The emergency department (ED) has long been described as the, “safety net of the safety net,” providing care to anyone, for anything at any time, including the most vulnerable of populations. Emergency physicians have long seen the impact of social factors such as food scarcity, housing instability, and discrimination (including systemic racism) have on the health and well-being of our patients—issues that are pervasive regardless of one’s location or practice setting.

I disagree with those who assert that addressing social needs is outside the purview of the field of medicine. The COVID-19 pandemic is an extreme, but excellent, example of the interconnections between public policy and public health. As Dr. Rudolph Virchow famously stated, “medicine is a social science,” indicating that physicians cannot practice in a vacuum and ignore the social context of our patients’ (and our own) lives and experiences.

Care Coordination Decreased Inpatient Hospitalizations by 40%

by Dr. Diana Halloran

The population of older adults is expected to double by 2050—and it is anticipated that emergency department visits and hospitalizations among this group will continue to rise. Given our already overburdened health care system, which has become even more strained with the COVID-19 pandemic, it will be pivotal to identify interventions that can reduce the strain on hospitals and health care workers.

A recent article did just that by assessing changes in health care utilization after enrolling older adults in a community care connection program.1 The program aimed to coordinate health care and social services for older adults to minimize hospitalizations and emergency department visits and to improve health outcomes. Interestingly, the program was associated with 40 percent fewer inpatient hospitalizations within the 90 days after program enrollment but was not associated with fewer ED visits. The authors suspect the absence of reduced ED visits could be due to errors in matching the enrollment group to the comparison adult group, underlying institutional or social factors, or the continued care-seeking behavior of the patients who desired to visit the ED.

Overall this paper is consistent with previous studies showing evidence of decreased hospitalizations upon the addition of social interventions. Managing patients’ medical issues without addressing their social needs ignores the effect of social determinants on health. The joining of health care and social programs, such as meal programs and care coordination, can be fundamental in improving health care systems and patient care overall. However, the data are not straightforward. A systematic review revealed the limited availability of research on emergency department visit reduction programs, and a recent randomized controlled trial regarding assigning health care super-utilizers to a care-transition program failed to reduce readmission rates. The union between health care and social programs remains a complex issue and the previously mentioned research demonstrates the need for additional studies and discussion in this area.