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

项目摘要/摘要 新冠肺炎疫情使长期存在的无家可归问题成为人们关注的焦点 在美国，无家可归是一个主要的公共卫生问题，因为无家可归既是一个原因，也是一个因素 心理和身体健康状况不佳。不断加剧的收入不平等和不同的获得机会 弱势人群的服务/资源因大流行而加剧 这导致了大量面临无家可归风险的人。 需要初级预防努力来消除无家可归者，但科学 无家可归的预防是有限的，没有已知的科学严格的试验来测试其影响 将无家可归者转用作为对健康和住房的干预。急诊科 (ED)提供适当的空间，以针对无家可归者的分流工作，最大限度地扩大到 健康和住房需求增加的个人。我们的长期目标是让 关于无家可归者转移的知识库，包括了解是否嵌入 医院内的无家可归者分流计划ED出院系统有健康和健康 为受助人(个人)和为他们提供服务的组织(社区)提供福利。 在前期工作和数据的指导下，这一目标将通过三个具体目标来实现 要：1)确定是否将无家可归者转移计划纳入医院边缘 排放系统将通过增加住房保留率和幸福感来降低ED的使用量。我们的 假设是相对于接受标准护理的个人，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科使用量来减少 住房保留率和与健康相关的生活质量。我们测试工作的方法 假设是对1,000名个体进行务实的单盲随机试验 离开急诊室，分析六个月后的结果。2)确定的特征 最有可能从无家可归者转移中受益的个人。我们的方法将是进行 对我们的随机试验的数据进行二次分析，以确定社会人口学和临床 与无家可归者转院服务结果相关的因素。3.发现量身定做的机会 为无家可归者提供分流服务，以更好地满足不同社区的需求。我们将进行 对40个不同的无家可归者分流对象进行调查和焦点小组，然后考虑 关键利益攸关方。这个项目的发现将提供关于大多数 有效的战略，以转移面临无家可归迫在眉睫风险的个人，提供 上游干预措施，以解决这一弱势群体中的健康不平等问题。

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.