RAND Corporation, Santa Monica, CA, USA.
RAND Corporation, Boston, MA, USA.
Health Soc Care Community. 2021 Nov;29(6):e259-e268. doi: 10.1111/hsc.13348. Epub 2021 Mar 11.
Homelessness is a pervasive public health problem in the United States (U.S.). Under the U.S. Affordable Care Act, the nation's public health insurance program (Medicaid) was expanded to serve more individuals, including those experiencing homelessness. Coupled with changes in financial incentives designed to reduce healthcare costs, health plans, hospitals and large health systems have started to operate permanent supportive housing (PSH) programmes as a healthcare benefit. To better understand patient perceptions of care coordination in a PSH programme operated by a large health plan in Southern California, we conducted 22 semi-structured in-depth patient interviews between October and November 2019. Two coders analysed these data inductively and deductively, using pre-identified domains and open coding. Coding reliability and thematic saturation were also assessed. Findings indicated positive experiences with care coordination for physical health and social supports, such as food distribution and transportation. Identified service gaps included mental health support and help securing public assistance (e.g., cash benefits). Opportunities to enhance PSH care coordination were also identified, such as the need for a simplified approach. Hospitals, health plans and systems considering PSH programmes may look to these results for implementation guidance.
在美国，无家可归是一个普遍存在的公共卫生问题。根据《美国平价医疗法案》，美国的公共医疗保险计划（医疗补助）扩大了服务对象范围，包括那些无家可归的人。再加上旨在降低医疗成本的财务激励措施的变化，医保计划、医院和大型医疗系统开始将永久性支持性住房（PSH）项目作为一种医疗保健福利。为了更好地了解在加利福尼亚州南部由大型医疗计划运营的 PSH 计划中患者对护理协调的看法，我们在 2019 年 10 月至 11 月期间进行了 22 次半结构化深入患者访谈。两名编解码器使用预先确定的域和开放式编码对这些数据进行了归纳和演绎分析。还评估了编码可靠性和主题饱和度。调查结果表明，患者对身体健康和社会支持（例如食品分发和交通）的护理协调有积极的体验。确定的服务差距包括心理健康支持和获得公共援助（例如现金福利）的帮助。还确定了增强 PSH 护理协调的机会，例如需要简化方法。考虑 PSH 计划的医院、医保计划和系统可以参考这些结果来获得实施指导。
