The goal of our study is to understand the role of neurology social work at an urban safety-net hospital.

While the value of social work has been well-characterized in disease-specific and well-resourced programs, there is a need to characterize neurology social work at a U.S. safety-net hospital. A neurology social worker may impact patients’ quality of life by reducing disease-related job loss and improving access to other health care services. Analyzing the impact of a neurology social worker can help provide financial justification for the role in resource-limited settings.

This project was conducted in the outpatient neurology clinics of an academic safety-net medical center in Boston where 75% of visits are made by low-income and elderly patients. 200 hours of neurology social work patient encounters were analyzed for demographic information, referring provider’s subspecialty, the patient’s diagnosis, intervention relevance to the diagnosis, time needed to complete the intervention, and intervention type. Intervention type was based on a classification system in social work literature derived from natural language processing.

We analyzed 200 consecutive hours of interventions (125 encounters) with neurology patients referred to social work. Median age was 59, 68% of patients identified as non-white, and 32% were non-English speaking. The neurology social worker spent the greatest amount of time on care coordination (40%) followed by housing insecurity (14%). In 90 cases (72%), the social work intervention was specific to the neurologic disorder.

Most interventions were directly related to the patient’s neurologic disorder, highlighting the importance of a neurology-specific social worker. The distribution of time spent on these interventions may reflect our status as a safety-net hospital, as a substantial proportion of our patients require help with coordinating visits and home care. Embedding a social worker in a multi-specialty neurology clinic may address many factors contributing to neurologic health disparities.