Social Determinants of Health

Addressing the social determinants of health in its members and their communities is an organizational priority for Kaiser Permanente. Social determinants of health are the conditions in which people are born, grow, work, live and age, and the wider set of forces shaping the conditions of daily life. IHR researchers have focused attention on health care system interventions to identify and ease basic resource needs (food insecurity, housing instability, and inability to pay for transportation, energy/utilities, and medical costs). We collaborate with organizational leaders at Kaiser Permanente Colorado, other KP regions, and KP Program Office to conduct evaluations and research on the effectiveness of these interventions in improving a wide array of health outcomes.


Social Determinants of Health Researchers


Featured Projects

Investigator: Cheryl Kelly, PhD, MPH, MA
Thrive Local links clinical care to social care through data integration with community-based partner organizations. Thrive Local consists of three key functions: a resource directory that provides up-to-date and searchable information on community resources; geographically-based networks of social service organizations; and a technology platform that engages clinicians and staff, members, and employees of community organizations to make rapid, secure referrals between health care providers and social care providers and track the outcomes of those referrals. As the cross-site evaluators, the Colorado (Kelly) and Washington (Cheadle) teams are using a mixed methods approach for the evaluation, combining qualitative data on implementation and user experience with quantitative data on individual patient outcomes. The implementation evaluation is assessing the extent to which the social needs system elements are in place and functioning. The outcome evaluation is assessing the overall reach of the Thrive Local, including the characteristics of patients who consent to participate and receive services from CBOs and assessing whether patients who receive services through Thrive Local report fewer social needs over time and improved self-efficacy and health outcomes.
Funder: Kaiser Permanente National Community Health
Study End Date: 2022
Investigators: Cheryl Kelly, PhD, MPH, MA and Morgan Clennin, PhD, MPH
The Office of Health Equity’s (OHE) Health Disparities Grant Program (HDGP) is providing support to agencies across Colorado to address these upstream determinants of health (e.g., housing, education) with the goal of improving downstream health outcomes (e.g., access to care, decreased chronic disease rates). Grantees are focusing on changing systems and policies that impact the upstream determinants of health. The goal of the evaluation is to design and implement a utilization-focused evaluation to assess the impact of the initiative on systems and policies, equitable access to resources and health disparities. The main outcomes of the evaluation are documenting shifts in the availability, accessibility and acceptability of social and economic resources.
Funder: Colorado Department of Public Health and Environment
Study End Date: 2021
Investigators: Cheryl Kelly, PhD, MPH, MA and Morgan Clennin, PhD, MPH
Newly enacted Colorado HB1309, 1196, and 1201 require the Colorado Division of Housing to institute new regulations for manufactured housing parks and grants cities the authority to enact ordinances that support the safe and equitable operation of these communities. This study will evaluate the implementation process and impact of these policies in 3 different Colorado communities. The first aim is to use a case study approach and conduct a policy implementation evaluation of all 3 policies to determine how implementation varied across three diverse Colorado communities. The second aim is to use a cross-sectional pre-post design to assess the impact of all 3 policies on housing security, safety, and affordability in all 3 communities. This study will fill a gap in the literature by assessing how these statewide policies are implemented in three different small to moderate-sized communities and the impact of the policy on the housing security of the residents who live there.
Funder: Robert Wood Johnson Foundation
Study End Date: 2022
Investigator: John F. Steiner, MD, MPH
The goal of this project is to establish a learning network, the Social Needs Network for Evaluation and Translation (SONNET), to promote rigorous evaluation of Kaiser Permanente programs that address social, economic and behavioral needs (SEBN) among Kaiser members.
Funder: Kaiser Permanente Colorado
Study End Date: 12/31/2020