Assessing the Impact of Social Work on Patient Outcomes and Long-Term Care Utilization: Evidence from Primary Care Teams in the Veterans Health Administration

Primary-care medical-home models of care that include a social-work case manager on the care team are being adopted across health systems, but the impact of social workers on health care outcomes has not been rigorously studied. Starting in 2016, the Veterans Health Administration funded an initiative to place additional social workers in rural primary-care clinics to address barriers to accessing health care, coordinate with community providers, and provide case management services. We leveraged variation in the timing of social worker start dates at 109 participating sites to estimate the difference-in-differences effect of social work staffing on Veterans’ health care utilization and outcomes, using data from the electronic health records and charges from non-VA providers for 938,000 Veterans. We found that an additional social worker in a rural primary-care medical home increased the rate of hospital admissions by 1.4 percentage points (p<0.01), an increase of about fifteen percent from the mean, but had no effect on hospitalizations for ambulatory-care sensitive conditions. Our findings suggests that social workers facilitate access to the health care system and enable treatment for acute conditions, particularly in vulnerable populations such as homeless and high-risk Veterans.