Currie Jane, Doherty Claire, Hutton Jennie, Vasquez-Hernandez Alejandro, Suggett Paisley, Chan Andrew, Pepper Hayley, Duff Jed, Jones Lee
School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
Healthcare for the Homeless Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
BMJ Open. 2025 Aug 28;15(8):e097615. doi: 10.1136/bmjopen-2024-097615.
To determine the feasibility of conducting a multisite randomised controlled trial of the Healthy and HomED model of care to determine its capacity to reduce emergency department (ED) representations among people experiencing homelessness.
Feasibility randomised controlled trial with process evaluation.
Single site public metropolitan ED.
Our goal was to recruit 204 adults experiencing homelessness attending ED. In total, 190 participants were enrolled. The final sample comprised n=101 control and n=86 intervention.
The Healthy and HomED model of care comprises screening for homelessness, assessing unmet needs via the Homeless Health Access to Care Tool and a Decision Assistance Guide that informs care planning. The intervention was applied by the Assessment Liaison Early Referral Team (ALERT), an ED-based multidisciplinary team specialised in supporting underserved populations.
Clinician acceptability of the implementation of the model of care, improved identification of homelessness and a reduction in ED representations within 28 days among people experiencing homelessness.
Implementation of the Healthy and HomED model of care was feasible to the ALERT clinicians and the research team. While the Healthy and HomED did not significantly reduce representations to the ED, it improved the identification of homelessness by a third (35.3%). Qualitative findings suggest that the Homeless Health Access to Care Tool provided helpful standardisation to assessments. The Decision Assistance Guide was seldom added to the plan of care for senior clinicians but was reportedly helpful to junior clinicians with less experience in homeless healthcare.
The study provided assurance that running a multicentre hybrid trial to test the effectiveness and implementation of the Healthy and HomED is feasible. Process evaluation found that intervention adherence could be improved with greater contextualisation to local resources and increased engagement from ED medical and nursing teams. These factors could be addressed through the codesign of a future multisite trial.
ANZCTR 12622001085763.
确定开展一项关于“健康与居家护理”（Healthy and HomED）护理模式的多中心随机对照试验的可行性，以确定其降低无家可归者前往急诊科就诊次数的能力。
采用过程评估的可行性随机对照试验。
单一城市公立急诊科。
我们的目标是招募204名前往急诊科就诊的无家可归成年人。总共招募了190名参与者。最终样本包括n = 101名对照组和n = 86名干预组。
“健康与居家护理”护理模式包括筛查无家可归情况、通过“无家可归者医疗护理获取工具”评估未满足的需求以及一份为护理计划提供信息的决策辅助指南。干预措施由评估联络早期转诊团队（ALERT）实施，该团队是一个基于急诊科的多学科团队，专门为服务不足的人群提供支持。
护理模式实施的临床医生可接受性、改善对无家可归情况的识别以及在28天内降低无家可归者前往急诊科就诊的次数。
“健康与居家护理”护理模式对ALERT临床医生和研究团队而言是可行的。虽然“健康与居家护理”模式并未显著减少前往急诊科就诊的次数，但将无家可归情况的识别提高了三分之一（35.3%）。定性研究结果表明，“无家可归者医疗护理获取工具”为评估提供了有益的标准化。决策辅助指南很少被添加到资深临床医生的护理计划中，但据报道对在无家可归者医疗保健方面经验较少的初级临床医生有帮助。
该研究表明开展一项多中心混合试验以测试“健康与居家护理”模式的有效性和实施可行性是可行的。过程评估发现，通过更好地结合当地资源以及急诊科医疗和护理团队更多的参与，可以提高干预的依从性。这些因素可通过未来多中心试验的共同设计来解决。
ANZCTR 12622001085763。
