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针对医疗状况复杂家庭的住房干预与家庭健康改善:试点随机试验

Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized Trial.

作者信息

Bovell-Ammon Allison, Mansilla Cristina, Poblacion Ana, Rateau Lindsey, Heeren Timothy, Cook John T, Zhang Tina, de Cuba Stephanie Ettinger, Sandel Megan T

机构信息

Allison Bovell-Ammon ( allison. bovell-ammon@bmc. org ) is director of policy strategy at Children's HealthWatch in the Department of Pediatrics, Boston Medical Center, in Massachusetts.

Cristina Mansilla is a senior research assistant at Children's HealthWatch, Department of Pediatrics, Boston Medical Center.

出版信息

Health Aff (Millwood). 2020 Apr;39(4):613-621. doi: 10.1377/hlthaff.2019.01569.

DOI:10.1377/hlthaff.2019.01569
PMID:32250672
Abstract

The effects of housing instability and homelessness on child and adult health are well documented. However, few studies have explored health and housing interventions for families with children with the objective of health improvement. Housing Prescriptions as Health Care is a randomized controlled trial that is investigating the impact on physical and mental health of integrating priority placement in affordable housing and the provision of services (case management, financial, and legal), compared to the standard of care (providing resource guides and hospital-based social work or care navigation services). In 2016-19 seventy-eight homeless or housing-unstable families defined as "medically complex"-with a child or adult member who used more health services than usual or had a chronic disease or disability-were enrolled in the trial, and sixty-seven completed a six-month follow-up. A difference-in-differences analysis at six months showed decreases in the share of children in fair or poor health and in average anxiety and depression scores among parents in the intervention group, relative to the control group. Findings suggest that a population-specific model that integrates health, housing, legal, and social services can improve health-related outcomes at the household level.

摘要

住房不稳定和无家可归对儿童和成人健康的影响已有充分记录。然而,很少有研究探索以改善健康为目标,针对有子女家庭的健康与住房干预措施。“住房处方即医疗保健”是一项随机对照试验,该试验正在研究与标准护理(提供资源指南以及医院社会工作或护理导航服务)相比,将优先安置于经济适用房以及提供服务(个案管理、财务和法律方面)相结合对身心健康的影响。在2016年至2019年期间,78个被定义为“医疗情况复杂”的无家可归或住房不稳定家庭(家庭中有儿童或成年成员比平常使用更多的医疗服务,或患有慢性病或残疾)参与了该试验,67个家庭完成了为期6个月的随访。6个月时的差异分析显示,相对于对照组,干预组中健康状况为“一般”或“较差”的儿童比例以及父母的平均焦虑和抑郁得分均有所下降。研究结果表明,一种整合了健康、住房、法律和社会服务的针对特定人群的模式能够改善家庭层面与健康相关的结果。

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