开发无家可归者医疗保健获取工具以识别无家可归者的健康相关脆弱性：澳大利亚德尔菲研究
Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia.
作者信息
Currie Jane, Grech Elizabeth, Longbottom Erin, Yee Jasmine, Hastings Ruth, Aitkenhead Amy, Larkin Matthew, Jones Lee, Cason Amy, Obrecht Karin
机构信息
School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.
出版信息
BMJ Open. 2022 Mar 21;12(3):e058893. doi: 10.1136/bmjopen-2021-058893.
OBJECTIVES
In this paper, we report the development of the Homeless Health Access to Care Tool. This tool aims to improve the gap in assessing health need and capacity to access healthcare of people experiencing homelessness. Tools exist that prioritise people experiencing homelessness for housing, but none specifically designed to prioritise for healthcare, or that are succinct enough to be easily implemented to emergency department or primary healthcare settings.
DESIGN AND SETTING
The Homeless Health Access to Care Tool has been adapted from an existing tool, the Vulnerability Index Service Prioritisation Decision Assistance Tool through a five-step process: (1) domain identification, (2) literature review, (3) analysis of hospital admission data, (4) expert judges, and (5) Delphi study.
PARTICIPANTS
The tool was adapted and developed by homeless health clinicians, academics and people with lived experience of homelessness. The Delphi study (n=9) comprised emergency department and homeless health clinicians.
RESULTS
Consensus was gained on all but one item, five new items were added, and wording changes were made to six items based on expert feedback. Participants perceived the tool would take between 5 to 11 min to complete, the number of items were appropriate, and the majority agreed it would facilitate the assessment of health needs and capacity to access healthcare.
CONCLUSION
Robust development of the Homeless Health Access to Care Tool through the Delphi is the first phase of its development. The Homeless Health Access to Care Tool offers an opportunity to assess both health need and capacity to access healthcare with the aim to improve access to healthcare for people experiencing homelessness. This tool will facilitate standardised data collection to inform service design and data linkage regarding access to healthcare of people experiencing homelessness. The next stages of testing include construct validity, feasibility, usability and inter-rater reliability, and pilot implementation.
目的
在本文中，我们报告了无家可归者医疗保健获取工具的开发情况。该工具旨在缩小评估无家可归者的健康需求和获得医疗保健能力方面的差距。现有的工具将无家可归者列为住房优先对象，但没有专门针对医疗保健进行优先排序的工具，或者没有简洁到足以在急诊科或初级医疗保健机构轻松实施。
设计与背景
无家可归者医疗保健获取工具是通过五个步骤从现有工具——脆弱性指数服务优先排序决策辅助工具改编而来的：（1）领域识别，（2）文献综述，（3）医院入院数据分析，（4）专家评审，（5）德尔菲研究。
参与者
该工具由无家可归者健康临床医生、学者以及有过无家可归经历的人改编和开发。德尔菲研究（n = 9）包括急诊科和无家可归者健康临床医生。
结果
除一项外，所有项目均达成共识，新增了五个项目，并根据专家反馈对六个项目进行了措辞修改。参与者认为该工具完成时间为5至11分钟，项目数量合适，大多数人同意它将有助于评估健康需求和获得医疗保健的能力。
结论
通过德尔菲法对无家可归者医疗保健获取工具进行稳健开发是其开发的第一阶段。无家可归者医疗保健获取工具提供了一个评估健康需求和获得医疗保健能力的机会，旨在改善无家可归者获得医疗保健的机会。该工具将促进标准化数据收集，为服务设计和关于无家可归者获得医疗保健的数据链接提供信息。测试的下一阶段包括结构效度、可行性、可用性和评分者间信度，以及试点实施。
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