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

项目总结 新冠肺炎期间实施的联邦暂停驱逐和地方暂停驱逐 大流行为研究与驱逐相关的政策对医疗保健使用和 成本。长期目标是将住房和医疗保健领域的知识和投资连接到 解决将驱逐作为健康的社会决定因素影响健康和保健服务方面的差距的问题。 中心假设是，驱逐暂缓政策可以减少无家可归者和急性护理服务的使用。 租客和房东的关系对维持住房稳定很重要。这个项目的基本原理是 利用医疗保健部门的数据指导与驱逐有关的政策和做法的未来发展 防止无家可归和急性护理使用。在前期工作的指导下，本项目有三个具体目标：1) 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 无家可归者方案；2)评估驱逐暂缓对急性保健服务使用的影响以及 成本；以及3)检查联邦政府时期城乡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1000万名患者的数据由 美国退伍军人事务部(VA)医疗系统-美国最大的集成系统， 一个全面的电子病历系统-将被分析。对于第一个目标，创新自然 将部署语言处理系统，以识别医疗记录中的驱逐案例并测试 假设联邦和地方驱逐暂缓令降低了驱逐和利用无家可归者的比率 程序。对于第二个目标，将进行影响分析，以检验联邦政府 当地的暂缓驱逐减少了急性护理服务的使用和成本。在前两项的上下文中 目的、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，以及 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。对于第三个目标，定性采访 将对德克萨斯州和纽约的50对租户和他们的房东进行调查，讲述他们的经历 由于联邦暂停驱逐以及租户-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 驱逐预防和政策。本申请中提出的研究具有创新性，因为它使用了新的 数据科学方法应用于美国最大的医疗系统，以了解一套独特的政策 关于驱逐，所有这些都有助于提供这一领域所需的知识。拟议的研究是 意义重大，因为它将有助于解决与住房相关的重要公共卫生问题--驱逐问题 以及健康差距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，更好地服务于多样化和弱势群体。

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.