The Role of Social Workers in Addressing Patients' Unmet Social Needs in the Primary Care Setting

Indiana University-Purdue University Indianapolis (IUPUI)Unmet social needs pose significant risk to both patients and healthcare organizations by increasing morbidity, mortality, utilization, and costs. Health care delivery organizations are increasingly employing social workers to address social needs, given the growing number of policies mandating them to identify and address their patients’ social needs. However, social workers largely document their activities using unstructured or semi-structured textual descriptions, which may not provide information that is useful for modeling, decision-making, and evaluation. Therefore, without the ability to convert these social work documentations into usable information, the utility of these textual descriptions may be limited. While manual reviews are costly, time-consuming, and require technical skills, text mining algorithms such as natural language processing (NLP) and machine learning (ML) offer cheap and scalable solutions to extracting meaningful information from large text data. Moreover, the ability to extract information on social needs and social work interventions from free-text data within electronic health records (EHR) offers the opportunity to comprehensively evaluate the outcomes specific social work interventions. However, the use of text mining tools to convert these text data into usable information has not been well explored. Furthermore, only few studies sought to comprehensively investigate the outcomes of specific social work interventions in a safety-net population. To investigate the role of social workers in addressing patients’ social needs, this dissertation: 1) utilizes NLP, to extract and categorize the social needs that lead to referral to social workers, and market basket analysis (MBA), to investigate the co-occurrence of these social needs; 2) applies NLP, ML, and deep learning techniques to extract and categorize the interventions instituted by social workers to address patients’ social needs; and 3) measures the effects of receiving a specific social work intervention type on healthcare utilization outcomes

Using natural language processing to classify social work interventions

Objectives: Health care organizations are increasingly employing social workers to address patients' social needs. However, social work (SW) activities in health care settings are largely captured as text data within electronic health records (EHRs), making measurement and analysis difficult. This study aims to extract and classify, from EHR notes, interventions intended to address patients' social needs using natural language processing (NLP) and machine learning (ML) algorithms. Study design: Secondary data analysis of a longitudinal cohort. Methods: We extracted 815 SW encounter notes from the EHR system of a federally qualified health center. We reviewed the literature to derive a 10-category classification scheme for SW interventions. We applied NLP and ML algorithms to categorize the documented SW interventions in EHR notes according to the 10-category classification scheme. Results: Most of the SW notes (n = 598; 73.4%) contained at least 1 SW intervention. The most frequent interventions offered by social workers included care coordination (21.5%), education (21.0%), financial planning (18.5%), referral to community services and organizations (17.1%), and supportive counseling (15.3%). High-performing classification algorithms included the kernelized support vector machine (SVM) (accuracy, 0.97), logistic regression (accuracy, 0.96), linear SVM (accuracy, 0.95), and multinomial naive Bayes classifier (accuracy, 0.92). Conclusions: NLP and ML can be utilized for automated identification and classification of SW interventions documented in EHRs. Health care administrators can leverage this automated approach to gain better insight into the most needed social interventions in the patient population served by their organizations. Such information can be applied in managerial decisions related to SW staffing, resource allocation, and patients' social needs