Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2382–2389 | Cite as

Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study

  • Adam SchickedanzEmail author
  • Adam Sharp
  • Yi R. Hu
  • Nirav R. Shah
  • John L. Adams
  • Damon Francis
  • Artair Rogers



Programs addressing social determinants of health for high-utilizing patients are gaining interest among health systems as an avenue to promote health and decrease utilization.


To evaluate impacts of a social needs screening and navigation program for adult predicted high utilizers on total medical visit utilization.


A prospective, quasi-experimental study using an intent-to-treat propensity-weighted difference-in-differences approach. Stratified analyses assessed intervention effects among three low–socioeconomic status sub-samples: patients in low-income areas, in low-education areas, and with Medicaid insurance.


Predicted high utilizers—patients predicted to be in the highest 1% for total utilization in a large integrated health system.


A telephonic social needs screening and navigation program.

Main Measures

Primary difference-in-difference analyses compared total visit count utilization, including outpatient, emergency department (ED), and inpatient utilization, between the intervention and control groups at both in-network and out-of-network facilities. Prevalence of social needs among sample patients and their connection rates to social needs resources are also described.

Key Results

The study included 34,225 patients (7107 intervention, 27,118 control). Most (53%) patients screened reported social needs, but only a minority (10%) of those with a need were able to connect with resources to address these needs. Primary analysis found total utilization visits decreased 2.2% (95% CI − 4.5%, 0.1%; p = 0.058) in the intervention group. Stratified analyses showed decreases in total utilization for all low–socioeconomic status subgroups receiving the intervention compared with controls: − 7.0% (95% CI − 11.9%, − 1.9%; p = 0.008) in the low-income area group, − 11.5% (− 17.6%, 5.0%; p < 0.001) in the low-education area group, and − 12.1% (− 18.1%, − 5.6%; p < 0.001) in the Medicaid group.


Social needs navigation programs for high-utilizing patients may have modest effects on utilization for the population overall. However, significant decreases in utilization were found among low–socioeconomic status patients more likely to experience social needs.


social determinants of health high utilizers social needs health care utilization 



The authors wish to thank the patients of Kaiser Permanente for the use of information collected through the electronic health record.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5123_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 24 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Adam Schickedanz
    • 1
    Email author
  • Adam Sharp
    • 2
    • 3
  • Yi R. Hu
    • 2
  • Nirav R. Shah
    • 4
  • John L. Adams
    • 2
  • Damon Francis
    • 5
  • Artair Rogers
    • 5
    • 6
  1. 1.Department of Pediatrics David Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Research and Evaluation DepartmentKaiser Permanente Southern CaliforniaPasadenaUSA
  3. 3.Department of Emergency MedicineKaiser Permanente Los Angeles Medical CenterLos AngelesUSA
  4. 4.Stanford University Clinical Excellence Research CenterStanfordUSA
  5. 5.Health LeadsBostonUSA
  6. 6.Kaiser Permanente Southern CaliforniaPasadenaUSA

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