Comprehensive services delivery and emergency department use among chronically homeless adults.
Comprehensive services delivery and emergency department use among chronically homeless adults.
复制标题
DOI：
10.1037/ser0000111
复制
发表时间：
2017-05
影响因子：
2.3
通讯作者：
Rosenheck RA
中科院分区：
文献类型：
--
作者：
Moore DT;Rosenheck RA
无家可归的成年人使用急诊科（艾德）服务比其他成年人更频繁，但无家可归，健康状况，门诊服务的使用，和艾德利用率之间的关系知之甚少。从合作倡议，以帮助结束慢性无家可归（CICH）的数据被用来比较艾德使用的长期无家可归的成年人谁收到综合住房，病例管理，心理健康/成瘾和初级保健服务，通过CICH在美国的5个网站（N=274）和艾德使用控制组客户端接收一般可用的社区服务（N=116）在相同的网站。使用多重插补来解释缺失数据和队列间的差异性脱落率。建立纵向模型，比较两组在开始CICH服务后第一年内的艾德使用情况。中介分析进行，以确定被安置，门诊服务的接收，健康状况的相对贡献组差异艾德利用。接受CICH服务的参与者在进入项目后一年报告艾德使用的可能性显著降低（OR = 0.78，95% CI = 0.65-0.93）。减少艾德使用CICH参与者主要介导减少无家可归的情况下，而不是通过增加获得病例管理，其他门诊服务，或健康状况。这表明，住房是减少艾德使用的关键驱动因素，为无家可归的成年人提供住房的努力可能会导致艾德使用显着减少。需要开展进一步研究，以确定住房对健康状况的长期影响，并开发服务以改善健康状况。
Homeless adults use emergency department (ED) services more frequently than other adults but the relationships between homelessness, health status, outpatient service use, and ED utilization are poorly understood. Data from the Collaborative Initiative to Help End Chronic Homelessness (CICH) were used to compare ED use among chronically homeless adults who received comprehensive housing, case management, mental health/addiction and primary care services through CICH at five US sites (N=274) and ED use among control group clients receiving generally available community services (N=116) at the same sites. Multiple imputation was used to account for missing data and differential rates of attrition between the cohorts. Longitudinal models were constructed to compare ED use between the two groups during the first year after initiation of CICH services. A mediation analysis was performed to determine the relative contributions of being housed, the receipt of outpatient services, and health status to group differences in ED utilization. Participants receiving CICH services were significantly less likely to report ED use (OR = 0.78, 95% CI = 0.65–0.93) in the year after program entry. Decreased ED use by CICH participants was primarily mediated by decreased homelessness—not by increased access to case management, other outpatient services, or health status. This suggest that becoming housed is a key driver of reduced ED utilization and that efforts to provide housing for homeless adults may result in significantly decreased ED use. Further research is needed to determine the long-term effects of housing on health status and to develop services to improve health outcomes.