Evidence that supports the value of social work in hospitals

The value of hospital social work is supported by one hospital's tracking system that monitored social work discharge services and compared outcome with non-social work discharges. The sample consisted of a total of 64,722 patients admitted to the "med-surg" hospital unit over a two and one-half year time period from 2002 to 2004. Of the total patients in the sample, 15.7% (n = 10,156) had social work involvement. Sixty percent of the social worker patients were age 70 or over compared with the mean age of the sample of 56.2 years. The mean length of stay for social work served patients was 11.4 days (sd = 13.9) compared to 4.3 days (sd = 6.3) non-social work patients, a difference that was significant (t =-68.3; p = .000). The authors attribute the longer lengths of stay to social workers' receiving older and more difficult-to-place patients. An evidence-based case is made for the cost-containment value of social workers in hospitals and for the creation of a tracking infrastructure to aid in monitoring the daily achievements of medical/surgical social workers.     

Predicting length of stay in an acute care hospital: the role of psychosocial problems.

In an acute care hospital, a major performance indicator is patient length of stay. This study, in a large university teaching acute care hospital in Canada, examined the effect of psychosocial problems on length of stay, controlling for patient demographics and medical condition. Average days stay for Diagnostic Related Groups (DRGs) was used as a proxy variable for severity of medical condition, and the Person-in-Environment (PIE) classification system was used to measure psychosocial problems. Data were collected on a sample of 160 patients; 78 in psychiatry and 82 in medical/surgical wards. In a regression analysis, the severity of the patient's psychosocial problem was a more significant predictor of length of stay than the DRG variable. The identification of psychosocial problems and their severity add an important and complementary dimension to research into the effectiveness of social workers in reducing length of stay. Workers found clients had significantly more problems related to their social role functioning than problems in the environment.     

Evaluation research on social work interventions: a study on the impact of social worker staffing

This study examined the impact of social worker staffing on depression and health-related quality of life (QOL) of end-stage renal disease patients on hemodialysis. Social workers in most dialysis units work a 5-day week. Patients are usually dialyzed three times per week. Patients on a Monday-Wednesday-Friday schedule have access to their social worker 3 days a week, while the Tuesday-Thursday-Saturday schedule patients have only 2 days; that is, contact with the social worker is reduced by one third for those patients. Findings demonstrated that those patients who had access to the social workers one third less time had statistically significant poorer QOL on 4 of the 5 domains measured, and had clinically indicated levels of depression. Findings reinforce the importance of the social worker in the life of the dialysis patient.     

Evaluation Research on Social Work Interventions: A Study on the Impact of Social Worker Staffing

ABSTRACT

This study examined the impact of social worker staffing on depression and health-related quality of life (QOL) of end-stage renal disease patients on hemodialysis. Social workers in most dialysis units work a 5-day week. Patients are usually dialyzed three times per week. Patients on a Monday-Wednesday-Friday schedule have access to their social worker 3 days a week, while the Tuesday-Thursday-Saturday schedule patients have only 2 days; that is, contact with the social worker is reduced by one third for those patients. Findings demonstrated that those patients who had access to the social workers one third less time had statistically significant poorer QOL on 4 of the 5 domains measured, and had clinically indicated levels of depression. Findings reinforce the importance of the social worker in the life of the dialysis patient.     

Overcoming Barriers to Eye Care: Patient Response to a Medical Social Worker in a Glaucoma Service

This paper investigates the patient response to a medical social worker in a glaucoma clinic. The literature suggests that medical social workers are effective in a variety of health care settings, yet the efficacy of a medical social worker in an adult ophthalmic setting has not been studied. We present the results of a retrospective chart review of 50 patients with glaucoma referred to a medical social worker between January 5, 2015 and June 31, 2015 in an outpatient clinic of an urban eye hospital. Clinical and demographic data, as well as the data from a quality of care questionnaire, were collected for each patient. Patients rated their interaction with the medical social worker as highly positive (mean = 4.75, 5-point Likert scale), and nearly 90 % of patients expressed interest in future contact with the social worker. Additionally, most patients reported that the social worker resolved the issues they were facing (61.1 %), supported them in seeing their ophthalmologist (70.6 %), and helped them to manage their glaucoma (69.7 %). Reported barriers to glaucoma care were emotional distress; cost of office visits and medications; lack of medical insurance; transportation; poor medication adherence; impairment of daily activities; follow-up adherence; and language. As vision loss from glaucoma is irreversible, it is important to detect and treat patients at early stages of the disease. Therefore, it is imperative for patients to regularly visit their eye care providers and adhere to treatment and follow-up recommendations. This study suggests that a medical social worker could play a pivotal role in helping patients with glaucoma overcome barriers to treatment and facilitate disease management.     

Factors related to length of hospitalization of elderly patients during short stay

Length of stay of elderly patients in hospitals can be subdivised into a medical stay followed by a social stay. The average length of stay of 2134 patients aged 75 and over, admitted to 23 medical or geriatric acute wards in Aquitaine, was 13.6 days; 18% of the patients experienced a social stay of at least one day. The mean social stay was almost null (1 day) when the patient returned home, but could reach 5 days when he was discharged to a long term care facility. The kind of hospital, domicile in a rural area, the social network, and the grounds for hospitalization were significantly related to the total length of stay, but explained only 5% of variance if diagnosis was not taken into account. This percentage rose to 29% in the group with "bronchitis" as a main diagnosis. The length of social stay was related to the grounds for hospitalization, but also to recent family modifications; it did not depend on the kind of hospital. These results suggest a lack of accessibility to nursing-homes, following acute hospitalization.     

Timing of social work intervention and medical patient's length of hospital stay

Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the stay will be. A total of 243 patients referred for social services at a 440-bed teaching hospital were evaluated. Paired t-tests indicated a significant difference in the mean length of stay based on normative data. Timing of the intervention accounted for a significant amount of variance (13 percent) in length of hospital stay. The major clinical implications of the study are that social work intervention has the potential to decrease length of hospitalization, and that this methodology may be used reliably to evaluate changes in discharge planning protocol.     

The influence of social deprivation on length of hospitalisation

The implementation of activity-based payment system named T2A—tarification à l’activité—in 2004 profoundly modified the financing of French hospitals. Presently applied to activities concerning medicine, surgery and obstetrics, the pricing for these activities was developed using the National Costs Study. The considerable differences observed between costs in the private sector and those in the public sector are in part justified, by the latter, by caring for patients with social deprivation. The goal of this study is to measure the influence of social deprivation on the length of hospitalisation. A survey on inpatient social deprivation was carried out from November to December 2008 by the French Ministry of Health (Department of Research, Study, Evaluation and Statistics—DREES, and technical agency of Hospital information—ATIH). Four dimensions of social deprivation were taken into consideration after a previous qualitative study: social isolation, quality of housing, level of income and access to rights. The sample is based on 27 hospitals, including public and private (for-profit and not-for-profit), representing 57,175 stays, 6,800 of which were patients with social deprivation. After multivariate analyses adjusted for age, severity of illness and DRG, we found that there was a longer length of stay for inpatients with social deprivation (+16%), and in particular for patients living in social isolation (+17%) and for patients with inadequate housing (+17%). The impact of low income on the length of stay is less important. However, low income associated with inadequate housing significantly increases lengths of stay (+24%).     

Standardized screening of elderly patients' needs for social work assessment in primary care: use of the SF-36

Fewer hospitalizations and decreased lengths of stay in the hospital have resulted in an increased need for extensive support services and continuing care planning for elderly people in primary care. Early identification of elderly patients needing community and hospital nonmedical services is necessary so that timely appropriate services can be delivered. This study addresses the issue of whether a standardized health-related quality of life questionnaire, the SF-36, can be used independently as a screen predicting primary care elderly patients' needs for social work assessment. In addition, the question of what scales on the SF-36 a social worker would use to screen patients in need of assessment is explored.     

Psychosocial assessment of patients who have undergone inpatient cancer rehabilitation

This study summarized the social work services provided in an acute inpatient cancer rehabilitation program. Reviewed were 49 consecutive social worker assessments from February 2003 to March 2003. The social worker was consulted mostly for discharge planning (40/49, 82%) and helping patients cope (23/49, 47%). Sixty-seven percent of the patients (33/49) were coping well. Sixty-five percent of patients (32/49) had an identified caregiver. Most patients planned to go home (33/49, 67%) after their discharge. Interventions provided by the social worker included counseling (100% of patients/ families), referral to financial resources (24/49, 49%) and transportation services (21/49, 43%), and other resources (37/49, 76%). Age, gender, and identified caregiver did not show significant association with the coping status or referrals. The social worker is important in assessing cancer patients' coping and providing support.     

An evidence-based case for the value of social workers in efficient hospital discharge

A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.     

The inappropriate use of acute hospital beds in an inner London District Health Authority

The requirement for District Health Authorities to assess the health care needs of their population implies that they must consider how well acute hospital care meets these identified needs. This study, which was conducted in an inner London health district, identified that 123 (14.6%) patients were perceived by medical and/or nursing staff to be inappropriately located in an acute bed. This group was dominated by patients aged 65 years or above, those in general and geriatric medicine, those with a length of stay of 30 days or more, and those with high levels of physical and mental dependency. The main reasons for patients being labelled as 'inappropriate' were the need for non-acute health services (eg rehabilitation, terminal care etc), a need for nursing home places or because of social or housing problems. Five months after identification, the notes of 100 of the 123 inappropriate patients were traced. Retrospective classification of these notes using the more 'objective' Oxford Bed Study Instrument showed that 97 patients were still defined as inappropriate. Details of the length of inappropriate stay were available for 74 patients who accrued 7,519 inappropriate bed days at a cost of 836,547 pounds. These patients are an illustration of the potential failings of current health and social care systems and highlight the need for imaginative care solutions which bridge this divide.     

Single Contacts with Hospital Social Workers: The Clients' Experiences

Decreasing lengths of stay in acute hospitals result in social workers often being unable to engage in planned interventions with clients over a number of sessions. Single session work is a reality for much social work practice. This article reports on a qualitative study of clients' experiences of a single contact with a social worker in a hospital setting. Building on prior research on hospital social workers' experiences of single session work, the study found that rapport building, empathy, non-judgmentalism, practical assistance, and advocacy are important features of the social work role in the intense and time limited context of single session hospital social work.     

医疗保险模式对深圳市职工就医的影响

为研究医疗保险模式对职工就医行为的影响，采用分层整群随机抽样的方法对深圳市１３３６名职工进行了调查，结果表明：实施社会统筹与个人医疗帐户相结合的医疗保险模式、采用按平均费用标准偿付的支付方式，对职工就医行为及卫生服务利用程度上都有很大影响，职工两周就诊率和年住院率均高于１９９３年全国大城市平均水平，而年人均住院日与之比较则偏低，参保职工比未参保职工能更充分的利用卫生服务，职工的就医行为更规范、合理     

Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay.

OBJECTIVE: An evaluation of the impact of a social work preadmission program on length of stay (LOS) of orthopedic patients undergoing elective total hip or total knee replacement surgeries (under diagnosis-related groups [DRGs]) at the Hadassah Ein-Kerem Hospital in Jerusalem is Israel. INTERVENTION: The social work interventions included preadmission psychosocial evaluation and preliminary discharge planning, coordination of nursing and physiotherapy evaluations, ensuring completion of all medical tests prior to admission, and additional psychosocial follow-up during hospitalization to carry out the original discharge plan or prepare alternatives. PATIENTS: The intervention patients were divided into two groups in order to see changes over time: May through December 1994 (n = 48), and January through December 1995 (n = 81). The comparison groups included patients operated on at the same hospital during 1993 (n = 51) and during January through April 1994 (n = 21) and at the Hadassah Mount Scopus Hospital during the same time periods. Patients in the comparison groups received usual social work intervention, as necessary, only after hospitalization. RESULTS: Mean LOS was reduced significantly in the intervention patient groups, as compared to the preintervention patient groups in the same hospital, from 14.2 days (standard deviation [SD], 4.7) in 1993 and 14.7 (SD, 5.1) in January through April 1994 to 10.9 (SD, 3.0) in May through December 1994 and to 9.1 (SD, 2.8) in 1995 (P < .01). Length of stay also was reduced in the comparison hospital, but by 1995 was longer than in the intervention patients. No differences in LOS by gender, age, or marital status were found. Length of stay was significantly longer for those undergoing total hip replacement as compared to those undergoing total knee replacement in all the groups. CONCLUSIONS: Preadmission screening and case management by a social worker can contribute to the efforts to decrease LOS of orthopedic patients by early multidisciplinary evaluations, discharge planning, and coordination of services.     

Can physicians' admission evaluation of patients' status help to identify patients requiring social work interventions?

OBJECTIVE: To evaluate the utility of these physicians' initial clinical assessments in identifying patients admitted from their homes who subsequently require social work intervention for discharge planning. DESIGN: Retrospective chart review of discharge disposition correlated with a prospective physician evaluation of patients. SETTING: An academic medical center. Participants: Consecutive patients, (2,571) men and women, admitted at the New York Hospital between July 1, 1997 and October 31, 1997. MEASUREMENT: Prospective evaluation of clinical status, functional status, illness severity and stability by physicians within 24 hours of admission. RESULTS: Older patients, sicker and less functional, have higher needs for social work intervention (P < 0.001). New nursing home placement patients were older and had worse function (P < 0.001). Total cost of hospitalization and length of stay were predicted by discharge disposition. CONCLUSION: Early discharge intervention has often been targeted as a potential mechanism to lower hospitalization cost and reduce length of stay. Age and physician evaluation of functional status at admission may provide early identification of those who require social work assistance.     

Feeding practices of severely ill intensive care unit patients: an evaluation of energy sources and clinical outcomes

OBJECTIVE: The quantity of nutrition that is provided to intensive care unit (ICU) patients has recently come under more scrutiny in relation to clinical outcomes. The primary objective of this study was to assess energy intake in severely ill ICU patients and to evaluate the relationship of energy intake with clinical outcomes. DESIGN: Prospective cohort study. SUBJECTS/SETTINGS: Seventy-seven adult surgery and medical ICU patients with length of ICU stay of at least 5 days. STATISTICAL ANALYSES PERFORMED: Student's t test and chi2 tests were used to examine ICU populations. To determine the relationship of patient variables to hospital length of stay and ICU, length of stay regression trees were calculated. RESULTS: Both groups were underfed with 50% of goal met in surgical ICU and 56% of goal met in medical ICU. Medical ICU patients received less propofol and significantly less dextrose-containing intravenous fluids when compared to surgical ICU patients (P=0.013). From regression analysis, approaching full nutrient requirements during ICU stay was associated with greater hospital length of stay and ICU length of stay. For combined groups, if % goal was > or =82%, the estimated average value for ICU length of stay was 24 days; whereas, if the % goal was <82%, the average ICU length of stay was 12 days. This relationship held true for hospital length of stay. CONCLUSIONS: Medical and surgical ICU patients were insufficiently fed during their ICU stay when compared with registered dietitian recommendations. Medical ICU patients received earlier nutrition support, on average more enteral nutrition, with fewer kilocalories supplied from lipid-based sedatives and intravenous fluid relative to surgical ICU patients. Based upon length of stay, the data suggest that the most severely ill patient may not benefit from delivery of full nutrient needs in the ICU.     

四川省三级医院慢性阻塞性肺疾病患者参加医疗保险类型与其住院时间的关系——基于分位数回归模型的实证分析

目的:分析慢性阻塞性肺疾病(COPD)患者参加医疗保险类型与其住院时间的关系,对患者平均住院日的降低和医疗保险支付方式的完善提供参考。方法:利用2016年第四季度在四川省三级医院就诊的36329例COPD患者病案首页信息,采用分位数回归模型,分析患者不同参保方式与其住院天数的关系。结果:不同参保方式患者的住院时间存在统计学差异,且这种差异大部分是由参保方式不同造成的。全公费患者住院天数最长,新型农村合作医疗参保患者最短,这种差异随住院时间分位数的提高而变大。结论:不同参保方式的COPD患者住院时间存在差异。全公费和城镇职工医疗保险参保患者的住院天数相对更长的可能原因是医院过度提供医疗服务;新型农村合作医疗参保患者的住院时间最短,可能原因是医院将其住院床位转移给了全公费和城镇职工医疗保险患者;不同医疗保险主办方监管力度不同也可能是造成差异的原因。