Impact of Social Risk Screening on Discharge Care Processes and Postdischarge Outcomes A Pragmatic Mixed-Methods Clinical Trial During the COVID-19 Pandemic

Authors

• Andrea S. Wallace, University of Utah
• Alycia A. Bristol, University of Utah
• Erin Phinney Johnson, University of Utah School of Medicine
• Catherine E. Elmore, University of Utah
• Sonja E. Raaum, University of Utah School of Medicine
• Angela Presson, University of Utah School of Medicine
• Kaleb Eppich, University of Utah School of Medicine
• Mackenzie Elliott, University of Utah
• Sumin Park, University of Utah
• Benjamin S. Brooke, University of Utah School of Medicine
• Marianne E. Weiss, Marquette UniversityFollow

Document Type

Article

Publication Date

10-2024

Publisher

Lippincott Williams & Wilkins, Inc.

Source Publication

Medical Care

Source ISSN

0025-7079

Original Item ID

10.1097/MLR.0000000000002048

Abstract

Background: 

Social risk screening during inpatient care is required in new CMS regulations, yet its impact on inpatient care and patient outcomes is unknown.

Objectives: 

To evaluate whether implementing a social risk screening protocol improves discharge processes, patient-reported outcomes, and 30-day service use.

Research Design: 

Pragmatic mixed-methods clinical trial.

Subjects: 

Overall, 4130 patient discharges (2383 preimplementation and 1747 postimplementation) from general medicine and surgical services at a 528-bed academic medical center in the Intermountain United States and 15 attending physicians.

Measures: 

Documented family interaction, late discharge, patient-reported readiness for hospital discharge and postdischarge coping difficulties, readmission and emergency department visits within 30 days postdischarge, and coded interviews with inpatient physicians.

Results: 

A multivariable segmented regression model indicated a 19% decrease per month in odds of family interaction following intervention implementation (OR=0.81, 95% CI=0.76–0.86, P< 0.001), and an additional model found a 32% decrease in odds of being discharged after 2 pm (OR=0.68, 95% CI=0.53–0.87, P=0.003). There were no postimplementation changes in patient-reported discharge readiness, postdischarge coping difficulties, or 30-day hospital readmissions, or ED visits. Physicians expressed concerns about the appropriateness, acceptability, and feasibility of the structured social risk assessment.

Conclusions: 

Conducted in the immediate post-COVID timeframe, reduction in family interaction, earlier discharge, and provider concerns with structured social risk assessments likely contributed to the lack of intervention impact on patient outcomes. To be effective, social risk screening will require patient/family and care team codesign its structure and processes, and allocation of resources to assist in addressing identified social risk needs.

Comments

Accepted version. Medical Care, Vol. 62, No. 10 (2024, October): 639-649. DOI. © 2024 The Authors. Used with permission.

Recommended Citation

Wallace, Andrea S.; Bristol, Alycia A.; Johnson, Erin Phinney; Elmore, Catherine E.; Raaum, Sonja E.; Presson, Angela; Eppich, Kaleb; Elliott, Mackenzie; Park, Sumin; Brooke, Benjamin S.; and Weiss, Marianne E., "Impact of Social Risk Screening on Discharge Care Processes and Postdischarge Outcomes A Pragmatic Mixed-Methods Clinical Trial During the COVID-19 Pandemic" (2024). College of Nursing Faculty Research and Publications. 1100.
https://epublications.marquette.edu/nursing_fac/1100