Institute of Health Informatics, University College London, London, UK.
Farr Institute of Health Informatics Research, University College London, London, UK.
BMJ Open. 2017 Dec 14;7(12):e019282. doi: 10.1136/bmjopen-2017-019282.
People who are homeless often experience poor hospital discharge arrangements, reflecting ongoing care and housing needs. Specialist integrated homeless health and care provision (SIHHC) schemes have been developed and implemented to facilitate the safe and timely discharge of homeless patients from hospital. Our study aims to investigate the health outcomes of patients who were homeless and seen by a selection of SIHHC services.
Our study will employ a historical population-based cohort in England. We will examine health outcomes among three groups of adults: (1) homeless patients seen by specialist discharge schemes during their hospital admission; (2) homeless patients not seen by a specialist scheme and (3) admitted patients who live in deprived neighbourhoods and were not recorded as being homeless. Primary outcomes will be: time from discharge to next hospital inpatient admission; time from discharge to next accident and emergency attendance and 28-day emergency readmission. Outcome data will be generated through linkage to hospital admissions data (Hospital Episode Statistics) and mortality data for November 2013 to November 2016. Multivariable regression will be used to model the relationship between the study comparison groups and each of the outcomes.
Approval has been obtained from the National Health Service (NHS) Confidentiality Advisory Group (reference 16/CAG/0021) to undertake this work using unconsented identifiable data. Health Research Authority Research Ethics approval (REC 16/EE/0018) has been obtained in addition to local research and development approvals for data collection at NHS sites. We will feedback the results of our study to our advisory group of people who have lived experience of homelessness and seek their suggestions on ways to improve or take this work further for their benefit. We will disseminate our findings to SIHHC schemes through a series of regional workshops.
无家可归者经常面临糟糕的出院安排，这反映出他们持续存在的医疗和住房需求。为了促进无家可归患者安全、及时地从医院出院，已经开发并实施了专门的综合性无家可归者健康和护理服务（SIHHC）计划。我们的研究旨在调查接受一系列 SIHHC 服务的无家可归患者的健康结果。
我们的研究将在英格兰采用历史人群的基于队列的方法。我们将检查三组成年人的健康结果：（1）在住院期间接受专科出院计划服务的无家可归患者；（2）未接受专科计划服务的无家可归患者；（3）居住在贫困社区且未被记录为无家可归的住院患者。主要结果将是：从出院到再次住院的时间；从出院到再次急诊就诊的时间；以及 28 天内急诊再入院的时间。通过与医院入院数据（医院入院统计数据）和 2013 年 11 月至 2016 年 11 月的死亡率数据进行链接，将生成结果数据。多变量回归将用于对研究比较组与每个结果之间的关系进行建模。
已经获得了国民保健制度（NHS）保密咨询小组（参考号 16/CAG/0021）的批准，以便在使用未经同意的可识别数据的情况下开展这项工作。此外，还获得了健康研究管理局的研究伦理批准（REC 16/EE/0018），以及 NHS 站点数据收集的地方研究和开发批准。我们将向我们的无家可归生活体验咨询小组反馈我们的研究结果，并征求他们的意见，以寻求改善或进一步推进这项工作，以造福他们。我们将通过一系列区域研讨会向 SIHHC 计划传播我们的研究结果。
