Generated from Open Evidence

Evidence suggests that palliative care interventions, including those involving social workers, can generate cost savings and improve patient outcomes, though the specific return on investment (ROI) for palliative social work alone remains incompletely characterized.

Evidence for Palliative Care ROI

A systematic review of social work services across health settings found consistent cost savings across nearly all studies, with most demonstrating positive effects on health outcomes and service utilization.^[1] In palliative care specifically, a community-based program staffed by nurses and social workers showed a 20% reduction in total medical costs ($619 per enrolled member per month), along with 38% fewer ICU admissions and 33% fewer hospital admissions.^[2]

Hospital-based specialist palliative care (HSPC) demonstrates small but clinically meaningful improvements in patient-centered outcomes, including quality of life (SMD 0.26), symptom burden (SMD -0.26), and satisfaction with care (SMD 0.36), while increasing the likelihood of home death (OR 1.63).^[3] However, evidence on cost-effectiveness remains inconsistent across economic evaluations.^[3]

Social Work-Specific Contributions

Social workers appear integral to effective palliative care models. Interventions that included nurses and social workers were among the most effective in systematic reviews.^[4] In the VA system, adding social workers to primary care teams significantly increased palliative care utilization among recently hospitalized veterans, suggesting social workers facilitate access and care coordination.^[5] An inpatient study found that when palliative care social workers were involved, goals of care discussions were more likely to occur (90.7% vs. 87.4%) and dyspnea improved more frequently.^[6]

Methodological Considerations

The social return on investment (SROI) methodology has been proposed as particularly valuable for palliative care evaluation, as it captures broader social value beyond traditional cost-effectiveness measures.^[7] A hospice SROI analysis demonstrated ratios of $2.77:$1 for inpatient services and $11.85:$1 for day therapy services.^[8] However, most randomized trials were not adequately powered to detect cost effects, and observational studies may experience selection bias.^[9]

The evidence base would benefit from larger pragmatic trials, improved data linkage, and standardized patient-centered outcome measures.^[9-10]