Evaluating the impact of U.S. eviction moratoria on acute care use and costs

评估美国暂停驱逐对急症护理使用和成本的影响

• 批准号: 10606115
• 负责人: JACK TSAI
• 金额: $ 49.49万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606115
• 关键词: Acute; Address; Affect; Area; COVID-19; COVID-19 pandemic; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Clinical; Communities; Computerized Medical Record; Country; Data; Data Analyses; Data Science; Emergency Situation; Ethnic Origin; Evaluation; Event; Failure; Future; Goals; Group Identifications; Health; Health Care Costs; Health Care Sector; Health Services; Healthcare; Healthcare Systems; Homelessness; Housing; Incentives; Integrated Health Care Systems; Interview; Investments; Knowledge; Lead; Light; Link; Medical Records; Methods; Natural Language Processing; Natural experiment; New York; Outcome; Patients; Personal Satisfaction; Persons; Policies; Policy Developments; Population Heterogeneity; Poverty; Prevention; Process; Property; Public Health; Race; Records; Research; Risk; Role; Sampling; Services; System; Testing; Texas; Time; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; Work; acute care; care costs; care systems; cost; design; development policy; experience; health care service; health disparity; health inequalities; housing instability; improved; innovation; payment; prevent; programs; psychosocial; recruit; rural area; sex; social; social health determinants; sociodemographics; therapy development; urban area

PROJECT SUMMARY The federal eviction moratorium and local eviction moratoria that were implemented during the COVID-19 pandemic presents a unique opportunity to study the impact of eviction-related policies on healthcare use and costs. The long-term goal is to bridge the knowledge and investments of the housing and healthcare fields to address evictions as a social determinant of health that affects disparities in health and healthcare services. The central hypothesis is that eviction moratoria policies can reduce use of homeless and acute care services and tenant-landlord relationships are important to sustain housing stability. The rationale for this project is to guide future development of policies and practices related to evictions with data from the healthcare sector to prevent homelessness and acute care use. Guided by preliminary work, this project has three specific aims: 1) Assess the impact of the federal eviction moratorium and local eviction moratoria on rates of eviction and use of homeless programs; 2) Evaluate the impact of eviction moratoria on use of acute healthcare services and cost; and 3) Examine relationships between tenants and landlords in urban and rural areas during the federal eviction moratorium. To achieve these three aims, data on over 10 million patients from 2018-2023 served by the U.S. Department of Veterans Affairs (VA) healthcare system- the largest integrated system in the U.S. with a comprehensive electronic medical record system- will be analyzed. For the first aim, an innovative natural language processing system will be deployed to identify eviction cases in the medical record and to test hypotheses that the federal and local eviction moratoria reduced rates of evictions and use of homeless programs. For the second aim, impact analyses will be conducted to test the central hypothesis that the federal and local eviction moratoria reduced use of acute care services and costs. Within the context of these first two aims, sociodemographic and clinical characteristics predictive of eviction risk, homeless program use, and acute care use will be identified to inform targeted prevention initiatives. For the third aim, qualitative interviews will be conducted with 50 dyads of tenants and their landlords in Texas and New York about their experiences with the federal eviction moratorium and the role of tenant-landlord relationships in the eviction process, which will shed light on ways that tenants and landlords can be incentivized and considered important partners in eviction prevention and policies. The research proposed in this application is innovative because it uses new data science methods applied to the largest U.S. healthcare system to understand a unique set of policies around evictions, all of which can contribute to needed knowledge in this area. The proposed research is significant because it will help address evictions as an important public health problem associated with housing and health disparities with implications for the healthcare field. Ultimately, the project has the potential to advance the fields of housing and healthcare to better serve diverse and vulnerable populations.

项目摘要 COVID-19期间实施的联邦暂停驱逐和地方暂停驱逐 大流行提供了一个独特的机会，研究与驱逐有关的政策对医疗保健使用的影响， 成本长期目标是将住房和医疗保健领域的知识和投资联系起来， 解决驱逐问题，将其作为影响健康和保健服务差距的健康问题的一个社会决定因素。 中心假设是，暂停驱逐政策可以减少无家可归者和急性护理服务的使用 租户与房东的关系对维持住房稳定很重要。该项目的基本原理是 利用卫生保健部门的数据指导今后制定与驱逐有关的政策和做法， 防止无家可归和紧急护理使用。在前期工作的指导下，本项目有三个具体目标： 评估联邦暂停驱逐和地方暂停驱逐对驱逐率和使用率的影响 2）评估暂停驱逐对使用急性医疗保健服务的影响， 成本;以及3）审查联邦期间城市和农村地区租户和房东之间的关系 暂停驱逐为了实现这三个目标，2018-2023年超过1000万患者的数据由 美国退伍军人事务部（VA）医疗保健系统-美国最大的综合系统， 一个全面的电子病历系统-将进行分析。对于第一个目标，创新的自然 将部署一个语言处理系统，以确定医疗记录中的驱逐案件，并测试 假设联邦和地方暂停驱逐减少驱逐率和使用无家可归者 程序.对于第二个目标，将进行影响分析，以检验中心假设，即联邦 地方暂停驱逐减少了急性护理服务的使用和费用。在前两个背景下 目标，社会人口学和临床特征预测驱逐风险，无家可归者计划的使用， 将确定急性护理使用情况，以便为有针对性的预防举措提供信息。第三个目标是定性访谈 将在德克萨斯州和纽约对50对房客和房东进行调查，了解他们的经历 随着联邦暂停驱逐和租户-房东关系在驱逐过程中的作用， 将阐明如何激励租户和房东，并将其视为重要的合作伙伴， 驱逐预防和政策。这项申请中提出的研究是创新的，因为它使用了新的 数据科学方法应用于美国最大的医疗保健系统，以了解一套独特的政策 所有这些都有助于在这一领域获得所需的知识。拟议的研究是 意义重大，因为它将有助于解决驱逐问题，这是一个与住房有关的重要公共卫生问题 以及对医疗保健领域的影响。最终，该项目有可能 推进住房和医疗保健领域的发展，以更好地服务于不同的弱势群体。