Low-intensity social care and child acute health care utilization: A randomized clinical trial

Importance: Social care could be sustained with savings resulting from reduced acute health care utilization.

Objective: To evaluate the impact of CommunityRx, a low-intensity, high-scale social care assistance intervention.

Design, setting, and participants: This double-blind randomized clinical trial took place from November 2020 through August 2023 at an urban children’s hospital with 12-month follow-up. Inclusion criteria were primary caregiver of a child younger than 18 years who was hospitalized in general, intensive care, or transplant units, living in 1 of 42 zip codes, and consenting to text messages. Caregivers of healthy newborns and children with expected hospitalization less than 24 hours or longer than 30 days were excluded.

Interventions: Participants were randomized to usual care (n = 320) or usual care plus CommunityRx (n = 320). Essential intervention components included education about common social conditions, personalized information about local resources, and ongoing navigator support with automated, proactive text messages (3 months) and ongoing availability for participant-initiated requests (12 months).

Main outcomes and measures: Preplanned analyses focused on food insecure (FI) subgroup outcomes (n = 223): self-efficacy for finding resources at 12 months (primary), caregiver-reported child health, and number of child emergency department (ED) and hospital admissions over 12 months. Regression models were fit with treatment group and baseline outcome characteristics. Odds ratios (ORs) or incidence rate ratios (IRRs) and 95% CIs were calculated. Post hoc analysis examined outcomes among the food secure (FS) subgroup (n = 414).

Results: Preplanned analyses included 223 FI participants and most identified as female (180 [95%]) and had household income less than $50 000 per year (197 [91%]). Self-efficacy at 12 months was similar among treatment groups (OR, 0.59; 95% CI, 0.25-1.39, P = .23). At 3 months, when automated navigator texts ended, 53 intervention group participants (69%) and 39 controls (45%) rated their child’s health as excellent or very good (OR, 2.67; 95% CI, 1.14-6.24). During 12 months postdischarge, 54 FI children (41%) had 1 or more ED visits (median, 0; range, 0-32; intervention, 30%; control, 52%; IRR, 0.40; 95% CI, 0.21-0.76) and 32 had 1 or more hospitalizations (24%) (median, 0; range, 0-5; intervention, 15%; control, 34%; IRR, 0.48; 95% CI, 0.21-1.06). The intervention did not impact outcomes among FS caregivers.

Conclusion: A low-intensity, high-scale social care assistance intervention beginning with pediatric hospitalization may be sustainable by reducing acute health care utilization, but did not increase caregiver self-efficacy for finding resources.