Using Social and Medical Data Integration to Improve Primary Care and Population-Level Chronic Disease Prevention and Management. (University of California, San Francisco. Principal Investigators: Danielle Hessler and Caroline Fichtenberg). The grantee will: Develop, refine, and deploy integrated health and social risk data dashboards for use in chronic disease-related patient care, population health management, and community health planning. Seamlessly integrate health and social needs data, facilitating bi-directional referrals between health and social service providers. Evaluate the impacts of dashboards on cardiovascular disease prevention and management.