Differential effects of a social work staffing intervention on social work access among rural and highly rural Veterans: A cohort study.
Veterans
econometric models
population health
primary health care
rural health
social work
Journal
Health services research
ISSN: 1475-6773
Titre abrégé: Health Serv Res
Pays: United States
ID NLM: 0053006
Informations de publication
Date de publication:
17 Jun 2024
17 Jun 2024
Historique:
medline:
18
6
2024
pubmed:
18
6
2024
entrez:
17
6
2024
Statut:
aheadofprint
Résumé
To evaluate the impact on rural Veterans' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans' rurality, race, and complex care needs. Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021. The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters. We used difference-in-differences to estimate the program effect on urban, rural, and highly rural Veterans. Among rural and highly rural Veterans, we stratified by race (American Indian or Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White) and complex care needs (homelessness, high hospitalization risk, and dementia). We defined a cohort of 740,669 Veterans (32,434,001 monthly observations) who received primary care at a participating site. Average monthly social work use was 8.7 Veterans per 1000 individuals. The program increased access by 49% (4.3 per 1000; 95% confidence interval, 2.2-6.3). Rural Veterans' social work access increased by 57% (5.0; 3.6-6.3). Among rural/highly rural Veterans, the program increased social work access for those with high hospitalization risk by 63% (24.5; 18.2-30.9), and for Veterans experiencing homelessness, 35% (13.4; 5.2-21.7). By race, the program increased access for Black Veterans by 53% (6.1; 2.1-10.2) and for Asian Veterans by 82% (5.1; 2.2-7.9). At rural VA primary care sites with social work staffing below recommended levels, Black and Asian Veterans and those experiencing homelessness and high hospitalization risk may have unmet needs warranting social work services.
Identifiants
pubmed: 38886563
doi: 10.1111/1475-6773.14327
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development
ID : CDA 22-157
Organisme : Quality Enhancement Research Initiative
ID : PEC-018
Organisme : VA National Social Work Program
Organisme : VA Office of Rural Health
Organisme : Brown University Primary Care-Population Medicine Graduate Study Program
Informations de copyright
© 2024 Health Research and Educational Trust.
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