Interventions to address basic resource needs in Kaiser Permanente: A care continuum and an outcomes wheel

As Kaiser Permanente develops interventions to help members address basic resource needs such as food, housing, utilities, and transportation, the organization is concurrently developing a framework for program implementation, outcomes assessment, and interventions dissemination. This framework combines a care continuum, adapted from population-based care management strategies for chronic diseases, with an outcomes wheel, which reflects a broad range of health outcomes that are relevant to patients, valued by diverse stakeholders, and potentially modifiable through interventions. The resource-needs care continuum has 5 steps: 1) plan new interventions to generate evidence of effectiveness, 2) assess basic resource needs in broad or targeted membership groups, 3) connect individuals to community organizations that can fulfill basic resource needs, 4) improve health outcomes through these interventions, and 5) spread effective programs to other settings. Each step has multiple subcomponents that support implementation and evaluation. Although all stakeholders agree that interventions should assess fulfillment or mitigation of underlying basic resource needs, patients, clinicians, and organizational leaders often have different priorities for assessment of other health outcomes. The outcomes wheel identifies health outcomes at the individual, clinical, social, and system levels that can address these different priorities.The resource-needs care continuum and outcomes wheel can assist operational leaders in designing and implementing new interventions, evaluating their effectiveness, and planning dissemination. Early collaboration with evaluators and researchers helps ensure that programs select appropriate measures of basic resource needs and health outcomes, adopt rigorous evaluation designs, and are sufficiently large to support decisions about effectiveness and spread.