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Social Isolation within an Urban Safety Net Hospital Patient Population

Authors

Agnes Premkumar1, Alexandria Cantarero1, Kaitlin Vick1, Hayley W. Sayrs2, Kariamu Cross3, Charles E. Coffey Jr1,4. Author Affil: 1. Keck School of Medicine 2. Keck School of Medicine, Department of Preventive Medicine 3. UC Berkeley 4. LAC+USC Medical Center

Introduction

Social isolation (SI) is a largely silent social determinant of health that has been linked to various negative health outcomes including increased rates of cardiovascular diseases, depression, hospital readmissions, and increased health care costs. Numerous studies have also found that low income populations are more likely to be socially isolated. While SI is as common as food insecurity, little is known about the prevalence and impact of SI in patients hospitalized at safety net hospitals. We aimed to measure the prevalence of SI within the inpatient population and to better understand the factors that contribute to SI in order to create a unique intervention to ameliorate SI.

Methods

LAC+USC Medical Center is a 600-bed, Level 1 trauma center and one of the largest safety net hospitals in the nation, serving 10 million residents of the greater Los Angeles area. From June 2019 through November 2019 we conducted a point prevalence study of SI and a series of focused interviews with adult inpatients. We assessed the point prevalence of SI with a short two question screen of all willing and able patients in the medical/surgical wards of LAC+USC Medical Center. Hospital nursing staff helped identify patients with psychosocial risk factors for SI who would be willing to participate in an in-depth interview. These focused patient interviews included: 1) a 2-question SI screen, 2) an extended screening instrument adapted from the Berkman-Syme Social Network Index (BSNI), and 3) a series of open-ended questions investigating how to solve SI in hospitalized patients.

Results

We screened 149 patients hospitalized in the medical units to determine the prevalence of social isolation and loneliness. 54 of the patients (36%) screened positive for SI and 37 of the patients (24.8%) screened positive for loneliness. To date, we have completed 60 focused patient interviews using the BSNI. Of the 60 patients interviewed, 36 (63%) screened positive for social isolation and/or loneliness. Patients were most interested in resources including fitness activities, transportation assistance, group therapy, employment programs, and volunteering.

Conclusion

These results underscore the significant prevalence of SI within our hospitalized patients. They also highlight the need in our community for an intervention that targets social isolation in a patient-centered manner and meets the goals of our diverse community. We plan to continue screening and interviewing throughout the next several months to obtain a more comprehensive view of the barriers and pre-existing resources available to address social isolation within the safety net hospital system. In the near future, we will work with patients and community-based resources using human centered design techniques to develop and implement an intervention that would link patients with SI to existing community-based resources. Our goal is to improve individual patient outcomes and strengthen the linkages within our safety net health system to alleviate social isolation.

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Back to the September 2020 issue of ACP IMpact