Social Work Staffing and Use of Palliative Care Among Recently Hospitalized Veterans

Abstract

ImportancePalliative care improves quality of life for patients and families but may be underused.ObjectiveTo assess the association of an intervention to increase social work staffing in Veterans Health Administration primary care teams with use of palliative care among veterans with a recent hospitalization.Design, Setting, and ParticipantsThis cohort study used differences-in-differences analyses of the change in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, conducted from October 1, 2016, to September 30, 2019. The study included 71 VA primary care sites serving rural veterans. Participants were adult veterans who received primary care services from a site enrolled in the program and who received inpatient hospital care. Data were analyzed from January 2020 to August 2022.ExposuresThe PACT staffing program was a clinic-level intervention that provided 3-year seed funding to Veterans Health Administration medical centers to hire 1 or more additional social workers in primary care teams. Staggered timing of the intervention enabled comparison of mean outcomes across sites before and after the intervention.Main Outcomes and MeasuresThe primary outcome was the number of individuals per 1000 veterans who had any palliative care use in 30 days after an inpatient hospital stay.ResultsThe analytic sample included 43 200 veterans (mean [SD] age, 65.34 [13.95] years; 37 259 [86.25%] men) and a total of 91 675 episodes of inpatient hospital care. Among the total cohort, 8611 veterans (9.39%) were Black, 77 069 veterans (84.07%) were White, and 2679 veterans (2.92%) were another race (including American Indian or Alaskan Native, Asian, and Native Hawaiian or other Pacific Islander). A mean of 14.5 individuals per 1000 veterans (1329 individuals in all) used palliative care after a hospital stay. After the intervention, there was an increase of 15.6 (95% CI, 9.2-22.3) individuals per 1000 veterans using palliative or hospice care after a hospital stay, controlling for national time trends and veteran characteristics—a 2-fold difference relative to the mean.Conclusions and RelevanceThis cohort study found significant increases in use of palliative care for recently hospitalized veterans whose primary care team had additional social work staffing. These findings suggest that social workers may increase access to and/or use of palliative care. Future work should assess the mechanism for this association and whether the increase in palliative care is associated with other health or health care outcomes.

Benefits and challenges in the use of RE-AIM for evaluation of a national social work staffing program in the veterans health administration

“…The effectiveness measures evaluated were number of Veterans in a month with any social work engagement, hospitalizations, emergency department use, and palliative care use. The methods are explained in detail in previously published work ( 12 , 13 ). For the “adoption” domain, sites were designated as “eligible” for the Staffing Program if more than 50% of Veterans in primary care lived in rural or highly rural areas based on ZIP codes, or if more than 50% Veterans engaged with social work are from rural or highly rural areas.…”