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.
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...
| Publicado en: | Journal of Urban Health Vol. 98; no. 4; pp. 505 - 516 |
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| Autores principales: | , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Springer Nature
Aug2021
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=152043531&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 152043531 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 10993460 GMF jtl: Journal of Urban Health issn: 10993460 maglogo: N pubinfo: dt: Aug2021 vid: 98 iid: 4 pid: 237 pub: Springer Nature artinfo: ui: 152043531 10.1007/s11524-021-00550-1 ppf: 505 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P size: 468KB tig: atl: 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. aug: au: Lachaud, James Mejia-Lancheros, Cilia Durbin, Anna Nisenbaum, Rosane Wang, Ri O'Campo, Patricia Stergiopoulos, Vicky Hwang, Stephen W. affil: MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, M5B 1T8, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada Centre for Addiction and Mental Health, Toronto, ON, Canada Department of Medicine, University of Toronto, Toronto, ON, Canada su: Canada Homeless persons Mental health services Mental illness Housing Medical care use Visitation in hospitals sug: subj: Homeless persons Mental health services Mental illness Housing Canada Other Community Housing Services Offices of Mental Health Practitioners (except Physicians) Residential Mental Health and Substance Abuse Facilities Psychiatric and Substance Abuse Hospitals Medical care use Visitation in hospitals keyword: Emergency department visit Hospitalization Housing First Emergency department visit Hospitalization Housing First ab: 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 pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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