Development of a Level 1 Geriatric Outpatient Social Work Screen in a Veterans Primary Care Clinic

Patient Aligned Care Teams (PACT) provide primary care to veterans. We describe our experience in a PACT (average age 66, 98% men, 8 medications, 16% yearly hospitalization rate) using a nurse-administered screen to identify patients in need of intervention by a Masters-level Social Worker. Our screening results—98% Positive predictive value (included social work concerns) and 73% negative predictive value (excluded social work concerns)—suggest that the nurse accurately identified patients. Another 15% of patients were identified by the social worker. Similar screens used in interprofessional clinics could help target patients in need of further social work care.