Developing and harmonizing measures for social determinants of health (SDOH) is a big challenge for health systems seeking to assess the impact of their efforts. During a July 11 meeting held by the National Quality Forum, Matthew Stiefel, senior director of the Center for Population Health at Kaiser Permanente, described some of his organization’s progress and challenges.
Stiefel was speaking at a meeting of the NQF’s National Quality Partners (NQP) Social Determinants of Health Data Integration Action Team, which is working to develop and share successful approaches to integrating SDOH data to support providers and communities in their efforts to eliminate disparities. The Action Team is calling for communities of providers, payers, federal agencies and community-based organizations to collaborate on improving the collection of top-down and bottom-up SDOH data and embedding a consumer perspective in the entire process. Its suggestions include focusing on ways to standardize and share data, demonstrate collaborations and partnerships across sectors and evaluate the effectiveness of interventions.
Stiefel highlighted three areas: connecting to social services, harmonizing measures and evaluation of interventions.
Creating connections between healthcare and social services: Kaiser Permanente recently launched a national initiative called Thrive Local in collaboration with an organization called UniteUs, with three aims. “One is to build resource directories in all our regions to build, maintain and curate these resource directories of social service organizations,” he said. “That has been a significant challenge in this area. At least in our organization, our navigators and social workers would have notebooks or Post-It Notes that had connections that were individual and would come in and out of date.” A second goal is to build a network of resource providers, and the third is to provide a platform that all the social service providers would be on, as well as the healthcare system, with bidirectional referrals and access to the electronic medical record. “Such a system has the capability to not just facilitate transactions at the micro level,” he added, “but also over time build a population-based community perspective of supply and demand and gaps between supply and demand.
Harmonization of measures: Stiefel called this a big challenge. He noted that UCSF SIREN’s Gravity initiative is providing a very important contribution in this domain by focusing on coding and standardization of measures. “That is a really important piece of the puzzle, but not the whole puzzle,” he stressed. There also is need for agreement and harmonization of the measures and the way the questionnaires are built and the questions are asked. “At KP, we had developed our own assessment called “Your current life situation” and had been using it for several years. Our vendor Epic just released their own social needs assessment instrument.” Unsurprisingly, they are not perfectly aligned, he explained. “We are working hard to align those. Epic’s tool has the advantage of being interoperable with the rest of the EMR. But there is a broader perspective. Maybe KP and Epic can get aligned, but that still raises question about alignment nationally. I know there is a PRAPARE instrument and Accountable Health Communities instrument, but there is not national standardization, and I would just put out the challenge to NQF — given its role as perhaps an organization that can work on this challenge and help coordinate national assessment instruments.”
Evaluation: Stiefel stressed the fundamental importance of research and evaluation in the SDOH area. First, the causal pathway is long and complicated to evaluate these interventions, he said. “If you think about assessing food insecurity, then making referrals and following up to see if the referrals were utilized. Did the need get met? Did the acute need get met and did the longer-term chronic need get met? These social needs are like chronic conditions that are challenging to meet over the long run. Did health improve as a result of meeting that need?” He added another question to be addressed: Did healthcare utilization and cost decrease? “Even if it is not defined as the most important aim, it is fundamentally important for healthcare systems because we are paid premiums to provide healthcare and our investment upstream must be guided at least in part by whether that investment yields returns that our members and customers value,” he said.
