Impact of social needs navigation on utilization among high utilizers in a large integrated health system: A quasi-experimental study

J Gen Intern Med

Background: 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.

Objective: To evaluate impacts of a social needs screening and navigation program for adult predicted high utilizers on total medical visit utilization.

Design: 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.

Participants: Predicted high utilizers-patients predicted to be in the highest 1% for total utilization in a large integrated health system.

Intervention: A telephonic social needs screening and navigation program.

Main Measures: 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.

Key Results: 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.

Conclusions: 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.

 

Schickedanz A, Sharp A, Hu YR, et al. Impact of social needs navigation on utilization among high utilizers in a large integrated health system: A quasi-experimental study. J Gen Intern Med. 2019. Epub ahead of print. PMID: 31228054. DOI: 10.1007/s11606-019-05123-2.

Publication Year: 
2019
Resource Type: 
Peer Reviewed Research
Study Design: 
Pre-post without Comparison Group
Social Determinant of Health: 
Economic Security
Employment
Food/Hunger
Health Care Access
Housing Stability
Public Benefits
Social Support/Social Isolation
Transportation
Utilities
Violence/Safety
Population: 
Complex Patients
Outcomes: 
Process
Social Needs/ SDH
Utilization
Screening Research: 
Yes