Improving Health Care Outcomes Among the Homeless

这项研究和培训计划的目标是让申请人获得必要的工具，成为无家可归者卫生服务研究和卫生保健政策的领导者。基于她在初级保健内科和临床流行病学方面的培训，申请人建议通过与多学科赞助团队的互动来发展额外的技能；2)旨在扩展她的理论和方法知识和技能的教程和课程；3)一系列重点突出的，有监督的研究项目。先前对无家可归者的研究主要集中在无家可归者的个体特征上；本研究计划的重点是社区因素在无家可归者的医疗保健利用和结果中所起的作用。拟议的项目调查住房、个案管理和一般无家可归者服务与无家可归者的保健利用模式和结果之间的关系，然后审查这些服务的成本效益。具体目标是：1)检查无家可归者的不同社区水平（住房、保健、整体服务）对无家可归者成人和儿童住院和急诊率的影响；2)检查病例管理作为改善感染艾滋病毒的无家可归者健康结果的战略的成本效益；3)检查在两种不同政策选择下一组无家可归者的保健利用和公共成本：支持性住房和日常护理。加州大学旧金山分校拥有广泛的卫生政策相关研究资源，为申请人进行研究和培训提供了良好的环境。申请人的资助人和指导团队在相关学科方面拥有丰富的经验，对于申请人作为一项专注于改善无家可归者健康的独立研究的发展至关重要。

The goal of this research and training program is for the applicant to gain the tools necessary to become a leader in health services research and health care policy of homeless persons. Building on her training in primary care internal medicine and clinical epidemiology, the applicant proposes to develop additional skills through interaction with a multi- disciplinary sponsorship team 2) tutorials and coursework designed to expand her theoretical and methodological knowledge and skills and 3) a series of focused, supervised research projects. Prior research on the homeless has focused on individual characteristics of homeless persons; this research program focuses on the role that community factors play in the health care utilization and outcomes of the homeless. The proposed projects investigate the association between housing, case management and general homeless services and the health care utilization patterns and outcomes of the homeless, than examines the cost-effectiveness of these services. The specific aims are: 1) to examine the effects of different levels of community levels for the homeless (housing, health care, overall services) on hospitalization and emergency department rates of homeless adults and children 2) to examine the cost-effectiveness of case-management as a strategy for improving health outcomes among HIV infected homeless persons and 3) to examine health care utilization and public cost of a cohort of homeless persons under two different policy options: supportive housing and usual care. The University of California, San Francisco, with its extensive resources for health policy related research provides an excellent environment for the applicant to pursue research and training. The applicant's sponsor and mentorship team have vast experience in the relevant disciplines and will be critical in the applicant's development as an independent research with a focus on improving the health of the homeless.