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Evaluating SDH Programs Caroline Fichtenberg, PhD Managing - - PowerPoint PPT Presentation
Evaluating SDH Programs Caroline Fichtenberg, PhD Managing - - PowerPoint PPT Presentation
Evaluating SDH Programs Caroline Fichtenberg, PhD Managing Director, Social Interventions Research and Evaluation Network, UCSF OPCA APCM Learning Session Aug 16, 2018 SIRENetwork.ucsf.edu Reduce Reduce Improve Reduce Social Costs
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Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs
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Screen for unmet social needs
Refer to internal resources, e.g. food pharmacy, medical-legal partnership Refer to external resources, e.g. food bank, benefits assistance, etc. Provide navigation, e.g. with CHW, SW, patient navigator, etc.
“Social needs care”
Refer to internal resources, e.g. food pharmacy, medical-legal partnership
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Does this work?
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siren Researchers Early-Adopters
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200 400 600 800 1000 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000
Number of articles
SDH SDH + Health care
Growth in SDH publications, 2000-2016
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9 8 4 3 11 6 3 4 1 1 1 5 2 5 2 1 200 400 600 800 1000 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000
Number of articles
Clinical SDH intervention evaluations SDH SDH + Health care
Growth in SDH evaluation publications
Gottlieb LM, Wing H, Adler NE. A systematic review of interventions on patients' social and economic needs. Am J Prev Med. 2017
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- Multicomponent
interventions
- Multiple impacts and
causal pathways
- Time horizon
Barriers to Evaluating Social Needs Interventions
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):931- 951.
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- Regression to the
mean
- Lack of control groups
- Limited evaluation
capacity and resources in intervention settings
Barriers to Evaluating Social Needs Interventions
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):931- 951.
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Measuring Impact (incl. ROI)
Data + Design
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Measuring Impact (incl. ROI)
Data + Design
- What services
patients received
- Relevant outcomes
- Potential
confounders
- Control group!!
- Time horizon
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Data for ROI: Think outside the $ box
$
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Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs
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Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs Reduce Health Inequities
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Call-center based social services referral program: Expenditures $2,443 (10%) lower if social needs met.
Pruitt Z et al. Popul Health Manag. 2018. Epub ahead of print.
Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs
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Medically tailored meal program:
- Fewer emergency department visits
- Fewer inpatient admissions
- Lower medical spending
Non-tailored meals:
- Fewer emergency department visits
- Lower medical spending
Berkowitz SA et al. Health Aff (Millwood). 2018;37(4):535-542.
Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs
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Systematically screening and referring for social needs services during well child care increased families’ receipt of community resources.
Garg A et al. Pediatrics. 2015;135(2):e296-304.
Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs Reduce Health Inequities
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Referring to services to address unmet basic resource needs in primary care was associated with modest improvements in blood pressure and lipid levels.
Berkowitz SA et al. JAMA Intern Med 2016;177(2):244-252
Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs Reduce Health Inequities
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In-person resource navigation for pediatric patients in primary care and urgent care settings reduced reported social and economic needs and improved caregiver reported child health status 4 months later.
Gottlieb LM et al. JAMA Pediatr. 2016;170(11):e162521.
Reduce Social Needs Improve Health Reduce Utilizations Reduce Costs Reduce Health Inequities
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Reduce Social Needs Improve Health Reduce Costs Reduce Health Inequities Improve Experience of Care Improve Quality of Care Reduce Staff Burnout Reduce Utilizations
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Reduce Social Needs Improve Health Reduce Health Inequities Improve Experience of Care Improve Quality of Care Reduce Staff Burnout Primary care: Knowing the patient had a social need changed care delivery in 23%
- f patients and helped
improve interactions with and knowledge of the patient in 53%.
Tong ST et al. JABFM 2018;31(3):351-363.
Reduce Costs Reduce Utilizations
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Reduce Social Needs Improve Health Reduce Health Inequities Improve Experience of Care Improve Quality of Care Reduce Staff Burnout Reduce Costs Reduce Utilizations Higher perceived
- rganizational capacity to
address SDH in the primary care setting significantly associated with lower provider burnout.
Olayiwola JN et al. JHCPU 2018;29(1):415-429.
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http://sirenetwork.ucsf.edu
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Time
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