Reconsidering Risk: Instrumental Social Support and 30-Day Utilization After Discharge

Introduction In alignment with CMS requirements, hospitals increasingly screen for health-related social needs (HRSNs)such as for 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 five medical-surgical units at a U.S. 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.