Reasons for Social Work Referrals in an Urban Safety-Net Population: A Natural Language Processing and Market Basket Analysis Approach

Abstract

Background Encouraged by multiple federal policies, healthcare organizations are assuming greater responsibility for patients' social needs. This study describes the individual and co-occurring social needs that lead to a referral to social workers in primary care. Methods In a secondary data analysis of a longitudinal cohort, we used natural language processing (NLP) to categorize reasons for social work referral documented in electronic health records referral orders (n = 9,473) from a federally qualified health center (2011–2016) in the United States, using a literature-derived classification scheme. We used market basket analysis (MBA) to identify co-occurring social needs. Results The most frequent needs leading to a social work referral were financial (25%), pregnancy (25%), behavioral health (16%), and family/social support (9%) needs. The most frequently co-occurring needs are pregnancy with language limitation (support = 0.07; confidence = 0.78); behavioral health with family/social support (support = 0.03; confidence = 0.28); and financial with behavioral health (support = 0.025; confidence = 0.14). Conclusion The diversity of reasons for social work referrals signifies the complexities of social needs among patients and the potential role for social workers in addressing these needs. A clearer understanding of patients’ social needs helps inform social work staffing decisions and the development of effective intervention packages to address patients’ social needs.