Emergency Department Linkage to Care for Patients Experiencing Homelessness
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 390
- 试验地点
- 1
- 主要终点
- ED visits
研究概览
简要总结
In an effort to improve access to primary care at time of discharge, patients who are homeless will be given either enhanced follow up through a street medicine team or routine follow up in clinic.
详细描述
Patients who experience homelessness frequently utilize the ED, but lack follow up primary care. In an effort to augment access to post-ED primary care, the investigators propose a quasi-experimental equivalent time sample study in which patients fitting certain diagnostic and inclusion criteria are allocated to either a) a referral to the Comprehensive Care Clinic at Denver Health, or b) a referral to Colorado Coalition for the Homeless (CCH) Stout Street medicine clinic. The street medicine clinic aims to lower barriers to access by locating patients on the street and providing primary care rather than asking patients to present to clinic. All patients will still receive the hospital appointment line number at time of discharge. 1 month and 3 months after index visit, the investigators will examine follow up rates at both clinics as well as secondary outcomes including ED visits, hospitalizations, and mortality through chart review of Denver Health and CCH electronic health records and CORHIO.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •adult (≥18 years of age) DHMC ED patient,
- •currently unsheltered, defined as living on the streets, in a vehicle, or in another place not fit for human habitation,
- •anticipating ED discharge, with
- •a diagnosis listed below that requires short-term follow up:
- •COPD or asthma exacerbation
- •Bacterial or viral pneumonia
- •CHF with volume overload
- •Dehydration requiring IV fluids
- •Hyperglycemia secondary to DM
- •Frostbite
- •First- and second-degree burns
- •Bacterial ENT infections
- •Diabetic foot infection
- •Traumatic head injury
- •Pregnancy
- •Opioid overdose
- •a stable location (i.e., an intersection, landmark, or encampment where they can be located by the street medicine team) within Denver County for at least 2 weeks.
排除标准
- •have altered mentation (e.g., intoxication, or secondary to medical, psychiatric, or behavioral conditions) that are unable to communicate their location, contact information, or agree to follow up.
- •are prisoners,
- •previously enrolled.
研究组 & 干预措施
Standard of Care
Patients will receive a referral to a rapid follow up clinic at time of discharge
Street medicine
Patients will receive a referral to street medicine at time of discharge
干预措施: Street medicine follow up (Behavioral)
结局指标
主要结局
ED visits
时间窗: 1 and 3 months
Repeat visits to the ED
次要结局
- Inpatient hospitalizations(1 and 3 months)
- Mortality(3 months)
研究者
KJoseph
Principal Investigator
Denver Health and Hospital Authority