Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults A Randomized Trial
Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults A Randomized Trial
复制标题
DOI：
10.1001/jama.2009.561
复制
发表时间：
2009-05-06
影响因子：
120.7
通讯作者：
Buchanan, David
中科院分区：
文献类型：
--
作者：
Sadowski, Laura S.;Kee, Romina A.;Buchanan, David
背景无家可归的成年人，特别是那些有慢性医疗疾病，经常使用昂贵的医疗服务，特别是急诊科和医院services.Objective评估的有效性的情况下，管理和住房计划，减少使用紧急医疗服务的无家可归的成年人与慢性医疗疾病。设计，设置和参与者随机对照试验，在公立教学医院和私立，伊利诺伊州芝加哥的一家非营利性医院。参与者是407名社会工作者转介的无家可归的成年人与慢性医疗疾病（89%的转介），从2003年9月至2006年5月，随访至2007年12月。干预住房作为出院后的过渡住房提供，随后安置在长期住房;在主要研究中心、过渡住房和稳定住房中心提供现场病例管理。住院护理参与者接受标准的出院规划，从医院的社会workers.Main结果测量住院，住院天数，和急诊科的访问测量使用电子监控，医疗记录，和采访。模型根据人口统计学、保险状况、既往住院或急诊就诊、人类免疫缺陷病毒感染、目前使用酒精或其他药物、精神健康症状和其他因素的基线差异进行调整。（n=405 [n=201为干预组，n=204为常规护理组]）为78%的男性和78%的非洲裔美国人，无家可归的中位持续时间为30个月。18个月后，73%的参与者至少有一次住院或急诊就诊。与常规护理组相比，干预组未经调整的年平均住院次数减少0.5次（95%置信区间[CI]，-1.2至0.2），住院天数减少2.7天（95% CI，-5.6至0.2），急诊就诊次数减少1.2次（95% CI，-2.4至0.03）。调整基线协变量后，与常规护理组相比，干预组的住院率相对降低了29（95% CI，10%-44%），住院日为29%（95% CI，8%-45%），急诊科就诊率为24%（95%CI，3%-40%）。结论调整后，与常规护理相比，为患有慢性内科疾病的无家可归成年人提供住房和病例管理可减少住院天数和急诊就诊次数。clinicaltrials.gov
Context Homeless adults, especially those with chronic medical illnesses, are frequent users of costly medical services, especially emergency department and hospital services.Objective To assess the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical illnesses.Design, Setting, and Participants Randomized controlled trial conducted at a public teaching hospital and a private, nonprofit hospital in Chicago, Illinois. Participants were 407 social worker-referred homeless adults with chronic medical illnesses (89% of referrals) from September 2003 until May 2006, with follow-up through December 2007. Analysis was by intention-to-treat.Intervention Housing offered as transitional housing after hospitalization discharge, followed by placement in long-term housing; case management offered on-site at primary study sites, transitional housing, and stable housing sites. Usual care participants received standard discharge planning from hospital social workers.Main Outcome Measures Hospitalizations, hospital days, and emergency department visits measured using electronic surveillance, medical records, and interviews. Models were adjusted for baseline differences in demographics, insurance status, prior hospitalization or emergency department visit, human immunodeficiency virus infection, current use of alcohol or other drugs, mental health symptoms, and other factors.Results The analytic sample (n=405 [n=201 for the intervention group, n=204 for the usual care group]) was 78% men and 78% African American, with a median duration of homelessness of 30 months. After 18 months, 73% of participants had at least 1 hospitalization or emergency department visit. Compared with the usual care group, the intervention group had unadjusted annualized mean reductions of 0.5 hospitalizations (95% confidence interval [CI], -1.2 to 0.2), 2.7 fewer hospital days (95% CI, -5.6 to 0.2), and 1.2 fewer emergency department visits (95% CI, -2.4 to 0.03). Adjusting for baseline covariates, compared with the usual care group, the intervention group had a relative reduction of 29% in hospitalizations (95% CI, 10% to 44%), 29% in hospital days (95% CI, 8% to 45%), and 24% in emergency department visits (95% CI, 3% to 40%).Conclusion After adjustment, offering housing and case management to a population of homeless adults with chronic medical illnesses resulted in fewer hospital days and emergency department visits, compared with usual care.Trial Registration clinicaltrials.gov Identifier: NCT00490581