Embedding Social Workers in VA Primary Care Teams Reduces Emergency Department Visits
Social workers embedded in primary care settings serve as integral members of the care team and address social determinants of health (i.e., housing, economics, access to care, psychological status, functional status, social support) experienced by Veterans, their families, and caregivers. In addition, social workers provide care coordination, education, and participate in quality improvement efforts to identify and advocate for needed resources and services in VA. In 2016, VA's National Social Work Program initiated the Social Work Patient Aligned Care Team (PACT) Staffing Program, which provided funding from the Office of Rural Health for PACT social workers to serve Veterans living in rural areas. This study evaluated the impact of this program on 379,213 Veterans who had at least one primary care visit between October 2016 and June 2019 at one of 93 VA outpatient sites. The evaluation team measured three main outcomes: encounters with a social worker, emergency department (ED) visits, and hospital admissions.
- Results from the first three years of the Social Work PACT Staffing Program suggest that addressing Veterans’ social determinants of health is an integral component of delivering effective primary care. For example, the percentage of ED visits for Veterans in the study cohort decreased after a PACT social worker was assigned to the primary care clinic.
- Among high-risk patients (n=46,828) there was a 3% decrease in Veterans who had ED visits and a 4% decrease in the number of Veterans who had acute hospital admissions. This translates to an expected decrease of about 8,000 fewer VA-paid ED visits per year after the deployment of additional social workers, and as many as 9,000 fewer hospital days.
- The program increased social work visits by 33% (46 visits per 1,000 Veterans per 60 days) in the full cohort, and by 29% (194 visits per 1,000 Veterans per 60 days) in the high-risk group.
- Social workers provide measurable value in reducing preventable urgent care use in VA. Policymakers and administrators in other healthcare systems also may take note of the unique contributions of social workers in identifying and addressing patients' social determinants of health.
- The evaluation team was only able to measure healthcare provided by or paid for by VA.
- Sites that participated in the Social Work PACT Staffing Program were not representative of VA primary care clinics nationally: they served more Veterans from rural areas.
This study was partly funded by VA HSR&D’s Quality Enhancement Research Initiative (QUERI) and by the National Social Work Program Office. Ms. Taylor is the National Director of Social Work. Drs. Cornell and Rudolph, and Mr. Halladay are part of HSR&D’s Center for Innovation for Long-Term Services and Supports for Vulnerable Veterans in Providence, RI.
Cornell PY, Halladay CW, Ader J, Halaszynski J, Hogue M, McClain CE, Silva JW, Taylor LD, Rudolph JL. Embedding Social Workers in Veterans Health Administration Primary Care Teams Reduces Emergency Department Visits. Health Affairs. April 2020;39(4):606-612.