, urgent care encounters, and secure patient messages. Using an intent-to-treat approach, the authors used negative binomial regression models to compare visit counts and logistic regression to estimate differences in the probability of any emergency department visit or inpatient admissions between groups. The authors conducted secondary as-treated analyses comparing participants who received resource information from community resource specialists with those who did not. 

RESULTS: Unadjusted results showed no statistically significant differences between community resource specialists and Connections Call Center. Adjusted results showed that community resource specialist participants received 1.04 more primary care encounters than Connections Call Center participants (95% CI=0.336, 1.746). As-treated results showed that participants who received support from community resource specialists had higher counts of primary care encounters, specialty care encounters, and patient messages than those who did not. 

CONCLUSIONS: Beyond social needs navigation, clinic-based supports may be better integrated with care teams to provide ongoing support for patients' medical needs. Findings from this primary care social health pilot program showed that local, clinic-based support was associated with greater outpatient utilization than a call center support.