mHealth Technology to Connect and Empower People Experiencing Homelessness to Improve Health and Social Need Outcomes

移动医疗技术连接无家可归者并赋予他们权力，以改善健康和社会需求成果

• 批准号: 10251148
• 负责人: Leticia Rae Moczygemba
• 金额: $ 39.6万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10251148
• 关键词: mHealth; Technology; Connect; Empower; People

PROJECT SUMMARY/ABSTRACT People experiencing homelessness (PEH) are at exceptionally high risk of frequent emergency department (ED) and hospital use, poor functional outcomes, and increased morbidity and mortality from poorly managed chronic health conditions and complex social needs. Significant deficiencies in continuity of care and poor communication between PEH and health and social services providers contribute to these bleak long-term outcomes. Evidence-based interventions of particular promise for reducing ED and hospital utilization and improving health outcomes and meeting social needs involve: 1) providing care in the community to overcome barriers including transportation and fear of stigmatization; 2) coordination of care transitions following ED or hospital discharge to improve access to needed community supports and reduce the risk of readmission; and 3) using mHealth technology to link PEH with appropriate community-based health and social services. This project will build on evidence from two feasibility studies in order to integrate and test a mHealth intervention, comprised of global positioning system technology and text messaging components, into a community setting to connect PEH with a community-based case manager and healthcare and social services. Our hypothesis is that integrating the mHealth intervention into an established, trusted navigation center for PEH will mitigate barriers to care and gaps in the care continuum resulting in decreased ED and hospital use and improved health outcomes and attainment of social needs. Our specific aims are to: 1) refine the existing mHealth intervention and implementation strategy using a community-based participatory research approach; 2) conduct a stratified RCT to compare a mHealth intervention with usual care community-based case management to examine the impact on healthcare utilization (primary outcome), medication adherence, social support, psychological distress and social needs attainment (secondary outcomes) in PEH; and 3) identify and understand factors from PEH and stakeholder perspectives that impact sustainability of the mHealth intervention. The project will be conducted in four phases. During phase one, we will refine the intervention (Aim 1) by eliciting feedback from PEH, key informants, and our community advisory board before conducting a usability test of the refined mHealth intervention. Phase two will consist of the RCT (Aim 2) to compare the efficacy of the mHealth intervention to a usual care control group. Phase three will identify factors to facilitate sustainability of the mHealth intervention (Aim 3) using stakeholder interviews. Phase four will consist of data analysis, triangulation of findings, and dissemination. This study is significant and innovative for several reasons: targets an AHRQ understudied group with complex needs and use of high cost services at a critical transition point; is based in a community-based navigation center instead of a traditional health or social services setting; and recognizes the need for end-user engagement in design.

项目总结/摘要 经历无家可归（PEH）的人经常急诊的风险非常高 (ED)和医院的使用，不良的功能结果，以及由于管理不善而增加的发病率和死亡率， 慢性健康状况和复杂的社会需求。护理连续性方面存在重大缺陷， PEH与卫生和社会服务提供者之间的沟通有助于这些黯淡的长期 结果。减少艾德和医院利用的循证干预措施， 改善健康结果和满足社会需求涉及：1）在社区提供护理， 障碍，包括交通和害怕污名化; 2）协调艾德或 出院，以改善获得所需社区支持的机会，并降低再入院的风险; 3)使用移动医疗技术将PEH与适当的社区卫生和社会服务联系起来。这 该项目将以两项可行性研究的证据为基础，以整合和测试移动健康干预措施， 由全球定位系统技术和文本消息组件组成， 将PEH与基于社区的案例管理器以及医疗保健和社会服务联系起来。我们的假设是 将mHealth干预整合到一个已建立的、可信赖的PEH导航中心中， 护理障碍和护理连续性中的差距导致艾德和医院使用减少， 健康成果和满足社会需求。我们的具体目标是：1）完善现有的移动健康 采用基于社区的参与性研究方法的干预和实施战略; 2） 进行分层随机对照试验，比较移动健康干预与基于社区的常规护理病例 管理，以检查对医疗保健利用（主要结局）、药物依从性、社会 支持，心理困扰和社会需求的实现（次要结果）在PEH;和3）确定和 从PEH和利益相关者的角度了解影响mHealth可持续性的因素 干预该项目将分四个阶段进行。在第一阶段，我们将改进干预措施， (Aim 1）在进行之前，从PEH，关键线人和我们的社区咨询委员会那里获得反馈 对改进后的移动健康干预措施进行可用性测试。第二阶段将包括RCT（目标2），以比较 移动健康干预对常规护理对照组的有效性。第三阶段将确定促进因素 移动健康干预措施的可持续性（目标3），使用利益相关者访谈。第四阶段将包括数据 分析、调查结果的三角测量和传播。这项研究对几个国家来说是重要的和创新的。 原因：目标是AHRQ未充分研究的群体，他们有复杂的需求，并在关键时刻使用高成本服务。 过渡点;基于社区导航中心，而不是传统的健康或社会 服务设置;并认识到最终用户参与设计的必要性。