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Running head: RESEARCH SUMMARY TABLE Research Summary Table: Homelessness Health Care

 

Chamberlain College of Nursing

 

NR 505: Advance Research Methods: Evidence-Based Practice

 

November 10, 2016

 

\ Purpose Author

 

(year) Sample/Number

 

of Participants

 

(provide

 

RESEARCH SUMMARY

 

TABLE

 

descriptive

 

statistics) O?Toole, T.

 

P., Johnson,

 

E. E., Borgia,

 

M. L., &

 

Rose, J.

 

(2015) Level of

 

Evidenc

 

e Findings

 

(provide any

 

inferential

 

statistics) Limitations To advance

 

understanding

 

of

 

characteristics

 

and costs

 

associated with

 

homeless ER

 

visits Convenience sample

 

of 61,124 ED visits

 

in a urban academic

 

medical center in one

 

year of period were

 

selected into this

 

study include

 

homeless patients (N

 

= 74) and nonhomeless patients (N

 

= 468).

 

The mean age of

 

homeless patient is

 

47 years, 85.1%

 

were male and

 

60.8% were from a

 

minority population. This is a retrospective

 

quantitative crosssectional study,

 

selected ED visits in

 

2006 at an unban

 

hospital. Level IV:

 

Evidence

 

from

 

welldesigned

 

casecontrol

 

and

 

cohort

 

studies The study obtained

 

better descriptions of

 

relationships for

 

homeless, frequent

 

ED visit and high

 

cost.

 

The study found

 

23.7% of ER visits

 

made by homeless

 

frequent users who

 

expended $4.8

 

million in ER in one

 

year. Housing status

 

was

 

underdetermined

 

due to people who

 

experience

 

homeless but not

 

report as it is and

 

people in unstable

 

housing were

 

unable to

 

determine by the

 

retrospective chart

 

review study

 

design.

 

The quality of the

 

data are various

 

due to

 

documentation

 

done by different

 

clinicians.

 

No comparison

 

data provided for

 

non-homeless

 

patient. To determine

 

factors related

 

with frequent

 

hospitalizations

 

and emergency

 

room visits

 

among

 

homeless

 

people covered

 

by Medicaid

 

and improve

 

Medicaid

 

utilization Convenience sample

 

of Massachusetts

 

Medicaid recipients

 

with mean age of

 

45.5 years, 71%

 

were male and 29%

 

were female, 56%

 

were from a minority

 

population, 21%

 

were housed. (N=

 

6494) This is a retrospective

 

analysis quantitative

 

cross-sectional study

 

with 1 year of data,

 

used Massachusetts

 

Medicaid members

 

who received services

 

from the Boston

 

health care for the

 

homeless program

 

(BHCHP) in 2010. Level IV:

 

Evidence

 

from

 

welldesigned

 

casecontrol

 

and

 

cohort

 

studies The study found

 

even though

 

Medicaid coverage

 

for the primary care

 

and improved access

 

to health care,

 

hospitalizations and

 

ED visits rates still

 

very high for

 

Medicaid recipients

 

experiencing

 

homeless. This study

 

also found frequent

 

users used for the

 

majority of

 

hospitalizations and

 

ED visits. The limitations of

 

this study include:

 

data used in this

 

study were before

 

current state

 

actions taken by

 

BHCHP, such as

 

implementation of

 

a patient-centered

 

medical home

 

model and

 

primary care

 

payment reform;

 

limit data of preMedicaid

 

expansion and

 

participant?s

 

housing history

 

before 2010. To explore

 

whether

 

outreach efforts

 

to increase

 

primary care

 

use among

 

homeless

 

veterans Convenience sample

 

of homeless Veterans

 

in two communities:

 

Providence, Rhode

 

Island and New

 

Bedford,

 

Massachusetts

 

enrolled, 36 were

 

subsequently

 

removed from the

 

analysis. 185

 

homeless Veterans

 

remained in the

 

study, had an

 

average age of 48.6

 

years, 94.6 % were This was a multicenter, prospective,

 

community-based,

 

two-by-two

 

randomized controlled

 

trial of homeless

 

Veterans, testing

 

whether an tailored

 

outreach intervention

 

that included a

 

personal health

 

assessment and brief

 

intervention, and a

 

clinic/health system

 

orientation separately

 

and in combination, Level II:

 

Evidence

 

obtained

 

from at

 

least one

 

welldesigned

 

Randomiz

 

ed

 

Controlle

 

d Trial

 

(RCT) The study findings

 

suggest that out-oftreatment homeless

 

Veterans can be

 

effectively engaged

 

in primary care

 

through a tailored

 

outreach process.

 

The engagement in

 

primary care was

 

sustained and

 

resulted in care being

 

provided across the

 

continuum of needs

 

facing this

 

population. This study?s

 

participants were

 

majority adult

 

male, therefore,

 

results might not

 

be applicable to

 

female and

 

homeless families Ku et al.

 

(2014) Lin, W.,

 

Bharel, M.,

 

Zhang, J.,

 

O'Connell,

 

E., & Clark,

 

R. E. (2015) Design RESEARCH SUMMARY TABLE Summary

 

The research summary table addressed the following research question: ?Does

 

increase usage of supported housing program (I) in chronic illness homelessness (P) will

 

decrease preventable emergency department visit (O) compared to without the supported

 

housing program?

 

The research articles in the summary table were been found in PubMed Central

 

(PMC) and Proquest databases. Keywords phrased such as ? homelessness?, ?supported

 

housing?, ? emergency department visit? have been used for searching along with

 

Boolean terminology ?AND?, ?OR?, ?NOR?. The research yielded 346 articles in PMC

 

and 154 articles in Proquest. After eliminated systemic review study and qualitative

 

research, the quantitative single original studies with most appropriate address research

 

question?s article have been selected. RESEARCH SUMMARY TABLE

 

Three of the studies in the table (Ku et al., 2014; Lin, Bharel, Zhang, O'Connell &

 

Clark, 2015; Thakarar, Morgan, Gaeta, Hohl, & Drainoni, 2015) are single descriptive

 

quantitative study. The study conducted by Ku et al. (2014) performed a case-control

 

study by using convenience sample as retrospective chart review from a urban academic

 

medical center, compared all ED visits? financial and hospital records for the crosssectional study. Two of the studies (Lin, et al., 2015;Thakarar, et al., 2015) used

 

convenience sample from the homeless program provided retrospective quantitative

 

cross-sectional study, correlated with urban hospital ED medical records to analyzed the

 

relationship between housing supported homeless and ED visit. The study of O?Toole,

 

Johnson, Borgia and Rose (2015), preformed a prospective quantitative retrospective

 

study, established two-by-two randomized controlled trial (RCT) of homeless Veterans.

 

Three of the studies in the table (Ku et al., 2014; Lin, et al., 2015;Thakarar, et al.,

 

2015) fall on the Level IV: Evidence from well-designed case-control and cohort studies

 

on the Levels of Evidence table. One study (O?Toole, et al., 2015) falls on Level II:

 

Evidence obtained from at least one well-designed RCT.

 

The studies in this table (Ku et al., 2014; Lin, et al., 2015; O?Toole, et al., 2015;

 

Thakarar, et al., 2015) demonstrated that increase usage of supported housing program in

 

chronic illness homelessness population would decrease preventable emergency

 

department visit. All studies in the summary table (Ku et al., 2014; Lin, et al., 2015;

 

O?Toole, et al., 2015; Thakarar, et al., 2015) demonstrated male in age around 48 years

 

are the majority of homeless population in supported housing program and users of ED.

 

Therefore, the target population for the research intervention is male in age around 48

 

years. In the study by Lin, et al. (2015) found even though Medicaid coverage for the RESEARCH SUMMARY TABLE

 

primary care and improved access to health care, hospitalizations and ED visits rates still

 

very high for Medicaid recipients experiencing homeless. Two of the studies (Lin, et al.,

 

2015; Ku et al., 2014) found homeless frequent users used for the majority of

 

hospitalizations and ED visits. In the study by O?Toole, et al. (2015) findings suggest that

 

out-of-treatment homeless Veterans can be effectively engaged in primary care through a

 

tailored outreach process. This study also described the engagement in primary care was

 

sustained and resulted in care being provided across the continuum of needs facing this

 

population (O?Toole, et al., 2015). Further, the study by Ku et al. (2014) found 23.7% of

 

ER visits made by homeless frequent users who expended $4.8 million in ER in one year,

 

one top frequent user accrued charges of $482,928 in one year period. The study of

 

Thakarar, et al. (2015) found housed patients were older than homeless patient, and had

 

more comorbidities and histories of alcohol use and mental health disorders, which may

 

indicate that individuals with more health problems have higher opportunities to

 

obtaining housing. In the same study also found hepatitis C is the significant predictor of

 

frequent ER visits in homelessness (Thakarar, et al., 2015).

 

All four studies answered the research question, that increase usage of supported

 

housing program in chronic illness homelessness will decrease preventable emergency

 

department visit compared to without the supported housing program.

 

Three of studies (Ku et al., 2014; Lin, et al., 2015; Thakarar, et al., 2015) used

 

objective numerical data, large convenience sample, took from homeless program and

 

hospital medical records that contents hundred of patient. The fourth study (O?Toole, et

 

al., 2015) recruited participants (N=221) from 11 community sites and social service

 

agencies in two communities. Ku et al. (2014) selected 61,124 ED visits in an urban RESEARCH SUMMARY TABLE

 

academic medical center in one year of period were selected into this study include

 

homeless patients (N = 74) and non-homeless patients (N = 468). Lin, et al. (2015)

 

included convenience sample of Massachusetts Medicaid recipients (N= 6494) who

 

received services from a health care for the homeless program in 2010. Thakarar, et al.

 

(2015) used convenience sample from a homeless program (N= 412) who visited their

 

main ER site in one year of period. All sample sizes in the studies are adequate. All

 

studies are a well designed study, quantify well-defined variables; study samples are

 

representative of the population.

 

Limitations of all studies include the following: (1) limitations of the patient

 

population that was being retrieved, (2) lack of reliable information, (3) lack of

 

information regarding follow up of patients not in the homeless program and used ED

 

service (4) although the studies showed a clear need for supported housing program to

 

prevent potential ER visit, there were not any information for homeless family or

 

homeless children recommendation given. Further researches are needed in homeless

 

family and homeless children as large potion of the homeless population.

 

Despite these limitations, all four studies does serves as a proof of concept that

 

supported housing program can connect homelessness with appropriated health care

 

service, promoted chronic illness homeless health, accordingly lower the health care

 

costs. As the result found in this studies that hepatitis C is the significant predictor of

 

frequent ER visits in homelessness, Medicaid should utilize nurse case management

 

service align with primary care service, put greater approach to Hepatitis C homelessness

 

population thus contain costs for preventable ED visit. RESEARCH SUMMARY TABLE References

 

Ku, B. S., Fields, J. M., Santana, A., Wasserman, D., Borman, L., & Scott, K. C. (2014).

 

The urban homeless: Super-users of the emergency department. Population

 

Health Management, 17(6), 366-371. doi:10.1089/pop.2013.0118

 

Lin, W., Bharel, M., Zhang, J., O'Connell, E., & Clark, R. E. (2015). Frequent emergency

 

department visits and hospitalizations among homeless people with medicaid:

 

Implications for medicaid expansion. American Journal of Public Health, 105,

 

S716-S722. Retrieved from

 

http://search.proquest.com.proxy.chamberlain.edu/docview/1732126006?

 

accountid=147674

 

O?Toole, T. P., Johnson, E. E., Borgia, M. L., & Rose, J. (2015). Tailoring outreach efforts

 

to increase primary care use among homeless veterans: Results of a randomized RESEARCH SUMMARY TABLE

 

controlled trial. Journal of General Internal Medicine, 30(7), 886?898.

 

http://doi.org/10.100 7/s11606-015-3193-x

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471019/

 

Thakarar, K., Morgan, J. R., Gaeta, J. M., Hohl, C., & Drainoni, M.L. (2015). Predictors

 

of frequent emergency room visits among a homeless population. PLoS ONE,

 

10(4). http://doi.org/10.1371/journal.pone.0124552

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407893/

 


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I have a paper need grammar correction, 6 pages, double spacing, thank you very much!


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