Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Popul Health Manag. 2022 Apr;25(2):227-234. doi: 10.1089/pop.2021.0348.
People with disabilities can face substantial barriers to living stably in community settings. Evidence shows that permanent supportive housing (PSH), which combines subsidized housing with individualized support services, can improve housing stability among subpopulations of people with disabilities, including those with behavioral health conditions. PSH has also been shown to improve some health outcomes among people with severe mental illness or substance use disorder, but effects varied by participants' program tenure. This study assessed retention in a PSH program serving a broad population of adults with disabilities and identified factors associated with program tenure. Administrative data from 2093 individuals who began participating in a North Carolina PSH program between 2015 and 2018 were analyzed. Participants' unadjusted probability of remaining in a PSH placement at specific time points was estimated, with censoring due to death or the end of the study period (July 2020). Using Cox regression, program tenure was modeled as a function of participant and PSH placement location characteristics. Participants had a 71% probability of remaining in PSH after 2 years. Older age, female gender, and non-Hispanic Black race/ethnicity were associated with lower hazard of PSH departure. Having a severe mental illness diagnosis was associated with greater departure hazard. Level of socioeconomic deprivation and rurality of the PSH placement ZIP code were not associated with departure hazard. PSH programs may be able to successfully retain a heterogeneous population of adults with disabilities, although tenure may vary by participant demographic and clinical characteristics.
残疾人在社区环境中稳定生活可能会面临巨大障碍。有证据表明，永久性支持性住房（PSH）将补贴住房与个性化支持服务相结合，可以提高包括有行为健康问题的残疾人在内的特定残疾人群体的住房稳定性。PSH 还被证明可以改善严重精神疾病或药物使用障碍患者的一些健康结果，但效果因参与者的项目期限而异。本研究评估了一项为广泛残疾成年人服务的 PSH 计划的保留率，并确定了与项目期限相关的因素。对 2015 年至 2018 年间开始参加北卡罗来纳州 PSH 计划的 2093 名个人的行政数据进行了分析。根据参与者死亡或研究期（2020 年 7 月）结束时的情况对特定时间点的 PSH 安置进行调整，以估计参与者保持 PSH 安置的未调整概率。使用 Cox 回归，将项目期限作为参与者和 PSH 安置地点特征的函数进行建模。参与者在 PSH 中的保留率为 71%。年龄较大、女性和非西班牙裔黑人种族/民族与 PSH 离开的风险较低有关。患有严重精神疾病诊断与更大的 PSH 离开风险相关。社会经济剥夺程度和 PSH 安置邮政编码的农村程度与离开风险无关。PSH 计划可能能够成功保留各种残疾成年人的人口，尽管参与者的人口统计学和临床特征可能会导致任期有所不同。
