A Pragmatic Randomized Trial Integrating Homelessness Diversion Services into an Emergency Department Discharge System

项目总结/摘要 2019冠状病毒病大流行使长期存在的无家可归问题成为人们关注的焦点 在美国，这是一个重大的公共卫生问题，因为无家可归既是一个原因，也是一个促成因素。 精神和身体健康状况不佳。收入不平等加剧， 这一流行病加剧了脆弱人口获得服务/资源的困难， 这导致大量人口面临无家可归的风险。 消除无家可归现象需要进行初级预防工作， 无家可归的预防是有限的，没有已知的科学严格的试验测试的影响， 将无家可归者转移作为健康和住房的干预措施。急诊科 (ED)为无家可归者转移工作提供适当的空间，以最大限度地扩大覆盖面， 有较高健康和住房需求的人。我们的长期目标是让 关于无家可归者转移的知识基础，包括了解是否嵌入一个 医院艾德出院系统内无家可归者转移计划 受益人（个人）和为他们服务的组织（社区）的福利。 在初步工作和数据的指导下，将通过三个具体目标实现这一目标 目的：1）确定无家可归者转移方案是否纳入医院艾德 排放系统将通过增加住房保留和健康来降低艾德的使用。我们 假设是，相对于接受标准护理的个人， 无家可归者转移服务将通过增加急诊室的使用率来降低急诊室的使用率。 住房保有率和与健康有关的生活质量。我们测试工作的方法 假设将进行一项有1,000人参加的实用性单盲随机试验 退出艾德并分析六个月的结果。2)确定的特点 最有可能从无家可归者转移中受益的人。我们的方法是 对我们随机试验的数据进行二次分析，以确定社会人口统计学和临床 与无家可归者转移服务结果有关的因素。3.发现定制机会 无家可归者转移服务，以更好地满足不同社区的需求。我们会进行 调查和焦点小组与40个不同的无家可归者分流客户，然后考虑 关键利益相关者。该项目的调查结果将提供有关最重要的信息， 采取有效战略，转移面临无家可归危险的个人， 上游干预措施，以解决这一弱势群体中的卫生不平等问题。

Project Summary/Abstract The COVID-19 pandemic has shined a spotlight on the long-standing problem of homelessness in the U.S., a major public health concern since homelessness is both a cause and contributor to poor mental and physical health. Rising income inequality and disparate access to services/resources among vulnerable populations has been exacerbated by the pandemic which has resulted in a large population of people who are at-risk of becoming homeless. Primary prevention efforts are required to eliminate homelessness but the science of homelessness prevention is limited with no known scientifically rigorous trials testing the impact of homelessness diversion as an intervention for health and housing. Emergency departments (ED) provide an opportune space to target homeless diversion efforts to maximize the reach to individuals with elevated health and housing needs. Our long-term goal is to inform the knowledge base about homelessness diversion, including understanding whether embedding a homeless diversion program within a hospital ED discharge system has health and wellness benefits for the recipients (individuals) and the organizations who serve them (community). Guided by preliminary work and data, this goal will be accomplished through three specific aims to: 1) Determine whether a homelessness diversion program integrated into a hospital ED discharge system will lower ED use via increased housing retention and wellbeing. Our hypothesis is that relative to individuals receiving standard care, individuals who receive homelessness diversion services will have lower emergency department use via increased housing retention and health-related quality of life. Our approach to testing the working hypothesis will be to perform a pragmatic single-blind randomized trial with 1,000 individuals exiting the ED and analyze outcomes over six months. 2) Determine characteristics of individuals most likely to benefit from homelessness diversion. Our approach will be to conduct secondary analyses of data from our randomized trial to identify sociodemographic and clinical factors related to outcomes from homeless diversion services. 3. Discover opportunities to tailor homeless diversion services to better meet the needs of diverse communities. We will conduct surveys and focus groups with 40 diverse homeless diversion clients followed by consideration of key stakeholders. The findings from this project will provide critical information on the most effective strategies for diverting individuals at imminent risk for homelessness, providing an upstream intervention to addressing health inequities among this vulnerable population.