{"doi":"10.1093/haschl/qxaf178","title":"Reconsidering risk: instrumental social support and 30-day utilization after discharge","abstract":"Introduction: In alignment with Centers for Medicare and Medicaid Services (CMS) requirements, hospitals increasingly screen for health-related social needs (HRSNs) such as housing, food, and transportation. However, these protocols often exclude instrumental social support-help with tasks like managing medications or attending appointments-which may influence post-discharge outcomes. Methods: We analyzed social risk data from 5 medical-surgical units at a US quaternary academic medical center. Among 413 inpatients (mean age 48.9 years; 52.1% male; 85.5% non-Hispanic White), we examined whether patient-reported instrumental social support and unmet HRSNs were associated with 30-day emergency department (ED) visits or rehospitalizations. Models were adjusted for LACE scores, a validated index of length of stay, admission acuity, comorbidity burden, and ED visits. Results: Within 30 days of discharge, 7.3% of patients had an ED visit, and 7.3% were rehospitalized. In adjusted models, higher instrumental social support was associated with lower odds of ED visits (OR = 0.76, 95% CI: 0.59-1.00). Unmet HRSNs were not significantly associated with either outcome. Higher LACE scores predicted increased utilization (ED visits, OR = 1.29, 95% CI: 1.15-1.45; rehospitalizations, OR = 1.21, 95% CI: 1.09-1.36). Conclusion: Instrumental social support may influence short-term post-discharge outcomes. Expanding CMS-aligned screening to include support availability could improve discharge planning and reduce unplanned utilization. Trial registration: Clinicaltrials.gov ID NCT04248738.","journal":"Health Affairs Scholar","year":2025,"id":574341,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8239,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04248738"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":567117,"name":"Sumin Park","orcid":"0000-0002-3007-8736","position":1,"is_corresponding":false},{"id":270399,"name":"Jia–Wen Guo","orcid":"0000-0002-4698-4696","position":2,"is_corresponding":false},{"id":741903,"name":"Erin Johnson","orcid":"0000-0003-1150-1823","position":3,"is_corresponding":false},{"id":1254418,"name":"M. Ruth Elliott","orcid":null,"position":4,"is_corresponding":false},{"id":738733,"name":"Catherine E. Elmore","orcid":"0000-0002-5908-8727","position":5,"is_corresponding":false},{"id":381422,"name":"Alycia A. Bristol","orcid":"0000-0001-5027-9984","position":6,"is_corresponding":false},{"id":270398,"name":"Andrea S. Wallace","orcid":"0000-0001-9694-2403","position":0,"is_corresponding":true}],"reference_count":24,"raw_metadata":null,"created_at":"2026-07-19T02:57:40.686992Z","pmid":"41079423","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}