Assistant Director Clinical Documentation Integrity
Clinical Documentation Integrity
Cheryl Codner, Cristina J. Toledo-Cornell, Mark J. Ommerborn, Cheryl R. Clark
Cheryl R. Clark
Research Category: PCERC/Health Policy/Outcomes
In 2017, the US Centers for Medicare & Medicaid Services (CMS) launched an initiative to test whether screening and referring for health-related social needs (HRSNs) would reduce utilization and health care expenditures. In a concurrent, local project we screened and referred 427 patients at two Brigham and Women’s Hospital Community Health Centers for HRSNs in 2017. We assessed each patient’s emergency department (ED) utilization from chart reviews of medical record over five years. We sought to understand associations between HRSNs and annual emergency department utilization. In fully adjusted ordinal logistic regression models, individuals who identified any social need (OR: 2.88, 95% CI: 1.21, 6.86) or identified financial hardship (OR: 1.97, 95% CI: 1.01, 3.84) were more likely to have three or more ED visits in a year compared to those who did not identify a need. Individuals who identified chronic pain (OR: 2.30, 95% CI: 1.13, 4.67) or anxiety/depression (OR: 3.35, 95% CI: 1.17, 6.59) were also more likely to visit the ED three or more times in a year. Based on these findings, we believe screening and referrals to address patient’s HRSNs may decrease emergency department utilization and improve health outcomes for patients over time.
In 2017, we launched a project to understand if screening and referring patients for social needs (i.e.: food insecurity, financial hardship, housing needs) would reduce emergency room visits and hospital services use. We screened 427 patients at two community health centers in Boston for social needs. We followed each patient for five years to understand if patients who identified social needs were more likely to go to the emergency department for care than patients who did not identify social needs. We found that patients who identified any social needs were more likely to go to the emergency department for care compared to patients who did not identify any social needs. We found that patients with financial hardship were particularly more likely to go to the emergency department for care compared to patients without financial hardship. To decrease the need for patients to have to go to the emergency department for care, it may be important for health systems to screen and refer patients for services addressing their social needs.