PRL-IHPS Focus on Social Determinants of Health

Social and Economic Policy Impacts on Health Equity
Rita Hamad is a social epidemiologist, family physician, and the director of the Social Policies for Health Equity Research (SPHERE) program. Her research team studies the impacts of social and economic policies on health equity. Much of her work focuses on the health effects of safety net policies like the earned income tax credit, which is the largest U.S. poverty alleviation policy for families with children, and WIC, which provides nutrition support for low-income pregnant and postpartum women and children under 5. Her most recent work, funded by a grant from the NIH, examines the effects of school racial segregation on cardiovascular risk factors among Black youth. Dr. Hamad’s research uses interdisciplinary quasi-experimental methods, including advanced epidemiologic and econometric techniques. While policy makers and advocates may assume that well-intentioned policies will have a positive effect on populations of interest, research sometimes demonstrates unintended negative consequences or spillover effects. The goal of Dr. Hamad’s work is therefore to provide evidence to inform the design of policies to address the social determinants of health at a population level.

 

Social Informatics
Julia Adler-Milstein, Laura Gottlieb and Matt Pantell have been working to create an electronic health record (EHR) data category typology and specific measures for social determinants of health being captured in the EHR. As efforts to capture SDOH in the EHR begin their translation to practice, a new subfield of health informatics is emerging. This new domain—which the researchers term social informatics—studies the application of information technologies to capture and apply social data in conjunction with health data to improve clinical care and advance individual and population health. Social informatics uses SDOH-relevant data from informatics resources, such as EHRs, claims data, and mobile health (mHealth) data, to inform research, enhance patient care, and facilitate rapidly growing activities at the intersection of SDOH and medical care. 

To date there has not been a standard approach to the integration of SDOH designated fields in the EHR. Adler-Milstein, Gottlieb and Pantell developed a generalizable set of measures for new fields as well as other common EHR data field categories to characterize the documentation and review of SDOH data. Measures are defined at both encounter and patient-year levels. These measures can guide optimization efforts, such as health professional education and workflow redesign, that advance towards the goal of ensuring that SDOH data inform clinical decision-making. Read a recent papers here.

Social Emergency Medicine  
Hemal Kanzaria and Maria Raven are the co-directors of the newly formed UCSF Department of Medicine, Social Emergency Medicine section, launched in January, 2021.  The section organizes faculty in the department interested in social emergency medicine, which explores the intersection of social forces and the emergency care system and how they act together to affect individual and community health.  The Social Emergency Section provides an infrastructure for collaboration, guidance, and/or mentorship on relevant research, policy, advocacy, and education project development.  Collaborations across UCSF and with community leaders and organizations are also a focus of the section. Recent activities have included, among others, volunteering at COVID-19 vaccination clinics, having a panel for medical students interested in social emergency medicine, serving on the national executive committee for social emergency medicine and a collaborative R01 on COVID-19 vaccine hesitancy.

With a grant from the San Francisco General Hospital Foundation’s ZSFG COVID-19 Fund, the social medicine team helped patients meet basic material needs related to food and financial insecurity, as well as barriers to transportation and medication access during the pandemic. In partnership with community-based organizations, the social medicine team provided hundreds of in-need patients’ food vouchers, hygiene kits, cell phones and clothing. The team also began formally assessing unhoused clients and supporting their entry into permanent supportive housing. Raven and Kanzaria, are also leading a team in collaboration with the Benioff Homelessness and Housing Initiative and San Francisco county leaders to evaluate the safety of isolation and quarantine hotels for unhoused individuals with mild to moderate COVID-19.   

Post-Hospitalization Recovery and Transistions
Oanh Nguyen’s research focuses on understanding how to address social determinants of health from health care settings to improve post-hospital recovery and health outcomes after hospitalization for cardiovascular illness. Her current research falls under three themes: 1) using existing electronic health record and big datasets to understand the impact of social needs to health outcomes; 2) leveraging hospitalization as an opportunity to connect patients to resources to address health-related social needs, including service referral and navigation, digital literacy training, substance use treatment; and 3) developing novel interventions such as unconditional cash transfer to augment existing treatment strategies for health-related social needs. Nguyen currently has a grant from NHLBI called ‘Understanding the Impact of Technology Access and Digital Literacy on Post-Discharge Care and Hospital Readmissions in Adults with Cardiovascular Disease’ and she is working on a white paper for the California Health Care Foundation on digital health equity and inclusion. Nguyen is also conducting a program evaluation on the effectiveness of a hospital-based addiction medicine consult service on connecting patients to substance use disorder treatment resources following discharge (also funded by CHCF). She is also working on a project as part of the Benioff Homelessness and Housing Initiative on the role of guaranteed income on outcomes among individuals and households recently experiencing homelessness in Santa Clara County.  

Rita Hamad, MD, PhD

Julia Adler-Milstein, PhD

Laura Gottlieb, MD

Matt Pantell, MD, MS

Hemal Kanzaria, MD, MSc

Maria Raven, MD, MPH

Oanh Nguyen, MD, MAS