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

基本信息

批准号：
10576952
负责人：
JOEL C CANTOR
金额：
$ 63.95万
依托单位：
RUTGERS BIOMEDICAL AND HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-21 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10576952
关键词：
Accident and Emergency department Address Adult Affordable Care Act African American African American population Age Ambulatory Care Area Chronic Communicable Diseases Communities Data Death Rate Disparity Disparity population Effectiveness Elements Emergency Situation Engineering Ethnic Origin Face Focus Groups Funding Geography Health Health Services Healthcare Hispanic Hispanic Populations Homeless persons Homelessness Hospitals Housing Improve Access Income Inpatients Intervention Knowledge Latinx population Link Managed Care Measures Medicaid Medicaid eligibility Medicine Mental Health Mental disorders Minority Groups Modeling Morbidity - disease rate New Jersey Patients Pattern Pennsylvania Persons Policies Population Population Heterogeneity Population Study Primary 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 access disparities behavioral health beneficiary care outcomes cost effective disparity reduction ethnic disparity 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 disparity recruit rural disparities social health determinants socioeconomic disadvantage substance use substance use treatment supported housing trend urban area

项目摘要

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.

抽象的有充分证据表明无家可归与无法充分获得基本卫生服务有关非裔美国人、西班牙裔/拉丁裔和农村人口面临无家可归和/或其无家可归的高风险结果。然而，对特定类型医疗保健的使用差距了解不足在无家可归的成年人中，这种差距在少数民族和农村人口中是否更大，以及永久支持性住房 (PSH) 计划有可能缩小差距。本研究的目的是：1）量化无家可归对医疗补助中基本卫生服务使用差距的贡献按种族/民族和农村居住状况划分的受益人； 2）评估差距的程度通过参加 PSH 计划来缓解； 3) 确定医疗补助和 PSH 政策和计划改善获得基本卫生服务并减少相关种族/族裔和农村人口的战略差异。这项研究将通过使用新颖的大规模、群体性研究来克服先前研究的缺点。基于长期数据，结合定量-定性综合研究方法。该研究将使用 10 年（2011-2020 年）关联的无家可归者服务和医疗补助行政管理来实现前两个目标新泽西州和宾夕法尼亚州的数据。无家可归对医疗保健差距和差异的影响将通过比较广泛的社区和医院的利用率和支出来衡量为无家可归的成年人提供与没有医疗补助的相匹配的受益人的医疗服务无家可归。将通过比较医疗保健使用趋势和种族/民族差异来评估 PSH 以及在类似情况下接受住房安置的成年人中的农村居住状况没有收到这样的安置。改进政策和实践的具体可行策略将是在与一线 PSH 专业人员的焦点小组中确定，在此期间将分享定量研究结果并进行了讨论。