SONNET Project: Fitzpatrick


SONNET is a national network of applied researchers who help design, evaluate, and implement effective social health interventions to improve member health across Kaiser Permanente. SONNET's work is made possible with funding from KP's National Community Health Program.

Social Context Informed Care at Kaiser Permanente
 

Project team

Stephanie Fitzpatrick, PhD, Principal Investigator, KP Northwest Center for Health Research 

Project summary

Social needs-targeted care is defined as “activities in clinical settings that seek to address patients’ social needs directly” whereas social needs-informed care is defined as “activities that involve modifications to traditional medical care to account for patients’ social circumstances.” Dr. Fitzpatrick’s work explores to what extent “adjustment strategies” are used across the 8 KP regions, the consistency in which they are implemented, or if their use is actually informed by member social needs data.  

She will examine gaps in the literature regarding how providers should adjust their care and treatment planning based on specific social needs – especially for chronic diseases in which clinical outcomes are impacted by the social context (e.g., diabetes, hypertension, cancer, obesity).  

This information will inform guidelines and trainings for providers on how to use the social needs data being collected and stored in the health record and in Thrive Local. Literature exploration will result in a scoping review that will:  

  • Identify types and key characteristics of social needs-informed care 

  • Determine the effectiveness based on clinical outcomes, patient engagement, and healthcare cost 

  • Examine health system strategies to implement social needs-informed care (e.g., provider trainings, technology, community partnerships, expanding the workforce).  

She and her team will conduct a series of semi-structured qualitative interviews with KP leaders, providers, members of KP’s national guideline program, and patients. Using both the scoping review and findings from the qualitative analysis, her team will develop a list of recommendations with potential strategies for implementing social needs-informed care across KP.  

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Social Risk-Informed Care Evaluation

Social-Risk-Informed-Care-Evaluation_Final-Report_Cover.pngRead results of SONNET's research on how to implement social risk-informed care in this report by Stephanie L. Fitzpatrick, PhD, and Dea Papajorgji-Taylor, MPH, from Kaiser Permanente Northwest Center for Health Research.


Contact SONNET

Email us at sonnet@kp.org to learn more about our work or request a consultation.