| Definitions | Medical conditions | Interventions | Disparities | COVID-19 |
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What is POPULATION HEALTH?
This term refers to the health outcomes of a group of individuals, and the distribution of such outcomes within a group.
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What is E?
a, c, d seem intuitive, but b. may be related to being able to remain employed.
Screening/treating this condition can prevent homelessness:
a. bipolar disorder, b. low back pain, c. substance use, d depression, e. all of the above |
What is SUPPORTIVE housing?
Housing + (usually social work, MH, or nursing) co-located can reduce ED visits, readmission, and for HIV+ patients, mortality.
This is an intervention (compared to usual discharge) that reduces LOS, ED utilization, and mortality among older homeless individuals discharged from hospitals in NY and Chicago.
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What is TRUE?
Re-entry is highest risk time for individuals leaving incarceration; top causes of death within 14days of release: overdose, violence suicide. It is difficult to get plugged into services after leaving prison bc MediCal has to be renewed, small supply of meds (if pharmacy open when indiv released) and multiple paperwork/social work/legal hurdles. Re-entry clinics can help with multiple services at one site.
T or F:
Compared to the general population (WA state,) individuals had 13 times higher ODDS of death in the first 14 days of leaving incarceration. |
What is (any of the following:)
shelters, jail/prisons, group homes, military residences/barracks, residential rehab facilities, dormitories
This is an example of CONGREGATE housing,
i.e. type of residence that may offer individual quarters but shared common spaces, usually high density. |
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What is 12 months or greater?
Per HUD 2016, individual w a disability + >12m unstably housed qualifies as chronically homeless
This is HOW LONG a person wi must be unstably housed (moving >3x/3yrs, unsheltered, or transitional housing) as a CHRONIC homeless individual
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What is (any one of the following) CA, CHD, SUD?
Given avg age at death mid 40-51, which has not changed in 20yrs, consider earlier screening/intervention for conditions with higher prevalence and options for treatment.
This is one of the top 3 causes of death among homeless individuals, who die on average 20 years earlier in 40-50's vs. general US population
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What is (any of the following:)
teach-back method, using simple ratios (3/1000 vs 0.3%,) written/verbal/visual communication, advanced directives (California) with more visuals (Sudore et al.)
This is one example of improving communication by considering patients' HEALTH LITERACY (multiple possible answers, pls give 1 example)
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What is E?
In boroughs in New York (5 total in NYC) zip codes with highest proportion of minorities, poverty, and overcrowding had highest rates of COVID-19 deaths.
These may be some of the risk factors for COVID-19 that are more prevalent among African American and LatinX communities: a. overcrowding (<1room/person,) b. lack of control over work/ability to work from home, c. front-line essential work (lower paid,) d. multigenerational living, e. all of the above
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What is (any of the following:) wearing masks, social distancing, using signs/clapping/kneeling instead of yelling/singing, meeting outside rather than indoors
This method of protesting may lower risk of COVID-19 transmission or exposure at rallies (name one of multiple possible methods:)
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What is CONGREGATE housing?
e.g. shelter, residential rehabilitation, dormitory, barracks, group homes. Transitional housing = housing designed for 2yrs or less (e.g. Section 8 vouchers to pay rent, case mgmt to stay housed)
This is a type of housing in which individuals may have their own sleeping quarters but share common areas e.g. kitchen, dining area, recreation room
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What is "Do you have access to a bathroom?"
Prep will require individual to have toilet/washroom access for 24hrs prior to procedure; VA has referral for housing on campus for appts/procedures if traveling or unstably housed.
This is one question to ask someone whom you are referring to screening colonoscopy, esp if they are unstably housed.
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What is SUD (etoh, tob, illicit screening;) Heart (DM, hyperlipid, HTN;) ID (HIV,TB,HCV,GC/CT, syphillis;) Mental Health (depression/bipolar;) IPV (if know resources)
Screening recommendations for homeless individuals are slightly different than for the general US population. This is 1 category of screening that differs (hint: SHIMI acronym, name 1 of those categories)
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What is TRUE?
Causes of death among homeless and housed indiv in MA: homeless white men had much higher risk of death (SUD, MH) compared to non-white homeless men, who died of poverty ie access/delays. Homelessness is a heterogeneous PATHWAY, not single predictor. Interventions should reflect diversity.
T or F:
While homeless individuals have a higher risk of death compared to the housed population, white homeless men had the highest risk of death compared to non-white homeless men and women in MA. |
What is (any of the following:)
>12ft/indiv at congregate housing (e.g. shelters, resid rehab,) mass testing at any encampment >10 indiv, accelerate affordable housing construction, reassigning staff to supportive housing at hotels/motels/RV for 1000 individuals
This is 1 of the interventions local counties have tried to reduce COVID-19 transmission and death among homeless individuals in Santa Clara county as of May 2020.
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What is: compared to medical care, housing (first, then taking care of MH/SUD/medical issues) is the foundation, ideally with support (co-located MH or nursing or social services) for reducing mortality and improving health outcomes. We know social circumstances and environmental determinants outperform medical care's impact on mortality in the US. MDs can vote, speak, and write; this is our lane.
"Housing is the most powerful medicine" per Margot Kushel MD; this is an explanation of this statement.
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