Impact of a Social Medicine Housing Program on the Health and Healthcare Utilization of Adults Who Are Unhoused and Have Complex Health Needs
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 100
- 试验地点
- 4
- 主要终点
- Number of emergency department visits
研究概览
简要总结
The study design is a cohort study with a propensity score-matched control group and difference-in-difference analysis to evaluate intervention effectiveness. A hybrid type 1 effectiveness-implementation study framework is used that incorporates mixed methods to determine clinical effectiveness and explore implementation and participant well-being. Participants are selected based on their utilization of health services. Selection favoured those individuals with the most health service utilization. A control group will be created by selecting individuals from administrative hospital records that are propensity-score matched to the individuals in the treatment group (1:4 pair). The hybrid type 1 effectiveness-implementation study framework was used to guide the selection of study aims and outcomes to focus primarily on clinical effectiveness, while also exploring implementation-related factors. The primary objective of the study is to evaluate the impact of the Initiative on the number of emergency department visits and days spent in the hospital. The secondary objectives are to 2) evaluate the impact of the Initiative on program participants' health and well-being, 3) evaluate the implementation of the Initiative and assess program fidelity and barriers, and 4) to calculate the cost avoidance and cost-effectiveness of the Initiative.
详细描述
The study design is a cohort study with a propensity score-matched control group and difference-in-difference analysis to evaluate intervention effectiveness. A hybrid type 1 effectiveness-implementation study framework is used that incorporates mixed methods to determine clinical effectiveness and explore implementation and participant well-being.
Using a quasi-experimental design approach, participants are not randomly assigned to the intervention group. Participants are selected based on their utilization of health services, satisfying the other inclusion criteria, and accepting to participate in the Initiative. Selection favored those individuals with the most health service utilization. All intervention participants will be invited to participate in the evaluation study. A control group will be created by selecting individuals from administrative hospital records that are propensity score matched to the individuals in the treatment group. Four control individuals will be selected for every one treatment individual (1:4 pair). Patient data from multiple time points, before and after intervention implementation, will be used to strengthen the analysis and to compare immediate and longer-term effects to the treatment group. The propensity-score matching procedure is described below.
The hybrid type 1 effectiveness-implementation study framework was used to guide the selection of study aims and outcomes to focus primarily on clinical effectiveness, while also exploring implementation-related factors. This approach helps to combine questions concerning the effectiveness of the intervention with questions about how best to implement it. The clinical, service, and implementation outcomes, according to Proctor's Outcomes for Implementation Research, will be analyzed in conjunction to provide a complete understanding of the program mechanisms of change.
Mixed methods will be used to combine quantitative and qualitative data in a convergent approach. The quantitative and qualitative data will be collected in parallel, primarily, to merge the information and compare the results for triangulation of the findings. Triangulating data from multiple methods and sources will allow us to comprehensively answer the evaluation questions, minimize bias, and increase the credibility of the results. Data collection sources are described below.
All participants that were selected and agreed to participate in the Social Medicine Housing Initiative will be invited to participate in the study. The tenants of Social Medicine Housing Initiative must consent to participate in the study. The participants will be housed at the newly constructed housing building in Toronto or will be housed in units that become available throughout the city. There are no exclusion criteria that would exclude participants who are receiving housing from participating in the research study. If participants are able to independently provide consent, or do not want to provide consent for the study, they will be excluded.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
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
- •The Housing Initiative is part of standard care and is not contingent on participating in any research activities. Patients that participate in the Housing Initiative will have the option to participate in the research study.
- •To qualify for housing through the initiative, patients must have had 2 or more inpatient admissions or 6 or more visits to the emergency department in the past 6 months. They must also either identify as Indigenous or be currently without housing, which is defined as having spent at least one night in a shelter or having received assistance from city-funded street outreach providers in the past 90 days. Historically marginalized groups, including people with disabilities, women, gender-diverse individuals, and Indigenous people, are given priority for housing. Eligible patients are prioritized for housing offers based on their use of the University Health Network emergency departments in the past year.
- •There are no
排除标准
- •that would disqualify participants from participating in the research study if they have already enrolled in the Social Medicine Housing Initiative.
结局指标
主要结局
Number of emergency department visits
时间窗: 30 Months
The primary objective of the study is to evaluate the impact of the Social Medicine Housing Initiative on the number of emergency department visits for University Health Network super utilizers compared to a propensity score-matched cohort. It is hypothesized that study participants who participate in the Housing Initiative will show a reduction in acute care utilization (emergency department visits) during the 30-month outcome ascertainment period.
Days spent in the hospital
时间窗: 30 Months
The primary objective of the study is to evaluate the impact of the Social Medicine Housing Initiative on the number of days spent in the hospital for UHN super-utilizers compared to a propensity score-matched cohort. It is hypothesized that study participants who participate in the Housing Initiative will show a reduction in acute care utilization (in-patient hospital days) during the 30-month outcome ascertainment period
次要结局
- Tenant Health status(30 months)
- Tenant Mental health(30 months)
- Tenant Substance Use(30 months)
- Tenant history of violence(30 months)
研究者
Andrew Boozary
Executive Director, Population Health and Social Medicine Gattuso Centre for Social Medicine, University Health Network
University Health Network, Toronto