The SIREN Podcast

This episode features a conversation between two health center-based community organizers: Hilary Mar Lopez Nichols, from Oregon Health Sciences University Family Medicine Clinic at Richmond, and Toffer Lehnherr, from Partnership Health Center in Missoula, Montana. This is the first in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are the last two “A”s of the National Academy of Medicine’s framework that SIREN’s used to organize Coffee & Science. Alignment and Advocacy are both about what health care can do at the community level to address social needs.  In this conversation, Hilary and Toffer share their experiences with using community organizing in clinical settings to help advance health equity.

Recommended references:

• Morris JE. When “Patient-Centered” is Not Enough: A Call for Community-Centered Medicine. Ann Fam Med. 2019.
• Christens BD, Peterson NA, Speer PW. Community participation and psychological empowerment: Testing reciprocal causality using a cross-lagged panel design and latent constructs. Health Educ Behav. 2011.
• Wolf L, Vigna AJ, Inzeo PT et al.  From Roots to Results: A Qualitative Case Study of the Evolution of a Public Health Leadership Institute Building Capacity in Collaborating for Equity and Justice. Health Educ Behav. 2019.
• Speer PW, Tesdahl EA, Ayers JF : Community organizing practices in a globalizing era: Building power for health equity at the community level. J Health Psychol. 2013.
• Speer PW, Christens BD. A Kansas City case study: Local community organizing and change: Altering policy in the housing and community development system in Kansas City. J Community Applied Soc Psychol. 2011.
• Collins CR, Nealth JW, Neal ZO. An article that links (theoretically) community organizing with efficacy and empowerment: Transforming individual civic engagement into community collective efficacy: The role of bonding social capital. Am J Community Psychol. 2014.

This episode features a conversation between Emmy Ganos, PhD, Senior Program Officer at the Robert Wood Johnson Foundation and Stacie Dusetzina, PhD, Associate Professor of Health Policy and Ingram Associate Professor of Cancer Research at Vanderbilt University Medical Center. This session is the last of four talks focused on health care sector efforts to Adjust clinical care based on information about patients’ social circumstances. In this conversation, Emmy and Stacie dive into the implications of real-time pharmacy benefit tools and explore what we know about patient and provider preferences when it comes to conversations about medication costs.

Recommended references:

• Everson J, Frisse ME, Dusetzina SB. Real-Time Benefit Tools for Drug Prices. JAMA. 2019.
• Doshi JA, Li P, Huo H et al. Association of Patient Out-of-Pocket Costs with Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents. J Clin Oncol. 2018.
• Sloan CE, Ubel PA. The 7 Habits of Highly Effective Cost-of-Care Conversations. Annals Intern Med supplement issue on cost-of-care conversations. 2019.
• America’s Essential Hospitals. Cost of Care Conversations Resources. Web collection.

This episode features a conversation between Kedar Mate, MD, President and CEO of the Institute for Healthcare Improvement and Saul Weiner, MD, Professor of Medicine, Pediatrics and Medical Education, Director of the Clinical Leaders and Academic Scholars Fellowship at the University of Illinois at Chicago, and Deputy Director of the Center of Innovation for Complex Chronic Health Care at the Veterans Health Administration. This session is the third of four talks focused on health care sector efforts to Adjust clinical care based on information about patients’ social circumstances. In this conversation, Kedar and Saul explore the intersection of social care adjustment and the practice of contextualizing care and raise questions about both potential benefits and unintended consequences of implementing contextualized care.

Recommended references:

•  https://www.contextualizingcare.org/ 
• Weiner SJ. Contextualizing care: An essential and measurable clinical competency. Patient Educ Couns. 2021. 
• Weiner SJ, Schwartz A, Altman L et al. Evaluation of a Patient-Collected Audio Audit and Feedback Quality Improvement Program on Clinician Attention to Patient Life Context and Health Care Costs in the Veterans Affairs Health Care System. JAMA Netw Open. 2020. 
• Weiner SJ, Schwartz A. Listening for What Matters: Avoiding Contextual Errors in Health Care. Oxford Univ Press. 2016.
• Weiner SJ. On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients. Johns Hopkins Univ Press. 2020.
• Gawande A. “Personal Best”. The New Yorker. 2011.

This episode features a conversation between Julia Adler-Milstein, Professor of Medicine and Director of the Center for Clinical Informatics and Improvement Research at the University of California, San Francisco and Tiffany Veinot, Professor of Health Behavior and Health Education cross-appointed at the School of Information and School of Public Health at the University of Michigan. This session is second of four talks focused on health care sector efforts to Adjust clinical care based on information about patients’ social circumstances. In this conversation, Julia and Tiffany explore the emerging discipline of social care informatics and ways informatics can support care adjustment strategies.

Recommended references:

• Computing Community Consortium research agenda. 2018.
• Veinot TC, Ancker JS, Bakken S. Health informatics and health equity: improving our reach and impact. JAMIA (introduction to special issue on health informatics and health equity). 2019.
• Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. JAMIA. 2018.
• Veinot TC et al. Leveling up: on the potential of upstream health informatics interventions to enhance health equity. Medical Care. 2019. 
• Senteio C, Adler-Milstein J, Richardson C, Veinot TC. Psychosocial information use for clinical decisions in diabetes care. JAMIA. 2019.
• Senteio C, Veinot T, Adler-Milstein J, Richardson C. Physicians’ perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care. Intl J Med Informatics. 2018

This episode features a conversation between Danielle Hessler Jones, PhD, SIREN investigator and Professor in the Department of Family and Community Medicine at the University of California, San Francisco and Rachel Gold, PhD, MPH, an investigator at the Kaiser Permanente Northwest Center for Health Research and Lead Research Scientist at the OCHIN community health information network. This session is the first of four talks focused on health care sector efforts to Adjust clinical care based on information about patients’ social circumstances. In this conversation, Danielle and Rachel define Adjustment and explore research on the use of clinical decision support tools that might facilitate related interventions.

Recommended references:

• NASEM. Integrating Social Care into the Delivery of Health Care. 2019.
• Weiner S, Schwartz A. Listening for What Matters. 2016.
• Hessler D, Bowyer V, Gold R et al. Bringing Social Context into Diabetes Care: Intervening on Social Risks versus Providing Contextualized Care. Curr Diab Rep. 2019.
• Cottrell EK, Gold R, Likumahuwa S et al. Using Health Information Technology to Bring Social Determinants of Health into Primary Care: A Conceptual Framework to Guide Research. J Health Care Poor Underserved. 2018.
• Current projects mentioned in episode: COHERE; CRISP.

This episode features a conversation between Tamara J. Cadet, PhD, LICSW, MPH, an Associate Professor at the Simmons School of Social Work and faculty at the Harvard School of Dental Medicine in Oral Health Policy and Epidemiology, and Bonnie Ewald, MA, the Associate Director of the Center for Health and Social Care Integration and Program Manager of Strategic Development and Policy for Rush University Medical Center’s Social Work and Community Health Department. This session is the sixth and final talk focused on health care sector efforts to provide patients with social service Assistance. In this conversation, Tammy and Bonnie dive into tele-social care practices, including ways these practices were affected by the COVID pandemic. Surfacing the perspectives of both patients and providers, they also explore the benefits and barriers to delivering social care by phone and video.

Recommended references:

• CHaSCI and the National Center for Complex Health and Social Needs. Tele-Social Care: Implications and Strategies. Feb 2021.
• CHaSCI and the National Center for Complex Health and Social Needs. Best practices and strategies for tele-social care (webinar recording).
• De Saxe Zerden L, Cadet TJ, Galambos C, Jones B. Social Work’s Commitment and Leadership to Address Social Determinants of Health and Integrate Social Care into Health Care. JHHSA. 2020.
• Kraus MW. Voice-Only Communication Enhances Empathic Accuracy. American Psychologist. 2017.
• DeGuzman PB, Jain N, Loureiro CG. Public Libraries as Partners in Telemedicine Delivery: A Review and Research Agenda. Public Library Quarterly. 2021.

This episode features a conversation between Lauren Taylor, PhD, MDiv, MPH, a postdoctoral scholar at NYU School of Medicine, and Kelly Cronin, MPH, MS, Deputy Administrator, Innovation and Partnership at HHS Administration for Community Living. This session is the fifth in a series focused on health care sector efforts to provide Assistance to patients to reduce their social risks. In this conversation, Lauren and Kelly explore pressing questions surrounding the governance and interoperability of software platforms marketed to health care systems and designed to streamline information about and connection to community resources to address social needs. 

Recommended references:

• The Gravity Project. https://www.hl7.org/gravity/
• Stewards of Change. Project Unify homepage on the National Interoperability Collaborative Hub. https://hub.nic-us.org/groups/project-unify 
• San Diego Community Information Exchange Toolkit. https://ciesandiego.org/toolkit/ 
• Nichols & Taylor. Social Determinants as Public Goods: A New Approach to Financing Key Investments in Healthy Communities. 2018.
• Bradley & Taylor. The American Health Care Paradox. 2013.
• Cartier, Fichtenberg, & Gottlieb. Community Resource Referral Platforms: A Guide for Health Care Organizations. 2019.

Edited audience questions (clustered by theme): 

• Interoperability: What are the emerging interoperability standards across platforms? Will the work of The Gravity Project enable standards consistency that might support the CBOs? Are there any national certification efforts similar to ONC EHR certification process to propel interoperability standards between these new platforms?
• Data uses: How can we leverage data on the back end of these platforms to assess needs, improve care, and support advocacy?
• Effectiveness: Have we seen evidence on how effective the R&R systems are? How much should we invest in improving them? Would the $ being invested in these platforms be better spent on actual services rather than on an infrastructure to connect to services that are not robust enough? 
• Government role: Should the government’s position be to support CBO funding, capacity, and standards, not procurement of software? Are there anti-trust laws that would avoid a single company owning this entire space?
• Resident/community ownership: Are there ways for the community to benefit financially from these platforms, especially because they are providing the referral resources? What is the role of residents in this – after all, isn’t this all “for them?” 

This episode features a conversation between Lucia Rojas-Smith, DrPH, MPH, Director of the Center for Community Health Evaluation and Economic Research at RTI and Shannon O’Connor, PhD, MS, MA, a social science research analyst at the Center for Medicare and Medicaid Innovation. This session is the fourth in a series focused on health care sector efforts to provide Assistance to patients to reduce their social risks. Drs. Rojas-Smith and O’Connor discussed findings from the Accountable Health Communities (AHC) Model’s first annual report. 

Recommended references:

• Accountable Health Communities (AHC) Model Evaluation. First Evaluation Report. 2020.
• CMS. Building strong community partnerships to address social needs: a case study in effective advisory board collaboration from the Accountable Health Communities model. 2021.
• Holcomb et al. Developing and evaluating a quality improvement intervention to facilitate patient navigation in the Accountable Health Communities model. Front Med. 2021.
• Gottlieb et al. Evaluating the Accountable Health Communities demonstration project. J Gen Intern Med. 2017.

This episode features a conversation between Reginald Williams II, Vice President of International Health Policy and Practice Innovations at the Commonwealth Fund, and Matt Pantell, MD, MS, a pediatric hospitalist, assistant professor of pediatrics at UCSF, and SIREN researcher. This session is the third in a series focused on health care sector efforts to provide Assistance to patients to reduce their social risks. Reggie and Matt define social isolation and loneliness and explore different approaches used in the UK, Norway, and elsewhere to mitigate loneliness and social isolation.

Recommended references:

• Tung E, De Marchis E, Gottlieb L, Lindau S, Pantell M. Patient experiences with screening and assistance for social isolation in primary care settings. J Gen Intern Med. 2021 Feb 2;1-7.  
• National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: National Academies Press; 2020.
• National Institute on Aging. Social Isolation and Loneliness Toolkit - An outreach toolkit to reduce social isolation and loneliness. Webpage.
• National Suicide Prevention Lifeline - National network of local crisis centers that provides emotional support to people in emotional distress or crisis. Telephone: 1-800-273-8255; Website: https://suicidepreventionlifeline.org 
• Friendship Line: Serves as both a crisis intervention hotline and a warmline for non-emergency emotional support calls for adults 60 years and older. Telephone: 1-800-971-0016; Web site: https://www.ioaging.org/services/all-inclusive-health-care/friendship-line 
• National Alliance on Mental Illness Helpline: Hotline that provides resources and support to people living with mental health conditions as well as their family and caregivers. Telephone: 1-800-950-NAMI (6264); Web site: https://nami.org/help

This episode features a conversation between Megan Sandel, MD, MPH, an associate professor of pediatrics at the Boston University Schools of Medicine and Public Health and co-lead principal investigator with Children’s Health Watch, and Rhea Boyd, MD, MPH, a pediatrician, public health advocate, and scholar who is the Director of Equity and Justice for The California Children’s Trust and most recently, co-developed THE CONVERSATION: Between Us, About Us, a national campaign to bring information about the COVID vaccines directly to Black communities. This session is the second in a series focused on health care sector efforts to provide Assistance to patients to reduce their social risks. Megan and Rhea explore the ways in which social inequality has been encoded and medicalized in the conceptualization of social care and challenge us to think differently about what “health equity” means. 

Recommended references:

• Boyd RW, Lindo EG, Weeks LD, McLemore MR. On Racism: A New Standard for Publishing on Racial Health Inequities. Health Affairs Blog. 2020.
• Benjamin R. Race After Technology: Abolitionist Tools for the New Jim Code. Polity. 2019.
• Eubanks V. Automating Inequality: How High-Tech Tools Profile, Police, and Punish the Poor. Picador USA. 2019.
• Krieger N, Boyd RW, De Maio F, Maybank A. Medicine’s Privileged Gatekeepers: Producing Harmful Ignorance About Racism and Health. Health Affairs Blog. 2021.
• Putnam-Hornstein E, Ahn E, Prindle J et al. Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in a California Birth Cohort, 1999–2017. AJPH. 2021.
• Hooks b. Feminist Theory: From Margin to Center. Routledge (3rd ed). 1984, 2014.
• Barceló N, Shadavran S. Race, Metaphor, and Myth in Academic Medicine. Acad Psychiatry. 2020.