Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation

Abstract

We conducted a qualitative exploration and implementation evaluation of a Massachusetts policy initiative, the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program, to examine how CHART innovations aimed at reducing unnecessary emergency department (ED) visits also addressed patients' social disconnection problems according to a social connection framework (structural, functional, quality or multilevel). We performed interviews with 236 stakeholders (hospital managers, CHART providers, staff, and community partners) one-year post CHART implementation. Interviews were analyzed using a directed content analysis approach. Data were then mapped to levels of the social connection framework. Our results support that social disconnection, described as “loneliness” and “social isolation” by stakeholders, met the definition of a structural social connection problem according to our framework. These structural problems led patients to the ED for reasons not always related to their physical health. CHART innovations involving home visit programs, elder services interventions, work flow changes in the ED, and regular telephone follow-ups provided functional level emotional and tangible support to meet these structural problems. We did not find substantive support for mapping interview data to the quality and multi-level dimensions of the framework. Innovations to address high ED use, according to stakeholders, provided functional level emotional and tangible support to address structural level problems of social disconnection. Future work should examine the sustainability of innovations in a value-based healthcare climate, and the effectiveness of these programs on reducing ED utilization.