Investing in Interventions That Address Non-Medical, Health-Related Social Needs Proceedings of a Workshop (2019) / Chapter Skim
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7 Research Gaps
7 Research Gaps
Pages 67-76
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From page 67... ...
(Fichtenberg) • Current screening tools for social risks identify many people who face social barriers to health but subsequently refuse help from the health system.
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From page 68... ...
A RESEARCH AGENDA FOR HEALTH CARE ACTIVITIES RELATED TO IMPROVING SOCIAL CARE AND SOCIAL CONDITIONS SIREN, explained Caroline Fichtenberg, is a research center focused specifically on building the evidence about how health systems can address social risks. She described the framework SIREN has been using
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From page 69... ...
This evidence gap exists, she added, despite the fact that there is a great deal of interest and work occurring around measuring social risks in health care settings. Researchers at Kaiser Permanente-Washington looked at the validity testing that had been done for 21 multi-domain social risk screening tools and found that the median number of quality validity tests conducted was two out of a possible eight (Henrikson et al., 2019)
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From page 70... ...
Another area needing research concerns the patient acceptability of health care–based social risk screening, including whether screening might stigmatize patients or lead to response-based discrimination, said Fichtenberg. Some suggested that social risk screening should occur only in the context of an ongoing relationship with a case manager, community health worker, or patient navigator.
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From page 71... ...
She added that it is also important to look at patient and provider experience of care, which have cost and quality implications. She noted there are a few studies showing that perceived organizational capacity to address social determinants of health in primary care settings is associated with lower provider burnout, which could also affect health systems' bottom lines.
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From page 72... ...
Longitudinal research would help with the directionality issue, said Doran, and there has been some work along those lines using administrative data sets, though many of the administrative data sets commonly used by health services researchers lack robust social determinants data. There are, however, ways of combining health services data with data from other sources that could provide useful information, she noted.
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From page 73... ...
"We need to do more thinking on what the best role is for us as the health care system." DATA AND RESEARCH GAPS HINDERING POLICY DEVELOPMENT Genevieve Kenney and Timothy Waidmann started their work on data and research gaps by assessing the role that Medicaid and Medicaidmanaged care plans play in helping enrollees address their non-medical, health-related social needs and then identifying the driving forces behind the activities and investments that are occurring. As part of this effort, they conducted key informant interviews with Medicaid officials, managed care plan representatives, academics, national policy experts, and other key stakeholders from around the country.
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From page 74... ...
Kenney noted that the current approach to evaluating interventions to address social needs undervalues investments that produce positive effects and savings across multiple sectors and across different levels of government. Investments in systems that combine administrative data from different sectors such as Medicaid, child protective services, criminal justice, education, housing assistance, and income supports -- an approach described earlier by Ross Owen -- can provide information about the extent to which the same individuals are touched by more than one program and potentially more than one caseworker.
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From page 75... ...
For example, the model developed by Len Nichols and Lauren Taylor that treats social determinants as a public good as a means of generating the will to finance healthy communities has theoretical promise and the support of many economists, but there needs to be research to see whether this approach is feasible (Nichols and Taylor, 2018)
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From page 76... ...
She noted that there are a number of health care organizations across the country that are looking at ways they can use their reserve dollars to invest in economic development and affordable housing. Health care organizations can also be strong advocates at local, state, and federal levels for changes to address the underlying social inequities that are creating the health-related social risks that contribute to escalating health care spending.
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