Tinelli Michela, Wittenberg Raphael, Cornes Michelle, Aldridge Robert W, Clark Michael, Byng Richard, Foster Graham, Fuller James, Hayward Andrew, Hewett Nigel, Kilmister Alan, Manthorpe Jill, Neale Joanne, Biswell Elizabeth, Whiteford Martin
Care Policy and Evaluation Centre, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
School of Health and Society, University of Salford, Mary Seacole Building, Frederick Road Campus, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
BMC Health Serv Res. 2025 Jun 3;25(1):794. doi: 10.1186/s12913-025-12704-x.
Recognising the diverse healthcare needs of the population, there is a growing emphasis on tailoring hospital discharge processes to address the unique challenges faced by individuals who are homeless, aiming to enhance the efficiency and effectiveness of post-hospitalisation care for this vulnerable demographic. This study aimed to evaluate the costs and consequences of specialist hospital discharge and intermediate care (support after discharge) services for people who are homeless in England.
We estimated the comparative costs and consequences of different types of specialist care provided by 17 homeless hospital discharge and intermediate care services. We compared 'clinically-led' (multidisciplinary) services with those that were 'housing-led' (uniprofessional). A retrospective observational study was conducted to estimate effectiveness and costs for two'intervention groups'(clinically-led and housing-led) and a previously published RCT for'standard care'. Use of resources data for specialist care was sourced through linkage with Hospital Episode Statistics. The measure of effectiveness was the number of bed days avoided (in terms of hospital stays for all readmissions in the follow-up period) per homeless user. Additional secondary analysis of three services looked at quality-adjusted life years (QALYs) and service delivery costs. The perspective adopted was NHS in England.
Data from the comparative analysis showed that specialist homeless hospital discharge (HHD) care is likely to be cost-effective compared with standard care. Patients accessing specialist care use fewer bed days per year (including both planned and unplanned readmissions). Patients using specialist care have more planned readmissions to hospital and, overall, use more NHS resources than those who use standard care. We interpret this as a positive outcome indicating that specialist care is likely to work more effectively than standard care to improve access to healthcare for this marginalised group. Specialist care remained cost-effective over a range of sensitivity analyses. Secondary analyses of three specific schemes found better QALY outcomes, but results are not generalisable to all 17 schemes.
Specialist HHD services are likely to be cost-effective for the NHS compared with standard care, although further research is needed to access patient level data for both costs and outcomes to conduct a rigorous statistical analysis between groups and address possible underlying biases due to data coming from non-randomised study design.
认识到人群多样化的医疗保健需求，人们越来越强调调整医院出院流程，以应对无家可归者所面临的独特挑战，旨在提高针对这一弱势群体的出院后护理的效率和效果。本研究旨在评估英格兰为无家可归者提供的专科医院出院及中间护理（出院后支持）服务的成本和后果。
我们估计了17项无家可归者医院出院及中间护理服务所提供的不同类型专科护理的比较成本和后果。我们将“临床主导”（多学科）服务与“住房主导”（单一专业）服务进行了比较。开展了一项回顾性观察研究，以估计两个“干预组”（临床主导组和住房主导组）的有效性和成本，并与之前发表的一项关于“标准护理”的随机对照试验进行比较。专科护理资源使用数据通过与医院事件统计数据的关联获取。有效性的衡量指标是每位无家可归使用者避免的床日数（就随访期内所有再入院的住院天数而言）。对三项服务进行的额外二次分析考察了质量调整生命年（QALYs）和服务提供成本。采用的视角是英格兰的国民医疗服务体系（NHS）。
比较分析的数据表明，与标准护理相比，专科无家可归者医院出院（HHD）护理可能具有成本效益。接受专科护理的患者每年使用的床日数更少（包括计划内和计划外再入院）。使用专科护理的患者计划内再入院次数更多，总体而言，比使用标准护理的患者使用更多的NHS资源。我们将此解释为一个积极结果，表明专科护理在改善这一边缘化群体获得医疗保健的机会方面可能比标准护理更有效。在一系列敏感性分析中，专科护理仍具有成本效益。对三个特定方案的二次分析发现了更好的QALY结果，但结果不能推广到所有17个方案。
与标准护理相比，专科HHD服务对NHS而言可能具有成本效益，不过需要进一步研究以获取成本和结果方面的患者层面数据，以便在组间进行严格的统计分析，并解决由于数据来自非随机研究设计而可能存在的潜在偏差。
