The Role of Homelessness and Supportive Housing in Healthcare Disparities among Adults in Medicaid

无家可归和支持性住房在医疗补助成年人医疗保健差异中的作用

• 批准号: 10408776
• 负责人: JOEL C CANTOR
• 金额: $ 64.82万
• 依托单位: RUTGERS BIOMEDICAL/HEALTH SCIENCES-RBHS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-21 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10408776
• 关键词: Accident and Emergency department; Address; Adult; Affordable Care Act; African American; African American population; Age; Ambulatory Care; Area; Caring; Chronic; Communicable Diseases; Communities; Data; Death Rate; Effectiveness; Elements; Emergency Situation; Engineering; Ethnic Origin; Face; Focus Groups; Funding; Geography; Health; Health Services; Healthcare; Hispanic; Homeless persons; Homelessness; Hospitals; Housing; Improve Access; Income; Inpatients; Intervention; Knowledge; Latinx population; Link; Measures; Medicaid; Medicine; Mental Health; Mental disorders; Minority Groups; Modeling; Morbidity - disease rate; New Jersey; Patients; Pattern; Pennsylvania; Persons; Policies; Population; Population Heterogeneity; Population Study; Primary Health Care; Qualitative Research; Race; Records; Reduce health disparities; Research; Research Methodology; Risk; Role; Rural; Rural Population; Sampling; Services; Social Work; Time; Translational Research; Traumatic injury; United States National Academy of Sciences; base; behavioral health; beneficiary; care outcomes; cost effective; disparity reduction; experience; falls; health care availability; health care disparity; health care service; health care service utilization; health management; health service use; high risk; homeless shelters; improved; interest; mortality; novel; population based; programs; racial and ethnic; racial and ethnic disparities; racial disparity; recruit; rural disparities; social health determinants; socioeconomic disadvantage; substance use; substance use treatment; supported housing; trend; urban area

Abstract There is ample evidence that homelessness is associated with inadequate access to essential health services and that African American, Hispanic/Latinx and rural populations are at high risk for homelessness and/or its consequences. However, there is insufficient knowledge about gaps in use of specific types of healthcare among homeless adults, whether such gaps are greater among minority and rural populations, and the potential of permanent supportive housing (PSH) programs to mitigate the gaps. This study aims to: 1) quantify the contribution of homelessness to gaps in essential health services use among Medicaid beneficiaries by race/ethnicity and rural residential status; 2) evaluate the extent to which the gaps are mitigated by placement in PSH programs; and 3) identify Medicaid and PSH policy and programmatic strategies for improving access to essential health services and reducing associated racial/ethnic and rural disparities. This study will overcome shortcomings in prior research by using novel large scale, population- based, long-term data, combined with integrated quantitative-qualitative research methods. The study will address the first two aims using 10 years (2011-2020) of linked homeless services and Medicaid administrative data for New Jersey and Pennsylvania. The contribution of homelessness to healthcare gaps and disparities will be measured by comparing utilization and spending for a broad spectrum of community-based and hospital health services among adults experiencing homelessness to matched Medicaid beneficiaries who have not been homeless. PSH will be evaluated by comparing trends in healthcare use and disparities by race/ethnic and rural residential status among those receiving housing placements to adults in similar circumstances who did not receive such placements. Specific actionable strategies for improving policy and practice will be identified in focus groups with front-line PSH professionals during which quantitative findings will be shared and discussed.

抽象的 有足够的证据表明无家可归与获得基本卫生服务的访问不足有关 而且非裔美国人，西班牙裔/拉丁裔和农村人口有无家可归和/或它的高风险 结果。但是，关于使用特定类型的医疗保健的差距的知识不足 在无家可归的成年人中，这种差距在少数群体和农村人口中是否更大， 永久支持住房（PSH）计划减轻差距的潜力。这项研究的目的是：1） 量化无家可归者对医疗补助中基本卫生服务使用差距的贡献 受益人按种族/种族和农村住宅地位； 2）评估差距的程度 通过放置PSH计划来缓解； 3）确定医疗补助和PSH政策以及程序化 改善获得基本卫生服务并减少相关的种族/种族和农村的策略 差异。这项研究将通过使用新型的大规模，种群 - 基于长期数据，结合了综合定量质量研究方法。研究将 使用链接的无家可归者服务和医疗补助管理的10年（2011 - 2020年）解决前两个目标 新泽西州和宾夕法尼亚州的数据。无家可归者对医疗差距和差异的贡献 将通过比较广泛基于社区和医院的利用和支出来衡量 没有家人的卫生服务对没有家人的无家可归者 无家可归。 PSH将通过比较种族/种族的医疗保健使用趋势和差异来评估PSH 在类似情况下为成年人接受住房安置的人的农村住宅地位 没有收到这样的位置。改善政策和实践的具体可行策略将是 在与前线PSH专业人员的焦点小组中确定的，在此期间将共享定量发现 并讨论。