1. Evaluating Social & Economic Interventions for Complex Populations
Caroline Fichtenberg, Managing Director, SIREN, UCSF
Putting Care at the Center
Los Angeles, November 16-17, 2017
I’m Laura Gottlieb. I’m a family physician and research and I work closely with Caroline Fichtenberg and Abby Arons at the UCSF-based Social Interventions Research and Evaluation Network or SIREN, where we accelerate and disseminate high quality research at the intersection of medical and social care delivery. On behalf of our team, including the national advisory committee members who are in this room, thank you all for joining us at today’s meeting.
siren

2. SIREN: Social Interventions Research and Evaluation Network
But part of SIREN’s work is about dot connecting. So in conversations with data users and health IT folks around the country, we heard from many of you that you think WE HAVE A SHORT WINDOW OF OPPORTUNITY for better coordination on the back-end around content and format standards for collecting and sharing this new SDH data to inform multiple use cases, including clinical care, panel management, community health, payment and risk adjustment, and research.
So we convened today’s group to help us figure this out.

3. SIREN Leadership and Staff
The program is led by myself, and Laura Gottlieb, associate professor of family and community medicine who is the reason why SIREN was created and who serves as its co-director, and Nancy Adler, SIREN’s co-director, and also the lisa and john Pritzker professor of medical psychology, director of the center for health and community, vice-chair of the dept of psychiatry and pioneer in the study of social determinants of health.
The project has one full time staff (me), one half time research associate and one half-time communications associate.

4. Why does SIREN focus on the social determinants of health
Why does SIREN focus on the social determinants of health? Well it’s because there has been slow stead accumulation of research over the past several decades that has really overturned thinking about health. While we focus a lot on health care as the means to ensuring we stay health, research actually shows that what makes us healthy has actually relatively little to do with our health care and much more to do with our behaviors, the environments we are exposed to and our socioeconomic circumstances.

5. Social determinants of health
Housing
Education
Social support
Food
Employment
Transportation
Financial security
Safety
Child care
I think everyone in the room is probably familiar with the concept of social determinants of health. These are the non medical factors that play a big role in shaping health status. Things like financial security, food and housing security, education, employment etc. Studies estimate they may determine 40 percent of our health status.
siren

6. Complex care interventions
Physical Health
Behavioral Health
Social Needs

7. Complex care interventions
Physical Health
Behavioral Health
Social Needs

8. Complex care interventions
Physical Health
Behavioral Health
Social Needs
WHAT WORKS?

9. Systematic review of research on social needs interventions
4,995 articles
(Jan 2000 – Feb 2017)
67 isolated social needs components
10% high quality
30% examined health or utilization outcomes
81 did not isolate social needs components
Gottlieb, Wing, & Adler. AJPM, 2016

10. Barriers to Evaluating Social Needs Interventions in Complex Needs Patients
Multicomponent interventions
The other major barrier theme we uncovered was the issue that there are a lot of steps on the path between addressing SD and health outcomes. As all of us in this room know, it’s a long and complicated causal chain.
For instance, evaluation of an intervention that helps families address legal needs requires capturing information on whether the patient connected with legal services following an initial referral, categorizing the types of legal services provided, defining success of the legal intervention, and having the patient return to the health care system to report on health outcomes. So 1) the time for each stage of that process could take months to years; and 2) many of these activities take place outside the health care system—so there’s a problem of data connectivity or integration. These present two unique barriers related to timeline and data collection.
Gottlieb L, Ackerman S, Wing H, Adler N. Evaluation activities and influences at the intersection of medical and social services. J Health Care Poor Underserved. 2017;28(3):

11. Barriers to Evaluating Social Needs Interventions in Complex Needs Patients
Multicomponent interventions
Regression to the mean
The other major barrier theme we uncovered was the issue that there are a lot of steps on the path between addressing SD and health outcomes. As all of us in this room know, it’s a long and complicated causal chain.
For instance, evaluation of an intervention that helps families address legal needs requires capturing information on whether the patient connected with legal services following an initial referral, categorizing the types of legal services provided, defining success of the legal intervention, and having the patient return to the health care system to report on health outcomes. So 1) the time for each stage of that process could take months to years; and 2) many of these activities take place outside the health care system—so there’s a problem of data connectivity or integration. These present two unique barriers related to timeline and data collection.
Gottlieb L, Ackerman S, Wing H, Adler N. Evaluation activities and influences at the intersection of medical and social services. J Health Care Poor Underserved. 2017;28(3):

12. Barriers to Evaluating Social Needs Interventions in Complex Needs Patients
Multicomponent interventions
Regression to the mean
Randomization challenges
The other major barrier theme we uncovered was the issue that there are a lot of steps on the path between addressing SD and health outcomes. As all of us in this room know, it’s a long and complicated causal chain.
For instance, evaluation of an intervention that helps families address legal needs requires capturing information on whether the patient connected with legal services following an initial referral, categorizing the types of legal services provided, defining success of the legal intervention, and having the patient return to the health care system to report on health outcomes. So 1) the time for each stage of that process could take months to years; and 2) many of these activities take place outside the health care system—so there’s a problem of data connectivity or integration. These present two unique barriers related to timeline and data collection.
Gottlieb L, Ackerman S, Wing H, Adler N. Evaluation activities and influences at the intersection of medical and social services. J Health Care Poor Underserved. 2017;28(3):

13. Barriers to Evaluating Social Needs Interventions in Complex Needs Patients
Multicomponent interventions
Regression to the mean
Randomization challenges
Long causal chains
The other major barrier theme we uncovered was the issue that there are a lot of steps on the path between addressing SD and health outcomes. As all of us in this room know, it’s a long and complicated causal chain.
For instance, evaluation of an intervention that helps families address legal needs requires capturing information on whether the patient connected with legal services following an initial referral, categorizing the types of legal services provided, defining success of the legal intervention, and having the patient return to the health care system to report on health outcomes. So 1) the time for each stage of that process could take months to years; and 2) many of these activities take place outside the health care system—so there’s a problem of data connectivity or integration. These present two unique barriers related to timeline and data collection.
Gottlieb L, Ackerman S, Wing H, Adler N. Evaluation activities and influences at the intersection of medical and social services. J Health Care Poor Underserved. 2017;28(3):

14. Barriers to Evaluating Social Needs Interventions in Complex Needs Patients
Multicomponent interventions
Regression to the mean
Randomization challenges
Long causal chains
Limited research capacity and resources in intervention settings
The other major barrier theme we uncovered was the issue that there are a lot of steps on the path between addressing SD and health outcomes. As all of us in this room know, it’s a long and complicated causal chain.
For instance, evaluation of an intervention that helps families address legal needs requires capturing information on whether the patient connected with legal services following an initial referral, categorizing the types of legal services provided, defining success of the legal intervention, and having the patient return to the health care system to report on health outcomes. So 1) the time for each stage of that process could take months to years; and 2) many of these activities take place outside the health care system—so there’s a problem of data connectivity or integration. These present two unique barriers related to timeline and data collection.
Gottlieb L, Ackerman S, Wing H, Adler N. Evaluation activities and influences at the intersection of medical and social services. J Health Care Poor Underserved. 2017;28(3):

15. Panel Q&A Maria Raven, UCSF Steve Asch, Stanford University
Daniel Lessler, Washington State Health Care Authority
Q&A

16. Q&A caroline.fichtenberg@ucsf.edu http://sirenetwork.ucsf.edu
What is the responsibility of primary care around addressing patients’ SDH during clinical encounters?
What work is already happening in this field and how do we better coordinate those efforts?
How can we increase both evidence and evidence-based practice around SDH interventions?
How could our professional organizations catalyze more work at the intersection of medical and social care?
@SIREN_UCSF

17. https://prezi.com/view/emAKt4gqIKwI4ba8xh0j/