Big decline when student volunteers helped safety-net households address social needs

Children and families from safety-net clinics saw considerably fewer hospitalizations when a patient navigator helped them address social needs, new randomized clinical trial data show.

“We found that during the 12 months after study enrollment, children enrolled in the trial’s patient navigator intervention had a 69% reduced risk of hospitalization than children in the active control group, but the intervention had no effect on ED visits,” wrote Matthew Pantell, MD, a pediatrician-researcher with the University of California, San Francisco, and colleagues, in JAMA Network Open. “This translated to only 4.6% of patient navigator families having their child hospitalized versus 7.5% among the active control group.”

The recent data were the latest products of a study that previously linked in-person navigation to improved child health and decreases in reported social needs. Several leading medical organizations have endorsed the use of screenings as a way to shed more light on the social determinants of health, but there is less clarity when it comes to actually addressing the needs that screenings identify.

“To date, 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,” Pantell and colleagues wrote. “In this study, we contribute to the rapidly evolving literature by investigating the effect on acute health care utilization in the 12 months following enrollment in 1 of 2 social care interventions designed to assist caregivers of pediatric patients with access to social resources.”

The study authors recruited student volunteer caregivers to provide support to children and families from 2 safety-net health systems located in northern California. All participating caregivers were at least 18 years old and were familiar with a participating household’s social characteristics, among other factors. Most children in the study lived in households taking in $20,000 or less each year. Navigators received 8 hours of training on topics including cultural humility, motivational interviewing, and relevant social services.

Of the 1,300 caregivers enrolled in the study, about two-thirds spoke English (878 [67.5%]) and were women (1,127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years of age. Most children in the study were 0-5 years of age (779 of 1,300 [59.9%]), 723 (55.6%) were of Hispanic ethnicity, and 462 children (35.5%) were determined to be in excellent health.

All told, 637 families (49.0%) were randomized to the navigator group, with 663 (51.0%) assigned to an active control group.

Children in the navigator group saw a lower hospitalization risk within 12 months (HR 0.59; 05% CI 0.38-0.94; P=.03) compared with the active control group. At the same time, emergency visits did not differ significantly between the two groups, with 236 children (37.1%) in the intervention group visiting the emergency department at least once during the study period compared with 250 children (37.7%) in the active control group. Concordantly, the intervention group saw a -0.7% lower risk of emergency visits between navigator and active control participants (95% CI -5.9%-4.6%), and a relative risk of 0.98 (95% CI 0.85-1.13).

Fewer children from the navigation group (29 [4.6%]) were hospitalized during the post-enrollment year compared with those in the active control group (50 [7.5%]; risk difference, -3.0%; 95% CI -5.6% to -0.4%; RR 0.60; 95% CI 0.39-0.94).

Among the limitations identified by the authors, a low rate of enrollment may have led to selection bias, with families enrolling in the study not representative of broader clinic populations. Further, families in the intervention group reported more social needs at baseline, although both groups reported more than 2 such needs at baseline.

In an accompanying editorial, Chen Kenyon, MD, with the Center for Pediatric Clinical Effectiveness and PolicyLab at the Children’s Hospital of Philadelphia, and colleagues, none of whom were affiliated with the study, wrote that the new data further reinforced the study’s original findings—that these interventions can yield real results.

“Based on the findings, health systems hoping to implement social needs interventions in pediatrics can claim with more certainty that social needs interventions can lead to meaningful improvements in a costly health care outcome, ie, hospitalization,” Kenyon and colleagues wrote.

With the findings seeming to underscore the potential viability of the interventions, Kenyon and colleagues stated that new studies into the details of in-person navigation assistance is an important next step.

“We still do not know enough about how these interventions work or can work,” Kenyon and colleagues wrote. “However, a necessary stakeholder must remain at the table as we move to implement these now-reimbursable services: the families we serve. We need to listen to families’ concerns regarding privacy, data-sharing, and, most importantly, what level of support they think they need to make meaningful referral connections.”

  1. Hospitalization risk declined by two-thirds among children who worked with patient navigators.

  2. Experts: navigation helps clinics follow through on social needs issues uncovered by screenings, which can decrease healthcare utilization.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this article disclosed any relevant financial relationship with industry.

Cat ID: 138

Topic ID: 85,138,585,730,138,139,192,925