King County Mental Health and Chemical Abuse and Dependency Services, Seattle, WA 98104, USA.
Am J Public Health. 2013 Feb;103(2):316-21. doi: 10.2105/AJPH.2012.300867. Epub 2012 Dec 13.
We examined changes in service use in a Housing First (HF) pilot program for adults who were homeless with medical illnesses and high prior acute-care use relative to a similar comparison group.
We used a 1-year pre-post comparison group design. The 29 participants and 31 comparison group members were adults who were homeless with inpatient claims of at least $10 000 or at least 60 sobering "sleep off" center contacts in the prior year.
Participants showed a significantly greater reduction in emergency department and sobering center use relative to the comparison group. At a trend level, participants had greater reductions in hospital admissions and jail bookings. Reductions in estimated costs for participants and comparison group members were $62 504 and $25 925 per person per year-a difference of $36 579, far outweighing program costs of $18 600 per person per year.
HF participants showed striking reductions in acute-care use relative to the comparison group, demonstrating that HF can be a successful model for people with complex medical conditions and high prior acute-care use. Despite notable methodological limitations, these findings could be used to inform a larger multisite study that would establish greater generalizability.
我们考察了住房优先（HF）试点项目中患有医疗疾病且既往急性护理使用率较高的无家可归成年人的服务使用变化情况，与类似的对照组进行了比较。
我们采用了 1 年前后比较组设计。29 名参与者和 31 名对照组成员均为患有住院费用至少为 10000 美元或在前一年至少有 60 次清醒中心“清醒”记录的无家可归成年人。
与对照组相比，参与者的急诊和清醒中心使用率显著降低。在趋势水平上，参与者的住院和监禁人数有所减少。参与者和对照组成员的估计成本减少额分别为每人每年 62504 美元和 25925 美元，相差 36579 美元，远远超过每人每年 18600 美元的项目成本。
HF 参与者与对照组相比，急性护理使用率显著降低，表明 HF 可以成为患有复杂医疗状况和既往急性护理使用率较高人群的成功模式。尽管存在明显的方法学限制，但这些发现可以用于为更大的多地点研究提供信息，从而提高普遍性。
