Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness.
Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness.
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DOI：
10.1001/jamanetworkopen.2021.0490
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Kanzaria HK
中科院分区：
文献类型：
--
作者：
Fuchs JD;Carter HC;Evans J;Graham-Squire D;Imbert E;Bloome J;Fann C;Skotnes T;Sears J;Pfeifer-Rosenblum R;Moughamian A;Eveland J;Reed A;Borne D;Lee M;Rosenthal M;Jain V;Bobba N;Kushel M;Kanzaria HK
对于确诊或疑似患有2019冠状病毒病（COVID - 19）且症状为轻至中度的无家可归者，能否在指定的隔离检疫（I/Q）酒店进行安全监测？
在这项针对从医院、门诊和公共卫生监测机构转诊的1009名隔离检疫酒店客人的队列研究中，81%的人完成了推荐的隔离检疫疗程，从县医院转诊的人中只有4%因COVID - 19病情进展需要再次入院。
这项研究表明，在COVID - 19大流行期间，一种基于酒店的隔离检疫策略，为无家可归者提供综合医疗和行为健康支持，可以在医院环境之外安全实施。
美国的几个辖区已经租用酒店，为确诊或疑似患有2019冠状病毒病（COVID - 19）需要隔离或检疫的无家可归者提供临时住所。据我们所知，对于这些项目如何在医院环境之外为这一弱势群体提供服务，我们知之甚少。
为了评估基于酒店的隔离检疫（I/Q）护理系统的安全性及其与住院医院容量的关联。
这项对加利福尼亚州旧金山无家可归者和居住不稳定者基于酒店的隔离检疫护理系统的回顾性队列研究于2020年3月19日至5月31日进行。患有轻至中度COVID - 19无法在家安全隔离或检疫的个人、受调查者或密切接触者从医院、门诊和公共卫生监测机构被转诊至5家隔离检疫酒店。在1009名隔离检疫酒店客人中，346人从一家为无家可归患者服务的大型县公立医院转诊而来。
一个由医生监督的护士和卫生工作者团队提供全天候支持，包括症状监测、健康检查、膳食、减少伤害服务以及针对阿片类药物使用障碍的药物治疗。
隔离检疫酒店客人的特征、项目留存情况、县医院再入院情况以及平均住院时间。
总体而言，1009名隔离检疫酒店客人的中位年龄为44岁（四分位间距为33 - 55岁），756人（75%）为男性，454人（45%）为拉丁裔，501人（50%）为有庇护（n = 295）或无庇护（n = 206）的无家可归者。总体而言，463人（46%）被诊断患有COVID - 19；907人中有303人（33%）患有合并症，907人中有225人（25%）患有合并精神健康障碍，907人中有236人（26%）患有合并物质使用障碍。955名客人中有776人（81%）完成了在隔离检疫酒店的住宿；与提前终止最密切相关的因素是无庇护的无家可归状态（调整后的优势比为4.5；95%置信区间为2.3 - 8.6；P <.001）和检疫状态（调整后的优势比为2.6；95%置信区间为1.5 - 4.6；P =.001）。总共549名患者中有346人（63%）从县医院转诊；在113例不符合条件的转诊中，48名患者（42%）的行为健康需求超出了隔离检疫酒店的能力。从县医院转诊的346名患者中有13人（4%）因COVID - 19病情恶化再次入院。总体而言，从急诊和门诊直接转诊至隔离检疫酒店避免了许多住院情况。2020年3月至5月，确诊或疑似患有COVID - 19的住院患者的平均住院时间从5.5天降至2.7天，但差异无统计学意义（P =.11）。
为了在COVID - 19大流行期间支持无家可归者，旧金山迅速且安全地扩大了一种基于酒店的隔离检疫模式，这种模式与住院容量的压力减轻有关。提高客人留存率和解决酒店环境中未满足的行为健康需求的策略是干预的重点。
这项队列研究评估了在COVID - 19大流行期间基于酒店的隔离检疫护理系统的安全性及其与医院住院容量的关联。
Can persons experiencing homelessness with confirmed or suspected coronavirus disease 2019 (COVID-19) and mild to moderate symptoms be safely monitored in designated isolation and quarantine (I/Q) hotels? In this cohort study among 1009 I/Q hotel guests referred from hospitals, outpatient settings, and public health surveillance, 81% completed their recommended I/Q course, and only 4% of those transferred from the county hospital required readmission for COVID-19 progression. This study suggests that, during the COVID-19 pandemic, a hotel-based I/Q strategy that delivers integrated medical and behavioral health support to people experiencing homelessness can be done safely outside the hospital setting. Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting. To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity. This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness. A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder. Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay. Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11). To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities. This cohort study assesses the safety of a hotel-based isolation and quarantine care system and its association with hospital inpatient capacity during the COVID-19 pandemic.
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影响因子：
11.8
作者：
Imbert, Elizabeth;Kinley, Patrick M.;Fuchs, Jonathan D.
通讯作者：
Fuchs, Jonathan D.
影响因子：
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DOI：
10.1007/s11524-008-9270-2
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2008-05-01
影响因子：
6.6
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作者：
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通讯作者：
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影响因子：
3.3
作者：
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通讯作者：
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