The rising medical costs associated with cancer have led to considerable financial hardship for patients and their families in the United States. Using data from the LIVESTRONG 2012 survey of 4,719...

In the US, there is growing recognition that social factors (eg, financial hardship, food insecurity, housing instability) influence individual and population health. This has led to increased efforts to address these social determinants of health (SDH) within the delivery system. Yet, limited information exists about the strategies health care systems employ to identify and address SDH. Kaiser Permanente Northwest (KPNW) is an integrated health care delivery system that has implemented a comprehensive approach toward addressing its patients’ SDH. This article describes the tools and processes used at KPNW for identifying and addressing SDH. Tools included use of electronic health record-based data elements, International Classification of Diseases, Tenth Revision social diagnostic codes (Z codes), and the development of novel workflows via nonclinical patient navigators to address patients’ SDH through community resource referrals. Between March 31, 2016, and March 25, 2018, KPNW patient navigators screened patients with SDH. Patient navigators screened 11,273 patients with SDH, identifying and documenting 47,911 SDH in the electronic health record. During the same 2-year period, 18,284 community resource referrals were made for 7494 patients. The novel electronic health record-based tools developed by KPNW have led to standardized, measurable, and actionable SDH data being used to tailor and target specific resources to meet the identified needs of our patients. By disseminating information about these efforts at KPNW, we aim to help build an evidence basis of different approaches for addressing SDH within the health care system as well as defining opportunities to improve care efficiency for patients with SDH.

Background: There is no model to estimate absolute invasive breast cancer risk for Hispanic women. Methods: The San Francisco Bay Area Breast Cancer Study (SFBCS) provided data on Hispanic breast cancer case patients (533 US-born, 553 foreign-born) and control participants (464 US-born, 947 foreign-born). These data yielded estimates of relative risk (RR) and attributable risk (AR) separately for US-born and foreign-born women. Nativity-specific absolute risks were estimated by combining RR and AR information with nativity-specific invasive breast cancer incidence and competing mortality rates from the California Cancer Registry and Surveillance, Epidemiology, and End Results program to develop the Hispanic risk model (HRM). In independent data, we assessed model calibration through observed/expected (O/E) ratios, and we estimated discriminatory accuracy with the area under the receiver operating characteristic curve (AUC) statistic. Results: The US-born HRM included age at first full-term pregnancy, biopsy for benign breast disease, and family history of breast cancer; the foreign-born HRM also included age at menarche. The HRM estimated lower risks than the National Cancer Institute’s Breast Cancer Risk Assessment Tool (BCRAT) for US-born Hispanic women, but higher risks in foreign-born women. In independent data from the Women’s Health Initiative, the HRM was well calibrated for US-born women (observed/expected [O/E] ratio = 1.07, 95% confidence interval [CI] = 0.81 to 1.40), but seemed to overestimate risk in foreign-born women (O/E ratio = 0.66, 95% CI = 0.41 to 1.07). The AUC was 0.564 (95% CI = 0.485 to 0.644) for US-born and 0.625 (95% CI = 0.487 to 0.764) for foreign-born women. Conclusions: The HRM is the first absolute risk model that is based entirely on data specific to Hispanic women by nativity. Further studies in Hispanic women are warranted to evaluate its validity.