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

项目摘要/摘要 由冠状病毒(新冠肺炎)大流行引发的公共卫生危机加剧了前所未有的 努力解决弱势人群中的感染和传播风险，包括提供 向无家可归者提供非集合性住房。加快住房建设步伐 服务还解决了造成健康差距的最古老和最根深蒂固的因素之一--缺乏 安全稳定的住房。在这个独特的时刻，我们有机会审查是否迅速提供 在社区一级推广住房可以缓解新冠肺炎的影响，以及这样做可能会如何影响 影响新冠肺炎后果的个人、社会和结构性因素。我们建议一个混合的- 安全地面行动(OSG)--一种社区层面的干预方法研究 加利福尼亚州阿拉米达县无家可归者中新冠肺炎感染情况。于4月启动 2020年，OSG为易受新冠肺炎感染的无家可归者提供长期住所 由于年龄(&gt；65岁)或慢性病。到目前为止，有1000多人，大约占该县人口的10% 无家可归者，已进入OSG。这项拟议的研究是一项“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，以 描述计划的开发和实施，定义其操作特点，以及 调查影响项目参与者结果的背景因素。我们将使用整合的 实施研究框架(CFIR)来组织这项调查。在目标2和目标3中，我们将比较 干预组(OSG客户)随时间的个体水平结果，结果如下 在精心构建的对比组中，我们将使用倾向性分数创建类似的非客户 加权方法。我们将纳入调解和缓和分析，以审查机制和 有助于解释结果的互动。数据将从一个名为Social的县级数据库中提取 医疗信息交换(SHIE)，这是一个协调医疗、住房和社会服务的集中系统 有复杂健康和社会需求的县医疗补助消费者的服务使用情况。大约8,000 无家可归的消费者，包括所有OSG参与者，在SHIE中都有代表。通过追求这一独特的 有了这个机会，我们将获得宝贵的知识，以帮助改进对这一大流行病的长期反应，并 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.