Veteran Use of Palliative Care Doubled When Social Workers Joined Primary Care

The addition of social workers to primary care teams was associated with a statistically significant and clinically important increase in the use of palliative care among veterans with recent hospitalizations, according to a study published in JAMA Network Open.

Researchers analyzed changes in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, which provided funding for new social work positions on primary care teams at Veterans Affairs sites.

“The Social Work PACT staffing program funded PACT social work positions for 3-year terms at sites serving rural veterans. The program funded social workers at outpatient clinics colocated in a medical center as well as stand-alone, community-based outpatient clinics,” explained corresponding author Portia Y. Cornell, PhD, of the Providence VA Medical Center in Rhode Island, and coauthors. “The VA PACT Handbook suggests an optimal 1 social worker per 2 advanced-practice clinicians, that is, a panel of 2400 veterans per social worker.”

The analysis included 43,200 rural veterans, with a total 91,675 inpatient stays, from 71 primary care sites.

Per 1000 veterans, a mean 14.5 patients used palliative care after an inpatient hospitalization, according to the study. After the staffing intervention, there was an increase of 15.6 patients per 1000 veterans using palliative or hospice care after hospitalization. When researchers controlled for national time trends and veteran characteristics, the use of palliative care was doubled compared with before the social work staffing program.

“The findings of this cohort study suggest that adding a social worker to the primary care team may help veterans to access palliative care,” researchers wrote. “The findings from this program evaluation offer insights into how investment in social workers may increase use of a high-value service.”

Reference:
Cornell PY, Halladay CW, Montano AR, et al. Social work staffing and use of palliative care among recently hospitalized veterans. JAMA Netw Open. Published online January 3, 2023. doi:10.1001/jamanetworkopen.2022.49731