Reconsidering risk: instrumental social support and 30-day utilization after discharge.

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.