TABLE 1—
Characteristics of International Studies Published From 1990 to May 2017 on Effects of Social Work Services on Health and Cost Outcomes
| Study | Study Design and Study Duration | Sample Demographics and Study Setting | Intervention and Comparison Groups | Economic Method | QHES Score and Quartile | Health Outcomes | Utilization Outcomes | Cost Outcomes |
| Pediatric and maternal and child health populations (4 studies) | ||||||||
| Social worker–led | ||||||||
| Sullivan et al.27 | RCT 2 y | Children aged 5–11 y with asthma and their families n = 1032 (n = 515 intervention; n = 518 control); hospital and community | Asthma education and environmental control to facilitate community resource referrals, identify asthma triggers, improve access to care, and educate families about physician’s asthma care plan; usual care | Cost-effectivenessa | 87 (high) | Intervention led to more symptom-free days than usual care (565.1 vs 538.1) | Yes—used to compute cost-savings analysis; no significant differences between groups in rate of physician visits, hospital admissions, and ED visits | Costs were $245/person higher for children in the intervention compared with control group in the first year |
| Key et al.28 | Prospective cohort study 2–3 y | Adolescent mothers n = 314 (n = 63 intervention; n = 252 control); school and home-based | School based intervention and home-visits (group meetings, CM, coordinated medical care); propensity-matched comparison group | Cost–benefit; cost savings | 58 (fair) | Intervention led to fewer births compared with control group (17% vs 33%) | Not reported | Intervention led to $19 097 cost savings per birth avoided ($5055 per month) |
| Social worker on interdisciplinary team | ||||||||
| Stankaitis et al.29 | Cross-sectional: retrospective chart review comparison 4 y | High-risk pregnant women (n = 6000 live births over 6 y); Medicaid managed care program | Identification and stratification of high-risk women via health risk assessment form, multidisciplinary outreach, managed care; usual care | Cost savings | 57 (fair) | Not reported | Intervention reduced NICU admissions more than usual care (56.7 vs 107.6 per 1000 births) | Program enhancements led to 4-y cost NICU overall savings of $1 875 463 and ∼$2 return on investment per $1 spent |
| Blackhurst et al.30 | Cross-sectional retrospective comparison 1 y | Adolescent mothers n = 1233 (n = 922 intervention; n = 311 control); hospital and home | 1-y TPP; parent neonatal classes, nutrition counseling, SW evaluation, CM, postpartum home visit; usual care | Cost savings | 41 (poor) | TPP led to improved 5-min Apgar scores < 8 (4.3% vs 6.6%) and birth weight < 2500 g (12.2% vs 21.5%)* vs usual care | TPP reduced NICU admissions rate compared with usual care (10.5% vs 16.4%) | TPP led to overall cost savings of $894 195 |
| Vulnerable adult populations (8 studies) | ||||||||
| Social worker–led | ||||||||
| Basu et al.31 | RCT 18 mo | Homeless adults with chronic medical illness n = 407 (n = 201 intervention; n = 206 control); hospital and community | CM plus HF services; usual care | Cost savingsa | 81 (high) | Not reported | Yes—used to compute cost-savings analysis | CM/HF showed annual savings of $6307/person; most savings for chronically homeless ($9809/person) and HIV patients ($6622/person) |
| Claiborne18 | RCT 10 mo | Adults with diagnosis of mild stroke n = 28 (n = 16 intervention; n = 12 control); hospital | Care coordination and treatment (mental health assessment, crisis intervention, caregiver support, CM); usual care | Cost-effectiveness | 59 (fair) | Not reported | Yes—used to compute cost-savings analysis | Intervention led to average cost savings of $1339/person compared with usual care in 1-y |
| Weerahandi et al.32 | Retrospective cohort study 2 y | Adult high user inpatients (≥1 in past month or ≥2 in past 6 mo); n = 1158 (n = 579 intervention; n = 579 control); community | PACT: collaborative care team to reduce 30-d hospital readmission rates; matched controls | Cost savings | 58 (fair) | Within 30 d of enrollment, 1 death in PACT patients vs 13 in controls | Significantly reduced readmission rates at 30, 60, and 90 d, but not 180 d | Intervention led to overall cost savings of $900 000; lower 30-d costs for PACT ($2.7 million) vs controls ($3.6 million) |
| Rose et al.33 | Open pilot trial 3 y | High-risk adults frequenting ED (n = 12 completers); family practice | ED-based collaborative care planning intervention | Cost savings | 57 (fair) | Not reported | Pre–post inpatient visits decreased from 98 to 50 (49%); ED visits decreased from 66 to 63 (5%) | Overall cost savings of $107 808/y for combined hospitalization and ED visits |
| Social worker on interdisciplinary team | ||||||||
| Timpka et al.34 | Prospective cohort study 1 y | Adults with minor illness and long-term absence from work (n = 239); outpatient tertiary care hospital | Tertiary care team-based clinical CM for vocational rehabilitation | Cost–benefita | 71 (fair) | Not reported | Vocational rehab rate was 20.5% at 1 y and 11.3% at 5 y | Team-based CM led to £2 500 000 cost savings to society after 5 y |
| Eggert et al.35 | RCT 2 y | Adults aged older than 18 y at risk for admission to SNF n = 563 (n = 273 intervention; n = 203 control); community and home | Neighborhood team CM model plus direct services (assessment, nursing care, education, counseling, reassessment) Individual CM as usual (assessment, care plan, reassessment) by hospitals and home health agencies | Cost savings | 61 (fair) | No differences in mortality rates between groups (41% vs 47%); trend toward lower mortality rate for team vs individual CM group year 2 | No significant differences in no. of admissions between groups; one third shorter length of stay for team cases vs controls (19 vs 28 d per admission) | Team CM group averaged $9.81/person (14%) lower estimated costs vs controls |
| Weiner et al.36 | Cross- sectional: retrospective comparison study 6 mo | Under- or uninsured adults utilizing a medication assistance program (n = 231); hospital | Medication assistance program for patients who lack insurance coverage or resources to pay for medications | Cost savings | 28 (poor) | Not reported | Yes—used to compute cost-savings analysis | Medication program led to overall $237 985 savings (13% from pharmaceutical companies; 63% from Medicaid) |
| Harris and Young37 | Longitudinal cohort study: retrospective comparison study 1 y | Adults with soft tissue infections (n = 2861); hospital | ISIS clinic (coordinated surgical intervention and wound care, substance abuse counseling, social services) | Cost savings | 28 (poor) | ISIS reduced number of infections requiring surgery by 70% (977 preclinic vs 286 postclinic) | ISIS reduced costs of ED visits (33.9%), surgical admissions (47.3%), inpatient bed days (33.7%), OR use (71%) | ISIS led to $8 765 200 overall cost savings over 1 y |
| Geriatric populations (4 studies) | ||||||||
| Social worker–led | ||||||||
| Toseland and Smith38 | RCT 2 y | Spouse or caregivers of hospitalized elders who had various health concerns (n = 105); HMO setting | Caregiver HEP emotion-focused coping, education, and support; 8 weekly group sessions and 10 monthly follow-ups; usual care | Cost savings | 68 (fair) | Not reported | Yes—used to compute cost-savings analysis | HEP caregivers and recipients overall cost savings was $309 461 for 2 y |
| Social worker on interdisciplinary team | ||||||||
| Rich et al.39 | RCT 1 y | High-risk previously hospitalized for congestive heart failure n = 282 (n = 142 intervention; n = 140 control); hospital and community | Community-based comprehensive patient and family education, social-service consultation and early discharge planning, review of medications, intensive follow-up; usual care | Cost savings | 56 (fair) | Not reported | Intervention group had significant (56.2%) reduction in 90-d readmission rate* | Intervention reduced total care cost by $460/person compared with usual care |
| Boult et al.40 | RCT 1 y | High-risk elders enrolled in Medicare Choice insurance plans n = 6409 (n = 3480 intervention; n = 2929 control); in 35 primary care practices | IEI program (1-y screening and referral); usual care (no screening) | Cost savings | 50 (fair) | Not reported | IEI program used significantly more CM services | IEI program reduced average payments for health care by $107/person vs usual care |
| Sommers et al.41 | Randomized controlled cohort trial 2 y | Elders with chronic illnesses n = 583 (n = 280 intervention; n = 263 control); in 18 primary care practices | SCC program: in-home risk screening, risk-reduction plan, ongoing telephone monitoring, small group meetings or home visits every 6 weeks; usual care | Cost savings | 32 (poor) | SCC group had fewer symptoms (17.9–18.9 vs 17.2–17.7) and slight (nonsignificant) health improvement | SCC decreased readmissions (6% to 4%) vs usual care increase (4% to 9%)*; office visits fell by 1.5 visits | SCC led to cost savings of $90/person in 1 y |
Note. CM = case management; ED = emergency department; HEP = health education program; HF = Housing First; HMO = health management organization; IEI = identification and early intervention; ISIS = Integrated Soft Tissue Infection Services; NICU = neonatal intensive care unit; OR = operating room; PACT = Preventable Admissions Care Team; QHES = Quality of Health Economic Studies; RCT = randomized controlled trial; SCC = Senior Care Connections; SNF = skilled nursing facility; TPP = teen pregnancy program.
a
Sensitivity analysis included.
*
P < .05.