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首页> 外文期刊>Journal of urban health >The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial
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The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

机译：住房介入对精神疾病无家可归的成年人急性医疗利用的影响：在家中的长期成果/ Chez-Soi随机务实试验

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We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified as having high (HN) or moderate need (MN) for mental health support services. Each group was randomized into intervention (HF) and treatment as usual groups, and 567 (98.6%) consented to link their data to health administrative databases. HF participants received a monthly rent supplement of $600 (Canadian) and assertive community treatment (ACT) support or intensive care management (ICM) support based on need level. Treatment as usual (TAU) participants had access to social, housing, and health services generally available in the community. Outcomes included all-cause and mental health-specific hospitalization, number of days in hospital, and ED visit. We used GEE models to estimate ratio of rate ratios (RRR). The results showed HF with ACT had no significant effect on hospitalization rates among HN participants, but reduced the number of days in hospital (RRR = 0.32, 95% CI 0.16-0.63) and number of ED visits (RRR = 0.57, 95% CI 0.34-0.95). HF with ICM resulted in an increase in the number of hospitalizations (RRR = 1.69, 95% CI 1.09-2.60) and ED visit rates (RRR = 1.42, 95% CI 1.01-2.01) but had no effect in days in hospital for MN participants. Addressing the health needs of this population and reducing acute care utilization remain system priorities. Trial registration: http://www.isrctn.com/identifier: ISRCTN42520374 Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00550-1.
机译：我们评估了多伦多网站住房的效果第一（HF）干预在7年后的无家可归者中与精神疾病的无家可归者成年人的探访。多伦多网站是未经关注的多网站的一部分，随机务实试验治疗加拿大精神疾病的无家可归的成年人，其中参与者长达7年。招募了五百七十五名参与者，归类为具有高（HN）或适度的需求（MN）的精神健康支持服务。每组随机被随机化为干预（HF）和常规群体治疗，并同意将其数据与健康行政数据库联系起来的567（98.6％）。 HF参与者收到了每月租金补充价为600美元（加拿大）和自信社区待遇（法案）支持或重症监护管理（ICM）支持，基于需求水平。常见（TAU）参与者的待遇可以访问一般在社区中提供的社会，住房和保健服务。结果包括所有原因和精神健康的住院治疗，医院的天数和ed参观。我们使用GEE模型来估计速率比率（RRR）。结果表明，HF对HN参与者之间的住院率没有显着影响，但减少了医院中的天数（RRR = 0.32,95％CI 0.16-0.63）和ED访问的数量（RRR = 0.57,95％CI 0.34-0.95）。与ICM的HF导致住院治疗人数增加（RRR = 1.69,95％CI 1.09-2.60）和ED访问率（RRR = 1.42,95％CI 1.01-2.01），但在医院的MN中没有效果参与者。解决这一人口的健康需求，降低急性护理利用率仍然是系统优先事项。审判注册：http：//www.isrctn.com/identifier：ISRCTN42520374在线版本的补充信息包含在10.1007 / S11524-021-00550-1中提供的补充材料。

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