The Opportunity
Social
determinants of health (SDOH) are critical factors that influence the health
outcomes of individuals. Economic stability, in particular, has a profound
impact on health and health care outcomes due to its direct relationship with
basic human needs. Among the primary issues of economic stability are food
insecurity and housing instability. Both concepts include varying forms of
homelessness and hunger. Several interventions are effective in reducing housing
instability and food insecurity. For example, a systematic review of the impact
of food banks on food insecurity found that food banks have the potential to
improve food security outcomes (e.g. quantity and quality of food eaten).
Another review of interventions found that permanent housing support, assertive
community treatment, and intensive case management services significantly
improved housing stability outcomes (e.g. reductions in homelessness). However,
health care organizations rarely assess risk or employ interventions to reduce
food insecurity and housing instability. Measurement can quantify the degree of
food insecurity and housing instability within a community. Similarly,
performance can be measured to quantify the level to which health care providers
are assessing risk and connecting patients to resources. Finally, measurement
can be applied to determine the effectiveness of interventions to reduce housing
instability and food insecurity. These measures can then be used for both
quality improvement and accountability initiatives. A framework is needed to
guide measure development and ensure a systematic approach.
About this Project
Objectives
In collaboration with Centers for Medicare & Medicaid Services, NQF will create a measurement framework to
assess food insecurity and housing instability. A measurement framework is a
conceptual model for organizing ideas about what is important to measure and how
measurement should take place (e.g., whose performance should be measured, care
settings where measurement is needed, when measurement should occur, which
individuals should be included in measurement, etc.). The framework provides a
structure for organizing currently available measures, areas where gaps in
measurement exist, and prioritization for future measure development. To
accomplish this task, NQF will:
- Convene a multi-stakeholder group of SDOH
experts with specific expertise in housing instability, food insecurity, and
measurement;
- Conduct a review of the evidence of effective
interventions and conceptual frameworks for measuring outcomes related to food
insecurity and housing instability;
- Conduct environmental scan of performance
measures that can be used to assess food insecurity and housing
instability;
- Key informant interviews with other experts in
the field;
- Document the expert panel’s recommendations in
a final report.
NQF Process
To develop a measurement framework that captures all important areas to measure, NQF will
convene an Expert Panel drawing on members of existing NQF standing committees
including Health and Well-Being and Disparities Standing Committees and the SDOH
Expert Panel. The panel will comprise experts in SDOH with specific expertise in
housing stability and food insecurity. The group of 10-12 experts will embody a
wide variety of stakeholders groups including but not limited to clinicians,
researchers, health plans, health systems, and consumer advocates. The Expert
Panel will provide guidance on the approach to each deliverable and ultimately
provide recommendations for the development of the conceptual framework. In
addition, through the direction of the expert panel NQF will draw on the
expertise of key informants to inform the literature review and environmental
scan.
Related NQF Work
Contact Information
For more information, contact the project team at 202-783-1300 or
foodandhousing@qualityforum.org.