Abstract
While many organizations endorse screening for social risk factors in clinical settings, few studies have examined the health and utilization effects of interventions to address social needs. To compare the acute care utilization effects of a written resources handout vs an in-person navigation service intervention to address social needs. In this secondary analysis of a randomized clinical trial, 1809 adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in northern California were recruited between October 13, 2013, and August 27, 2015. Each participating family was randomly assigned to an in-person navigator intervention vs active control to address the family's social needs. Analyses were conducted between February 28, 2018, and September 25, 2019. Caregivers either received written information about relevant local resources related to social needs (active control) or met with a patient navigator focused on helping them resolve social needs (navigator intervention). After an initial in-person visit, navigation services included telephone, email, and/or in-person follow-up for up to 3 months. Child emergency department visit or hospitalization within 12 months of study enrollment. Among the 1300 caregivers enrolled in the study without missing follow-up data, most spoke English (878 [67.5%]) and were women (1127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years. Most children were aged 0 to 5 years (779 of 1300 [59.9%]), 723 children (55.6%) had Hispanic ethnicity, and 462 children (35.5%) were in excellent health; 840 families (64.6%) were recruited from urgent care. In total, 637 families (49.0%) were randomized to the in-person navigator group and 663 (51.0%) to the active control group. There was no difference in risk of an emergency department visit between the 2 groups. Children enrolled in the in-person navigator group had a decreased risk of hospitalization within 12 months (hazard ratio, 0.59; 05% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized. In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but equally likely to have an emergency department visit. These findings strengthen our understanding of the effects of addressing social needs in clinical settings as part of a comprehensive strategy to improve health and reduce health care utilization. ClinicalTrials.gov Identifier: NCT01939704.
Highlights
A large and compelling body of evidence links social risk factors and child health outcomes.[1,2] Recently, medical professional organizations such as the American Academy of Pediatrics,[3] the American Association of Family Physicians,[4] and the National Academy of Medicine[5] have endorsed screening for social risk factors in clinical settings
In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but likely to have an emergency department visit
Key Points Question Can an in-person service navigation intervention to address family social needs decrease child health care utilization?. In this randomized clinical trial of 1300 families, provision of an in-person resource navigator significantly decreased the risk of child hospitalization during a 1-year period compared with written information. Meaning These findings suggest that providing a patient navigator to address family social needs can decrease child health care utilization
Summary
A large and compelling body of evidence links social risk factors and child health outcomes.[1,2] Recently, medical professional organizations such as the American Academy of Pediatrics,[3] the American Association of Family Physicians,[4] and the National Academy of Medicine[5] have endorsed screening for social risk factors in clinical settings. Despite general enthusiasm for social risk screening, few studies have documented the health effects of interventions designed to reduce identified social needs. Most studies on social care interventions in clinical settings have described process and social risk outcomes rather than outcomes on child health or health care utilization.[1,8] When health and/or utilization outcomes have been included in pediatrics-based studies, effects have been inconsistent.
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