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How Safety Net Organizations Address Social Determinants of Health

Nearly 6,000 health care professionals from around the world and thousands more via satellite broadcast attended the Institute for Healthcare Improvement (IHI) 24th Annual National Forum on quality Improvement in Health Care.

Held last month in Orlando, Fla., the annual conference is considered a premier “meeting place,” for thousands of health care leaders from around the world. The conference allows attendees to engage in hundreds of defining moments that will shape the future of health care quality, expose them to new ways of thinking, and empower them to effect real change.

Kaiser Permanente has had long-standing relationships with IHI and safety net organizations to help cultivate high-quality, evidence-based medical practices.

During the conference, Kaiser Permanente led a safety net town hall – Trauma: An Exploration of How Innovative Safety Net Organizations are Addressing Social Determinants of Health.

Facilitated by safety net leader, Amit Shah, MD, medical director of clinical informatics, Care Oregon, Inc., the town hall’s panelists included Kathy Colbenson, Chief Executive Officer of CHRIS Kids in Atlanta, Georgia; Stefania Kaplanes, MSW, of the Alameda County Medical Center, Trauma Department in Oakland, Calif., and Veronica Gunn, MD, vice president of Population Health Management & Payment Innovation and medical director of Community Services, Children’s Hospital of Wisconsin in Milwaukee.

The panelists were challenged to identify means in which health care sites identify individuals at risk suffering consequences of exposure to trauma and identify promising approaches and practices that disrupt the cycle. They also explained how systems interact with each other and engage community resources and identify quality improvement and/or research opportunities for advancing practice.

“We identified organizations in the safety net that truly are doing innovative things in breaking the cycle of emotional and social trauma—particularly in younger people—in the clinical setting and its relationship to acute and long term association with the development of chronic disease,” said Winston Wong, MD, medical director, Kaiser Permanente Community Benefit, Disparities Improvement and Quality Initiatives.

“We know through studies that individuals exposed to adverse events in childhood will have a much higher chance of manifesting deleterious behaviors and disease in later life,” said Dr. Wong. “We also recognize that vulnerable communities are particularly susceptible to these events, and that much has to be done in investing in individual and community resiliency in face of these challenges. “

“Our hope is that through this town hall we will build dialogue to see how this kind of work can be more systematically incorporated into a quality improvement model, and make its way through the IHI family,” said Dr. Wong.

For decades, safety net institutions have stood at the forefront in maintaining access to quality health care for those who can’t afford it, while constantly fighting for economic survival as stalwart advocates of the needs of the underserved. The clinicians, nurses and administrators of these organizations have forged innovative models of care, particularly for culturally and socio-economically diverse populations, and have addressed the complexities of caring for those with co-morbidities yet few resources to address them.

“Kaiser Permanente recognizes that our system for caring for our 9 million members is in some ways only as strong as the safety net around it,” Dr. Wong said.

At the IHI conference, we caught up with panelist Veronica Gunn, MD, from Children’s Hospital of Wisconsin. Dr. Gunn is the vice president of Population Health Management & Payment Innovation and medical director of Community Services. The Division serves as a center for research and development of best-practice programs to prevent illness, improve wellness, and manage health needs of populations. The Division also develops and tests new payment models to support the best-practice programs and transition a health system from being paid to treat sick children to being paid to keep children healthy.

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