Exploring the Efficacy of Social Work Interventions in Hospital Settings: A Scoping Review.

Social workers play an integral role in hospitals, particularly as it relates to improving patient outcomes. This scoping review was conducted to explore the impact of social work interventions in hospital settings on healthcare utilization. Research literature was identified using the following search engines: PsycINFO, CINAHL Plus, SocINDEX & MEDLINE. The initial search was conducted in May 2019, and an updated search was conducted in April 2021. Search results identified 2633 references and 110 articles met criteria for full-text review. Eighteen articles were included in the final review. Social work interventions include transitional care (56%), care coordination (22%), behavioral health (17%) and case management (5%). Significant improvements to readmission, mortality and utilizations rates are reported in over 80% of the studies, however the vast majority are non-randomized quantitative studies. More rigorous studies are needed to expand the literature and further evaluate the effectiveness of social work interventions in hospital settings.

Social work-based transitional care intervention for super utilizers of medical care: a retrospective analysis of the bridge model for super utilizers.

The present study was a retrospective evaluation of a social worker-led transitional care intervention that addresses the medical and social needs of inpatient super utilizers with ≥5 inpatient admissions in a 12-month period. Bivariate analyses revealed significant reductions in the total number of hospital admissions, 30-day readmission rates, number of emergency department visits, average hospital charges per episode, and total hospital charges per person after the intervention. This social work intervention may be of interest to providers and payers, particularly regarding addressing the psychosocial needs of complex patients who account for most of health care costs.

Implementing and sustaining evidence-based practice in health care: The Bridge Model experience.

This qualitative study analyzed the experience of community-based organizations (CBOs) implementing and sustaining the Bridge Model of Transitional Care, a social work-based health service intervention for reducing hospital readmissions. We conducted semi-structured interviews with clinical supervisors from 13 CBOs that received Bridge Model training between 2012 and 2015. CBOs faced significant challenges implementing and sustaining transitional care programs, particularly related to building effective and sustainable partnerships with hospitals. Additional barriers to program implementation and sustainability included financial barriers and staff turnover. Facilitators to implementation and sustainability included organizational champions, organizational culture, and value of evidence. Recommendations for CBOs to implement health service interventions include gaining early buy-in from hospital partners, creating a contractual arrangement with the hospital partner, understanding changes in health-care payment models, diversifying funding sources, developing an evaluation plan, and nurturing organizational champions.

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care.

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components-care coordination, case management, and patient engagement-which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment's emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.