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. 2019 Nov;34(11):2382-2389.
doi: 10.1007/s11606-019-05123-2.

Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study

Adam Schickedanz  1 , Adam Sharp  2   3 , Yi R Hu  2 , Nirav R Shah  4 , John L Adams  2 , Damon Francis  5 , Artair Rogers  5   6
Affiliations

Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study

Adam Schickedanz et al. J Gen Intern Med. 2019 Nov.

Abstract

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.

Keywords: health care utilization; high utilizers; social determinants of health; social needs.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Social needs screening and navigation program steps. Participation proportions in parentheses and pathways to scale according to absolute patient volume. Authors’ analyses of patient level social needs data from Kaiser Permanente Southern California patients using web-based Sankey diagram visualization (http://sankeymatic.com/build).
Figure 2
Figure 2
Social needs identified, enrollment uptake by social needs, and resolution. Pathways to scale according to absolute frequency. Authors’ analyses of social need level social needs data from Kaiser Permanente Southern California patients using web-based Sankey diagram visualization (http://sankeymatic.com/build).
See this image and copyright information in PMC

Comment in

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