Variability in comorbidites and health services use across homeless typologies: multicenter data linkage between healthcare and homeless systems.
Variability in comorbidites and health services use across homeless typologies: multicenter data linkage between healthcare and homeless systems.
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DOI：
10.1186/s12889-021-10958-8
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发表时间：
2021-05-13
影响因子：
4.5
通讯作者：
Toepfer PS
中科院分区：
文献类型：
--
作者：
Trick WE;Rachman F;Hinami K;Hill JC;Conover C;Diep L;Gordon HS;Kho A;Meltzer DO;Shah RC;Stellon E;Thangaraj P;Toepfer PS
无家可归与高发病率有关。无家可归者与卫生系统之间的数据联系对于了解无家可归人群的独特需求、识别未在无家可归者数据库中注册的无家可归者、量化住房服务对卫生系统使用的影响以及激励卫生系统和付款人为住房解决方案做出贡献非常重要。我们进行了一项横断面调查，包括伊利诺伊州库克县的六个卫生系统和两个无家可归者管理信息系统 (HMIS)。我们执行隐私保护记录链接，通过电子病历中捕获的 HMIS 或 ICD-10 代码来识别无家可归者。我们测量了以下类型的健康状况和卫生服务使用的普遍程度：按提供的服务（稳定、稳定加不稳定、不稳定）分层的住房服务利用者和非利用者（即通过诊断代码识别的无家可归者 - 未接受住房服务）。在 11,447 名接受医疗保健的无家可归者中，近五分之一的人仅通过 ICD10 代码识别，而没有记录无家可归者服务（n = 2177；19%）。几乎一半的人接受了不包括稳定住房的无家可归者服务（n = 5444；48%），其次是稳定住房（n = 3017；26%），然后接受了稳定和不稳定的服务（n = 809；7%）。将稳定住房接受者作为参考群体，我们发现行为健康状况逐步增加，从稳定住房到仅被卫生系统称为无家可归的人。与拥有稳定住房的人相比，没有无家可归者服务的人群的患病率（PRR）如下：抑郁症（PRR = 2.2；95% CI 1.9至2.5）、焦虑症（PRR = 2.5；95% CI 2.1至3.0）、精神分裂症（PRR = 3.3；95% CI 2.7）至 4.0）和酒精使用障碍（PRR = 4.4；95% CI 3.6 至 5.3）。未获得住房服务的无家可归者依靠急诊部门获得医疗保健——近四分之三的人至少去过一处，许多人 (24%) 去过多处。不同类型的无家可归者在行为健康状况和卫生系统使用方面的差异凸显了与无家可归者服务脱节的无家可归者所承受的特别沉重的负担。急诊科护理的分散和大量使用应该会激励卫生系统和付款人推广住房解决方案，特别是那些包含药物滥用和心理健康治疗的解决方案。在线版本包含可在 10.1186/s12889-021-10958-8 获取的补充材料。
Homelessness is associated with substantial morbidity. Data linkages between homeless and health systems are important to understand unique needs across homeless populations, identify homeless individuals not registered in homeless databases, quantify the impact of housing services on health-system use, and motivate health systems and payers to contribute to housing solutions. We performed a cross-sectional survey including six health systems and two Homeless Management Information Systems (HMIS) in Cook County, Illinois. We performed privacy-preserving record linkage to identify homelessness through HMIS or ICD-10 codes captured in electronic medical records. We measured the prevalence of health conditions and health-services use across the following typologies: housing-service utilizers stratified by service provided (stable, stable plus unstable, unstable) and non-utilizers (i.e., homelessness identified through diagnosis codes—without receipt of housing services). Among 11,447 homeless recipients of healthcare, nearly 1 in 5 were identified by ICD10 code alone without recorded homeless services (n = 2177; 19%). Almost half received homeless services that did not include stable housing (n = 5444; 48%), followed by stable housing (n = 3017; 26%), then receipt of both stable and unstable services (n = 809; 7%). Setting stable housing recipients as the referent group, we found a stepwise increase in behavioral-health conditions from stable housing to those known as homeless solely by health systems. Compared to those in stable housing, prevalence rate ratios (PRR) for those without homeless services were as follows: depression (PRR = 2.2; 95% CI 1.9 to 2.5), anxiety (PRR = 2.5; 95% CI 2.1 to 3.0), schizophrenia (PRR = 3.3; 95% CI 2.7 to 4.0), and alcohol-use disorder (PRR = 4.4; 95% CI 3.6 to 5.3). Homeless individuals who had not received housing services relied on emergency departments for healthcare—nearly 3 of 4 visited at least one and many (24%) visited multiple. Differences in behavioral-health conditions and health-system use across homeless typologies highlight the particularly high burden among homeless who are disconnected from homeless services. Fragmented and high use of emergency departments for care should motivate health systems and payers to promote housing solutions, especially those that incorporate substance use and mental health treatment. The online version contains supplementary material available at 10.1186/s12889-021-10958-8.
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影响因子：
3.1
作者：
Kuhn, R;Culhane, DP
通讯作者：
Culhane, DP
影响因子：
120.7
作者：
Sadowski, Laura S.;Kee, Romina A.;Buchanan, David
通讯作者：
Buchanan, David
影响因子：
3.7
作者：
Peterson, Rachel;Gundlapalli, Adi V.;Fargo, Jamison D.
通讯作者：
Fargo, Jamison D.
影响因子：
1.6
作者：
Ha, Yoonsook;Narendorf, Sarah C.;Bezette-Flores, Noel
通讯作者：
Bezette-Flores, Noel
影响因子：
3.4
作者：
Basu, Anirban;Kee, Romina;Sadowski, Laura S.
通讯作者：
Sadowski, Laura S.