Social media language of healthcare super-utilizers

Sharath Chandra Guntuku,Haley J Mccalpin,Elissa V Klinger,Raina M Merchant,David A Asch,Lyle H Ungar

doi:10.1038/s41746-021-00419-2

Abstract

An understanding of healthcare super-utilizers’ online behaviors could better identify experiences to inform interventions. In this retrospective case-control study, we analyzed patients’ social media posts to better understand their day-to-day behaviors and emotions expressed online. Patients included those receiving care in an urban academic emergency department who consented to share access to their historical Facebook posts and electronic health records. Super-utilizers were defined as patients with more than six visits to the Emergency Department (ED) in a year. We compared posts by super-utilizers with a matched group using propensity scoring based on age, gender and Charlson comorbidity index. Super-utilizers were more likely to post about confusion and negativity (D = .65, 95% CI-[.38, .95]), self-reflection (D = .63 [.35, .91]), avoidance (D = .62 [.34, .90]), swearing (D = .52 [.24, .79]), sleep (D = .60 [.32, .88]), seeking help and attention (D = .61 [.33, .89]), psychosomatic symptoms, (D = .49 [.22, .77]), self-agency (D = .56 [.29, .85]), anger (D = .51, [.24, .79]), stress (D = .46, [.19, .73]), and lonely expressions (D = .44, [.17, .71]). Insights from this study can potentially supplement offline community care services with online social support interventions considering the high engagement of super-utilizers on social media.

Highlights

Super-utilizers are patients with frequent acute healthcare encounters, often because of complex physical, behavioral, and social needs
We defined super-utilizers a priori as any patient who had six or more emergency department (ED) encounters within a 12-month time period within our urban health system[14]
Super-utilizers had more documented diagnoses of injury and poisoning, respiratory symptoms, skin disorders, anxiety, depression, and documented drug use when compared to the control group (Chi-squared statistic significant at p < .001), consistent with previous findings on the prevalence of comorbidities among super-utilizers[1]

Summary

INTRODUCTION

Super-utilizers are patients with frequent acute (i.e., emergency department) healthcare encounters, often because of complex physical, behavioral, and social needs. As Iovan et al (2019) found in a comprehensive review of super-utilizer interventions, most interventions target the downstream determinants surrounding patients’ material conditions (e.g. access to housing, food, and transportation), with only a select few offering interventions targeting the more fundamental social determinants of health with referrals to education, job opportunities, and vocational training[9,10,11]. Tackling these fundamental determinants requires a more targeted approach that can be tailored to the individual and engages the patient, their families, and caregivers beyond conventional healthcare visits. Distribution of top diagnoses are significantly different across groups at p < 0.001

RESULTS

METHODS

Limitations