Predictive Modeling for Social Needs in Emergency Department Settings

Indiana University518,512 enrolled

Overview

The overall objective of this study is to support emergency department management of patients' health-related social needs. This study will measure the impact of a decision support system that informs clinicians about which patients are likely to screen positive for a health-related social need. The system uses statistical models to create a health-related social need risk score for each patient. The main questions, the study aims to answer are: * Does providing emergency department clinicians with risk scores on health-related social needs increase screening and referral activities? * Does providing emergency department clinicians with risk scores on health-related social needs change patients' use of healthcare services? The decision support system with health-related social needs risk scores will be introduced for all adult patients at one emergency department. Screening rates, referrals, and subsequent healthcare encounters will be compared with emergency departments that did not have access to the decision support system.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

518,512

Conditions

Emergency Service, Hospital Social Determinants of Health

Interventions

The clinical decision support intervention will present emergency department clinicians at an Indianapolis, IN ED with a likelihood score for an adult patient screening positive for the following health-related social needs (HRSNs): housing instability, food insecurity, transportation barriers, financial strain, and history of legal involvement. For each HRSN, the likelihood of screening positive is reported as "high", "medium", or "low". These categorizations are the product of logistic regression models. The clinical decision support intervention will be delivered through an existing FHIR (Fast Healthcare Interoperability Resources) standards-based clinical decision support platform.

Outcomes

Primary Outcomes

Percent of emergency department encounters screened for health-related social needs (HRSNs)

The numerator will be an emergency department encounter with any indication of HRSN screening using any tool or questionnaire, regardless of patient completion or results. The denominator will be all eligible ED encounters.

Time frame: At time of emergency department encounter (or within 24 hours)

Percent of emergency department encounters that were referred for health-related social needs (HRSNs) services

The numerator will be emergency department encounters with a referral to social worker, case management, community health workers, or related services within 24 hours of the ED encounter. The denominator will be all eligible ED encounters

Time frame: At time of emergency department encounter (or within 24 hours)

Secondary Outcomes

Percent of encounters with an emergency department revisit measured at 3 days

The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 3 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator.

Time frame: within 3 days of emergency department encounter

Percent of encounters with an emergency department revisit measured at 7 days

The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 7 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator.

Time frame: within 7 days of emergency department encounter

Percent of encounters with an emergency department revisit measured at 30 days

The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 30 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator

Time frame: within 30 days of emergency department encounter

Percent of emergency department encounters with primary care visit within 7 days of an ED encounter

The numerator will include all emergency department encounters with a completed family medicine, internal medicine, OBGYN, or geriatrician visit64 within 7 days of the ED visit. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator.

Time frame: within 7 days of emergency department visit