Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
Am J Prev Med. 2021 Jul;61(1):e1-e12. doi: 10.1016/j.amepre.2021.01.027. Epub 2021 Mar 27.
Healthcare systems are increasingly interested in identifying patients' housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care.
This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018-2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019-2020).
Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96).
The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.
医疗保健系统越来越有兴趣识别患者的住房相关风险，但几乎没有信息可以为筛选问题的选择提供依据。主要研究目的是评估在医疗保健中使用的 5 种住房相关筛选问题之间的差异。
这是一项横断面多地点调查，使用便利样本对来自 9 个州的 7 个初级保健诊所和 4 个急诊部门的寻求自身或其子女护理的成年人进行社会风险测量。使用问责医疗社区筛选工具中的 2 个住房相关问题（当前/预期住房不稳定，当前住房质量问题）和儿童健康观察推荐的住房不稳定筛选措施中的 3 个（过去 12 个月：租金/抵押贷款压力，搬次数，当前/最近无家可归）来测量住房相关风险。采用双侧 Fisher 精确检验分析住房相关风险和参与者特征；逻辑回归探索与报告健康状况的关联（2019-2020 年）。
在 835 名参与者中，有 52%（n=430）筛查出至少 1 种住房相关风险呈阳性。比较这些工具，有 32.8%（n=274）筛查出不一致：有 11.9%（n=99）根据儿童健康观察问题呈阳性，但根据问责医疗社区呈阴性，有 21.0%（n=175）根据问责医疗社区工具呈阳性，但根据儿童健康观察呈阴性（p<0.001）。当前/预期住房不稳定（优势比=0.56，95%置信区间=0.32，0.96）或当前/最近无家可归（优势比=0.57，95%置信区间=0.34，0.96）与筛查阳性呈正相关。
这 5 个住房问题捕捉到了不同的住房相关风险，导致了不同的健康后果，并且与不同的亚人群相关。在实施住房相关筛选计划之前，医疗保健系统应该了解特定措施如何揭示不同的住房相关障碍。测量选择应取决于项目目标和干预资源。
