Social Needs Resource Navigators Help Limit Children's Health Care Utilization

Providing an in-person patient navigator to address family social needs can decrease child health care utilization, according to a study published in JAMA Network Open.

Previous research has established an association between social risk factors and child health outcomes, while professional medical organizations have endorsed screening for such factors in clinical settings.

Although uptake of screening has been inconsistent, the practice is more likely to occur in settings with high numbers of low-income patients. However, few studies have documented health effects of interventions designed to reduce identified social needs, according to researchers.

In a randomized clinical trial of 1300 families, investigators compared acute care utilization effects of a written resources handout with an in-person navigation service intervention to address social needs.

Between 2013 and 2015, adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in California were recruited to participate in the study. To address each family’s social needs, families were randomly assigned to an in-person navigator intervention (637 families [49%]) or an active control (663 families [51%]).

In the active control cohort, caregivers received written information about relevant local resources related to social needs, while the navigator intervention consisted of meeting with a patient navigator focused on helping resolve such social needs.

Specifically, “navigators contacted families every 2 weeks via telephone, email, or in person for up to 3 months or until either identified needs were met or caregivers declined ongoing assistance.” In the intervention group, navigators also “provided assistance connecting caregivers with clinic, government, or community resources targeted specifically to the social barriers that had been endorsed and prioritized by the caregiver.”

Social risk data were collected from each household using a questionnaire that asked about the following domains: food insecurity, problems paying utility bills, problems finding employment, housing instability, living in an unhealthy environment, problems paying medical bills, lack of health insurance, lacking a primary care physician, and problems with a current or former job, among other variables.

Of the 1809 caregivers recruited, 67.5% spoke English and the majority (86.7%) were women with an average age of 33 years. Caregivers were randomized to the active control group (937 [51.8%]) and the navigator intervention group (872 [48.2%]).

Out of 1300 families, 840 were recruited from urgent care facilities while most children (59.9%) were between ages 0 and 5. The majority of children (55.6%) were of Hispanic ethnicity.

Health care utilization was determined based on the number and date of emergency department (ED) visits and hospitalizations obtained from electronic health record data.

Although researchers found no significant difference in risk of an ED visit between the 2 groups throughout the 12-month follow-up period, data revealed:

• The active control group had 55 hospitalizations, with a mean of 0.08 hospitalizations per child (SD 0.30; 95% CI, 0.06 to 0.11)
• The patient navigator group had 35 hospitalizations, averaging 0.05 hospitalizations per child (SD 0.30; 95% CI, 0.03 to 0.08)
• Significantly fewer children from the in-person navigation group (29 [4.6%]) were admitted to the hospital during the year following enrollment compared with children from the active control group (50 [7.5%]; risk difference, −3.0%; 95% CI, −5.6% to −0.4%; relative risk, 0.60; 95% CI, 0.39 to 0.94)
• Children enrolled in the navigator intervention group had a decreased risk of being hospitalized (hazard ratio 0.59; 95% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized than children in the active control group

Currently, the average cost of a nonbirth pediatric inpatient hospitalization is $13,400, according to researchers, and the integration of an in-person navigator could lead to cost savings. To better understand the benefits of investing in the navigation intervention, cost-effectiveness analyses should be conducted, the authors noted.

Based on the results,the researchers hypothesized “decreased social risks may help families prioritize healthy behaviors, such as nutritious food or physical activity, or decrease unhealthy exposures, such as mold.” However, the current study does not clarify how the intervention specifically operated. Future research on how addressing social needs contributed to changes in children’s health and healthcare utilization should also be conducted, they wrote.

“The services of a volunteer navigator, who worked with families longitudinally to help them connect with available social services, were associated with reduced risk of child hospitalization,” the authors concluded. “Social care programs in other pediatric settings could potentially result in large reductions in inpatient stays and associated cost savings.”

Reference:

Pantell MS, Hessler D, Long D, et al. Effects of in-person navigation to address family social needs on child health care utilization: A randomized clinical trial [published online June 1, 2020]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.6445