Background: People experiencing homelessness (PEH) have significant healthcare needs leading to higher rates and longer periods of hospital use than the general population. Hospitals struggle to provide safe discharge for patients without homes, and medical respite care (MRC) can close this gap in care. Through short-term acute residential care, PEH too ill or frail to recover from an illness/injury on the streets can recuperate in a safe environment while accessing medical care and other supportive services. COVID-19 emphasized the critical need for MRC. Problems of focus include: a dearth of PCOR focused on MRC; barriers such as functional limitations and comorbidities that prevent PEH from engaging in healthcare research; and a lack of access to engage PEH in PCOR. These issues indicate the need to convene stakeholders to increase information and knowledge on how MRC can improve discharge planning options, care coordination, healthcare quality, and health outcomes for this vulnerable population.
Proposed Solution to the Problem: NHCHC’s stakeholder convening will engage 75 total stakeholders, including PEH, providers, researchers, and others in order to focus on PCOR and MRC, which has not yet been attempted. Together, the project team will develop resources that assist communities in establishing MRC programs. Leading up to the in-person convening, NHCHC will conduct an introductory meeting and two more pre-convening virtual working/planning meetings. After each convening, NHCHC staff members will draft evaluation reports. After the conclusion of the in-person convening, NHCHC project staff will jointly draft a comprehensive research model. NHCHC is the leading voice on MRC nationally and has already developed a wealth of MRC resources. The stakeholder convening will continue advancing that success, leaning on the PCORI principles of making better-informed health decisions and promoting the dissemination and uptake of evidence on how to prevent, diagnose, treat, monitor, and manage diseases, disorders, and other health conditions for PEH.
- Aim 1: Foster new patient/community partnerships to support future engagement in PCOR. Objective: NHCHC will plan a series of convenings to serve as stakeholder learning and collaboration opportunities.
- Aim 2: Identify potential topics for future PCOR focused on PEH in MRC. Objective: NHCHC will provide an in-person forum for stakeholders to reach consensus on research questions to be translated into future cutting-edge patient-engaged research.
- Aim 3: Address barriers to engaging PEH in PCOR. Objective: NHCHC will identify the complex, unique healthcare needs of PEH, including functional limitations and comorbidities. NHCHC will consult HCH consumers every step of the way.
- Aim 4: Expand opportunities for engaging PEH in PCOR. Objective: NHCHC will document the preferences, beliefs, and understandings that influence PEH to engage in PCOR. Additionally, they will discuss what specific settings and incentives will most encourage PEH to participate in PCOR. Aim 5: Create a comprehensive clinical research model. Objective: Stakeholders will prepare a model to guide future PCOR efforts. NHCHC will oversee efforts to consult the 25 MRC participants and NCAB members for feedback on improving the model and publication.
Activities: NHCHC will engage stakeholders from 25 geographically diverse MRC programs serving PEH. The team will create an application process and conduct a pre-application webinar to define project expectations. All selected MRC programs must commit to actively participate in three virtual and one in-person convening. Virtual meetings will ensure all voices are heard using Zoom breakout rooms where smaller groups can huddle. Agendas will focus on the need for PEH involvement in PCOR, research questions, sharing PCOR, and collaborations. Huddle participants will develop agendas and discussion priorities and recommend facilitators for the in-person meeting. Each MRC program will appoint three individuals to attend the in-person meeting, including an MRC program representative, a community partner, and a patient with lived homelessness experience, for a minimum of 75 attendees. All convenings will be evaluated. If the in-person meeting is not feasible, NHCHC will use Zoom for the fourth virtual convening.
Projected Outcomes and Outputs:
- Outputs: virtual meeting agendas, participants list, presentations, in-person meeting agenda, session evaluation reports, number of MRC programs represented, number and types of stakeholders/session, number of patients facilitating/presenting, meeting summary.
- Short-term outcome: documentation of prioritized research questions.
- Medium-term outcome: identification of PCOR topics.
- Long-term outcomes: a comprehensive model research plan for future PCOR; collaborations/networking opportunities to pursue PCOR; education/awareness materials created by stakeholders describing successful approaches to engage PEH in PCOR.
Patient and Stakeholder Engagement Plan: Patients engaged during this project include MRC consumers from around the country, who will represent one-third of total individual participants from the 25 selected MRC programs, in addition to members of the National Consumer Advisory Board (NCAB), that are HCH patients who are involved in council governance and guide community organization for other PEH who form CABs at the local level. Stakeholders engaged during this project include: leadership from participating MRC programs from around the country as well as an outside community partner from their locality, selected by the MRC program; the Respite Care Providers’ Network (RCPN) and RCPN steering committee, consisting of 14 members who are clinicians, academicians, researchers, an Accountable Care Organization representative, and PEH patients from MRC programs across 11 states; and the NCAB steering committee, consisting of 12 members from NCAB—one chair, two co-chairs, a peer advocate, three members at large, and five regional representatives.
Project Collaborators: NCAB, RCPN, RCPN steering committee.