Measuring Success: IHRI Dives Into Data for Social Determinants of Health

As a researcher in the field of social epidemiology, Paulina Kaiser has spent her career exploring the ways in which social determinants of health — things like access to housing, transportation and proper nutrition — influence health outcomes for entire populations.

“This is a really hard thing to study,” said Kaiser, Director of Health Outcomes, Research and Evaluation for Samaritan Health Services based in Corvallis. “What we find is there are a lot of differences between healthy populations and unhealthy populations that are not reducible to the differences in individual health risks and behaviors. A lot of that is because of the importance of social determinants of health and environmental influences.”

In 2022, Samaritan Health Services launched a collaboration with IHN-CCO called the InterCommunity Health Research Institute (IHRI). The goal was to analyze how community-led programs in Benton, Lincoln and Linn counties are creating healthier populations through quantifiable data.

That, in turn, will help these programs make their case for more funding and support, or develop new initiatives that lead to better outcomes.

“These community-based organizations have great ideas and do great work, but they are not researchers. They are not trained in data methods and statistical analysis,” Kaiser said. “Everybody recognizes that those kinds of things are really important to actually being able to understand the impact of these programs, especially if the goal is to sustain this work and be able to convince organizations with funding that these programs are worthwhile and do make a difference.”

IHRI is the brainchild of Bruce Butler, CEO of Samaritan Health Plans. Butler was inspired to form the initiative after hearing a presentation by Karen DeSalvo, former Acting Assistant Secretary of Health under President Barack Obama, who stressed that the U.S. health care system needs to do a better job of addressing social determinants of health.

Butler knew exactly where to turn.

“I happened to be a really good fit in terms of my background and my interests,” said Kaiser, who was tapped to lead the IHRI.

Kaiser and her team formed a Governance Committee made up of about 20 policyholders, community health organizations and academic institutions, including Oregon State University and the College of Osteopathic Medicine of the Pacific Northwest in Lebanon. The committee now meets quarterly to discuss research projects to improve population health outcomes and health equity.

The focus, Kaiser said, will be measuring progress and evidence-based results for pilot projects funded by IHN-CCO through its Delivery System Transformation Committee (DST). That committee provided approximately $1.13 million in funding for 11 projects in 2023, including resources for LGBTQ+ youth, emergency shelters and street outreach.

“There is increasing recognition that we won’t achieve the population health outcomes we want without addressing social determinants of health,” Kaiser said. “From a clinical care system, a lot of health is determined outside of clinic walls.”

Building Better Bridges

Since getting started, Kaiser said IHRI has spearheaded two data-driven projects. The first looked at merging data about clients accessing federal housing programs with electronic medical records supported by Samaritan Health Services.

“The idea was, we have all this data sitting in silos. We could probably learn a lot more if we could combine these data sources,” Kaiser said.

A major challenge, however, was merging these records without violating individuals’ privacy under the Health Insurance Portability and Accountability Act (HIPAA). Researchers eventually came up with a method known as “Privacy-preserving Record Linkage,” allowing them to match individuals from each dataset without requiring access to identifiable information, such as names, dates of birth or social security numbers.

With this method, Kaiser said they could begin studying trends in the data. For example, they recorded that residents experiencing chronic homelessness were more likely to have multiple visits to the emergency department (43%) compared to those with more stable housing (29%).

“The homeless population is not a homogenous group in any way,” Kaiser said. “Being able to dig into the data a little more could potentially justify and motivate specific interventions for them to build better bridges with medical care.”

‘A Lot of Opportunity’

The second project centers on a Community Doula Program created by a medical anthropologist at OSU and supported by IHN-CCO.

The program trains and matches doulas with families for support during pregnancy. Kaiser said they wanted to better understand differences in birth outcomes between those who have a doula, and those who don’t. The team hopes to publish its findings in a peer-reviewed journal soon.

Kaiser said she believes there is “a lot of opportunity” for IHRI to continue this kind of work with community partners throughout the region.

“My personal goal is to help Samaritan, including IHN-CCO, learn how to integrate and support community partners doing this work that is so important to health outcomes that is beyond the scope of the clinical system,” she said. “I think this region is really fertile ground for figuring out how to do this work together, because we have so many fantastic organizations.”