Evaluation of Operation Safer Ground: A Community-Level Rapid Housing Intervention for People Vulnerable to COVID-19.

项目总结/摘要 新型冠状病毒（COVID-19）大流行引发的公共卫生危机引发了前所未有的 努力消除脆弱人群中的感染和传播风险，包括提供 为无家可归的人提供非集体住房。加快实施住房 服务还解决了一个最古老和最根深蒂固的贡献者，卫生保健，缺乏 安全稳定的住房。在这个特殊的时刻，我们有机会审查是否迅速提供 社区层面的住房减少了COVID-19的影响，以及这样做可能如何影响 导致COVID-19后果的个人、社会和结构性因素。我们提出一个混合- 更安全地面行动（OSG）的方法研究，这是一项社区级干预措施， 加利福尼亚州阿拉米达县无家可归者中的COVID-19感染。4月启动 2020年，OSG为易受COVID-19感染的无家可归者提供长期住房 因为年龄（>65岁）或慢性疾病。到目前为止，已有1,000多人，约占该县人口的10%， 无家可归的人，已经进入OSG。这项研究是一项“自然实验”。在目标1中，我们将使用 对OSG参与者、工作人员和当地公共卫生官员进行文件审查和定性访谈， 描述该计划的开发和实施，定义其操作特性，以及 调查影响项目参与者成果的环境因素。我们将利用联合 实施研究框架（CFIR），以组织本次调查。在目标2和3中，我们将比较 干预组（OSG客户）随时间推移的个人水平结果， 在一个精心构建的比较组中，我们将使用倾向评分创建类似的非客户 加权方法。我们将纳入调解和适度分析，以审查机制， 有助于解释结果的互动。数据将来自一个名为社会数据库的县级数据库。 卫生信息交换（SHIE），一个协调卫生保健、住房和社会福利的中央系统。 有复杂健康和社会需求的县医疗补助消费者的服务使用。约8000人 无家可归的消费者，包括所有OSG参与者，都在SHIE中有代表。通过追求这种独特的 我们将获得宝贵的知识，以帮助改善对这一流行病的长期反应， 更有效地做好准备，在未来的公共卫生危机中保护弱势群体的健康。

PROJECT SUMMARY/ABSTRACT The public health crisis engendered by the coronavirus (COVID-19) pandemic has fueled unprecedented efforts to address the risk of infection and transmission among vulnerable populations, including provision of non-congregate housing to people experiencing homelessness. The expedited implementation of housing services also addresses one of the oldest and most entrenched contributors to health disparities—lack of safe and stable housing. In this unique moment, we have the opportunity to examine whether swift provision of housing at the community level mitigates the impact of COVID-19, as well as how doing so may affect the individual, social, and structural factors that contribute to consequences of COVID-19. We propose a mixed- methods study of Operation Safer Ground (OSG), a community-level intervention deployed to stem COVID-19 infection among people experiencing homelessness in Alameda County, CA. Initiated in April 2020, OSG provides long-term housing to homeless people who are vulnerable to COVID-19 infection because of age (>65 years) or chronic illness. To date, more than 1,000 people, roughly 10% of the county’s homeless population, have entered OSG. The proposed study is a “natural experiment.” In Aim 1, we will use document reviews and qualitative interviews with OSG participants, staff, and local public health officials to describe the development and implementation of the program, define its operational characteristics, and investigate contextual factors that influence outcomes for program participants. We will use the Consolidated Framework for Implementation Research (CFIR) to structure this inquiry. In Aims 2 and 3, we will compare individual-level outcomes over time among the intervention group (OSG clients) with outcomes among similar non-clients in a carefully constructed comparison group, which we will create using propensity score weighting methods. We will incorporate mediation and moderation analyses to examine mechanisms and interactions that help explain outcomes. Data will be drawn from a county-level database called the Social Health Information Exchange (SHIE), a centralized system that coordinates health care, housing, and social service use by county Medicaid consumers with complex health and social needs. Approximately 8,000 homeless consumers, including all OSG participants, are represented in the SHIE. By pursuing this unique opportunity, we will gain valuable knowledge to help improve the long-term response to the pandemic and prepare more effectively to protect the health of vulnerable populations in future public health crises.