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Cutuli JJ, Herbers JE, Vrabic SC, Baye O. Families with young children in homeless shelters: Developmental contexts of multisystem risks and resources. Dev Psychopathol 2023; 35:2430-2443. [PMID: 37533410 DOI: 10.1017/s0954579423000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
We apply a multisystem perspective to three aims relevant to resilience for young children in emergency and transitional homeless shelters. We consider profiles of risks and resources before shelter, early childhood program enrollment during shelter, and the likelihood of returning to shelter or having a subsequent child welfare placement. We used longitudinal, city-wide data from multiple sources integrated at the individual level across the lifespan for 8 birth cohorts. Young children (N = 1,281) stayed in family shelters during an 18-month period during a multisystem intervention. Risk factor rates were high as were rates of early childhood program enrollment (66.1% in any program; 42.3% in a high-quality program), which may suggest positive effects of the multisystem intervention. Multilevel latent class analysis revealed four profiles, considering prior shelter stays, prior child welfare placements, prior elevated lead levels, perinatal factors (teenage mother, prenatal care, low maternal education, and poor birth outcomes), demographics, and early childhood program enrollment and quality. One profile with higher rates of child welfare placement before the shelter stay and considerable enrollment in high-quality early childhood programs corresponded to lower rates of subsequent child welfare placement. Profiles did not differ on the likelihood of returning to shelter.
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Affiliation(s)
- J J Cutuli
- Nemours Children's Health, Wilmington, DE, USA
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Goddard J, Montgomerie A, Gialamas A, Haag D, Anderson J, Lynch J. Excess Hospital Burden Among Young People in Contact With Homelessness Services in South Australia: A Prospective Linked Data Study. J Adolesc Health 2023; 73:519-526. [PMID: 37330707 DOI: 10.1016/j.jadohealth.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Youth homelessness remains an ongoing public health issue worldwide. We aimed to describe the burden of emergency department (ED) presentations and hospitalizations among a South Australian population of young people in contact with specialist homelessness services (SHS). METHODS This whole-of-population study used de-identified, linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform on all individuals born between 1996 and 1998 (N = 57,509). The Homelessness2Home data collection was used to identify 2,269 young people in contact with SHS at ages 16-17 years. We followed these 57,509 individuals to age 18-19 years and compared ED presentations and hospital separations related to mental health, self-harm, drug and alcohol, injury, oral health, respiratory conditions, diabetes, pregnancy, and potentially preventable hospitalizations between those in contact and not in contact with SHS. RESULTS Four percent of young people had contact with SHS at ages 16-17 years. Young people who had contact with SHS were 2 and 3 times more likely to have presented to an ED and hospital respectively, compared to those who did not contact SHS. This accounted for 13% of all ED presentations and 16% of all hospitalizations in this age group. Excess burden causes included mental health, self-harm, drug and alcohol, diabetes, and pregnancy. On average, young people in contact with SHS experienced an increased length of stay in ED (+0.6 hours) and hospital (+0.7 days) per presentation, and were more likely to not wait for treatment in ED and to self-discharge from hospital. DISCUSSION The 4% of young people who contacted SHS at ages 16-17 years accounted for 13% and 16% of all ED presentations and hospitalizations respectively at age 18-19 years. Prioritizing access to stable housing and primary health-care services for adolescents in contact with SHS in Australia could improve health outcomes and reduce health-care costs.
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Affiliation(s)
- Joshua Goddard
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Alicia Montgomerie
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Angela Gialamas
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Dandara Haag
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jemma Anderson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia; Department of General and Adolescent Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - John Lynch
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Predmore Z, Heins S, Hoch E, Baxi S, Grigorescu V, Smith S. State Experiences Linking Medicaid Data With Birth Certificates and Other Data Sources. Med Care 2023; 61:353-359. [PMID: 37068021 PMCID: PMC10168110 DOI: 10.1097/mlr.0000000000001853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Many states link Medicaid claims with birth certificates or other data, often to inform programs and policies aimed at improving maternal and child health (MCH). OBJECTIVES To develop an up-to-date understanding of the extent of the use of linked Medicaid claims for MCH research by state. RESEARCH DESIGN We completed a structured literature review, developed an inventory of linkage efforts, and facilitated semistructured discussions with representatives from 9 states with established Medicaid claims data linkages to understand the technical details of linkages, experiences creating and maintaining linkages, and barriers or facilitators to establishing linkages. RESULTS We identified 45 peer-reviewed journal articles representing 22 states that used linked Medicaid data to study MCH and 33 states and territories that publicly report on Medicaid data linkages for a total of 39 states with any in-scope linkage. Discussions revealed that linkages often arose from the desire to answer a specific question or evaluate a program but then expanded to other use cases and that most states enable external researchers to access data for analysis. Respondents provided a few examples of where linked birth certificate data were used for health outcomes research. CONCLUSION Additional resources including technical assistance for identifying best practices along with interagency collaboration could overcome barriers and facilitate a coordinated and consolidated approach across states.
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Affiliation(s)
| | | | | | | | - Violanda Grigorescu
- Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
| | - Scott Smith
- Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
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Anastas TM, Stewart JC, Rand KL, Hirsh AT. Pain in People Experiencing Homelessness: A Scoping Review. Ann Behav Med 2023; 57:288-300. [PMID: 36745022 PMCID: PMC10094969 DOI: 10.1093/abm/kaac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prior work suggests that people experiencing homelessness (PEH) are at heightened risk for developing pain and have a uniquely burdensome pain experience. PURPOSE The aim of this scoping review was to map the current peer-reviewed, published literature on the pain experience of PEH. METHODS In accordance with the US Annual Homeless Assessment Report, we defined homelessness as lacking shelter or a fixed address within the last year. We conceptualized the pain experience via a modified version of the Social Communication Model of Pain, which considers patient, provider, and contextual factors. Published articles were identified with CINHAL, Embase, PubMed, PsycINFO, and Web of Science databases. RESULTS Sixty-nine studies met inclusion criteria. Studies revealed that PEH have high rates of pain and experience high levels of pain intensity and interference. Substantially fewer studies examined other factors relevant to the pain experience, such as self-management, treatment-seeking behaviors, and pain management within healthcare settings. Nonetheless, initial evidence suggests that pain is undermanaged in PEH. CONCLUSIONS Future research directions to understand pain and homelessness are discussed, including factors contributing to the under-management of pain. This scoping review may inform future work to develop interventions to address the specific pain care needs of PEH.
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Affiliation(s)
- Tracy M Anastas
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
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Barboza-Salerno GE, Kosloski A, Weir H, Thompson D, Bukreyev A. A Network Analysis of the Relationship Between Mental and Physical Health in Unsheltered Homeless Persons in Los Angeles County. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5902-5936. [PMID: 36300615 DOI: 10.1177/08862605221127222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Homelessness is a public health crisis both nationally, in the United States, and internationally. Nevertheless, due to the hidden vulnerabilities of persons who are without shelter, little is known about their experiences during periods of homelessness. The present research adopts a network approach that conceptualizes how the major risk factors of homelessness interact, namely substance abuse problems, poor mental health, disability, and exposure to physical or sexual violence by an intimate partner. Our analysis draws on a large demographic survey of over 5,000 unsheltered homeless persons conducted in 2017 by the Los Angeles Homeless Services Authority. We estimated a network structure for 12 survey items tapping individual risk using the graphical least absolute shrinkage and selection operator algorithm. We then examined network centrality metrics and implemented a community detection algorithm to detect communities in the network. Our results indicated that mental illness and intimate partner violence (IPV) are central measures that connect all other mental and physical health variables together and that post-traumatic stress disorder and IPV are both highly affected by changes in any part of the network and, in turn, affect changes in other parts of the network. A community detection analysis derived four communities characterized by disability, sexual victimization and health, substance use, and mental health issues. Finally, a directed acyclic graph revealed that drug abuse and physical disability were key drivers of the overall system. We conclude with a discussion of the major implications of our findings and suggest how our results might inform programs aimed at homelessness prevention and intervention.
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Affiliation(s)
| | - Anna Kosloski
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Henriikka Weir
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | | | - Alexey Bukreyev
- College of Arts, Letters and Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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Nederveld AL, Duarte KF, Rice JD, Richie A, Broaddus-Shea ET. IMAGINE: A Trial of Messaging Strategies for Social Needs Screening and Referral. Am J Prev Med 2022; 63:S164-S172. [PMID: 35987528 DOI: 10.1016/j.amepre.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Health-related social needs are associated with poor health outcomes. Many primary care practices now screen and refer patients with health-related social needs to assistance organizations, but some patients decline screening or assistance. Improving communication about health-related social needs screening and referral could increase screening response and assistance acceptance rates. STUDY DESIGN This is a pragmatic, nonrandomized 3-stage trial of messages and communication strategies for health-related social needs screening and referral. Messages and strategies were informed by qualitative analysis of stakeholder interviews and were developed through an iterative, patient-, and stakeholder-engaged process. SETTING/PARTICIPANTS Settings included 3 primary care clinics serving primarily low-income patients in western Colorado. INTERVENTION Stage 1 includes usual clinic processes for health-related social needs screening (form given to patients at the front desk without additional explanation), Stage 2 includes adding written patient-friendly messages regarding the purpose of health-related social needs screening and referral to usual clinic processes, and Stage 3 includes adding verbal messages delivered by a medical assistant (form given to patients by a medical assistant during the rooming process). MAIN OUTCOME MEASURES Primary outcomes include (1) screening form response rate and (2) acceptance of referral for assistance rate among patients with health-related social needs. Secondary outcomes include (1) comfort with screening, (2) perceived helpfulness of screening, and (3) receipt of explanation about screening. RESULTS All data collection and analysis occurred in 2021. Study Stage 2 was not associated with significant changes in any outcomes. Stage 3 was associated with decreased odds of screening form response at 2 of the 3 clinics relative to those of Stage 1 (OR=0.1, 95% CI=0.1, 0.3; OR=0.4, 95% CI=0.2, 0.7) but with increased odds of assistance acceptance (OR=2.1, 95% CI=1.1, 4.0) among patients with needs who responded to the screening form. Stage 3 was also associated with higher odds of patients perceiving screening as helpful and receiving an explanation about screening. CONCLUSIONS Altering practice workflows to provide verbal explanations of health-related social needs screening may reduce response rates but may encourage responders to accept assistance referrals. Optimal communication strategies and workflows will likely differ depending on the intended goals of health-related social needs screening and referral.
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Affiliation(s)
- Andrea L Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Kelsey Fife Duarte
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Rice
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ashlyn Richie
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; School of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Elena T Broaddus-Shea
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Ma A, Sanchez A, Ma M. Racial disparities in health care utilization, the affordable care act and racial concordance preference. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:91-110. [PMID: 34427837 DOI: 10.1007/s10754-021-09311-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
The Affordable Care Act was implemented with the aim of increasing coverage and affordable access with hopes of improving health outcomes and reducing costs. Yet, disparities persist. Coverage and affordable access alone cannot explain the health care gap between racial/ethnic minorities and white patients. Instead, the focus has turned to other factors affecting utilization rates such as the patient-provider relationship. Data from nationally represented U.S. households in 2009-2017 were used to study the association between patient-provider social distance as measured by "racial/ethnic concordance" and health care utilization rates for periods covering pre- and post-ACA. Despite the reduction in financial barriers to health access with the implementation of the ACA, the correlation between racial/ethnic concordance and utilization remains positive and significant. The results suggest that while the ACA may have improved coverage and affordability, other dimensions of access, particularly acceptability, as measured by patient-provider clinical interaction experience, remains a factor in the decision to utilize care.
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Affiliation(s)
- Alyson Ma
- Department of Economics, University of San Diego School of Business, 5998 Alcala Park, San Diego, CA, 92110, USA
| | - Alison Sanchez
- Department of Economics, University of San Diego School of Business, 5998 Alcala Park, San Diego, CA, 92110, USA.
| | - Mindy Ma
- Department of Psychology and Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
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Pro G, Liebert M, Remiker M, Sabo S, Montgomery BEE, Zaller N. Homeless Opioid Treatment Clients Transitioning to Dependent and Independent Housing: Differential Outcomes by Race/Ethnicity. Subst Use Misuse 2022; 57:867-875. [PMID: 35232321 DOI: 10.1080/10826084.2022.2046097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: Homeless opioid treatment clients who transition into housing generally demonstrate better outcomes, but housing environments vary widely and may not benefit racial/ethnic minority populations equally. We sought to identify how race/ethnicity moderates the association between positive opioid treatment response and moving into dependent or independent living environments. Methods: We used the Treatment Episode Dataset-Discharges (2018-2019) to identify outpatient treatment clients who were homeless at admission and indicated heroin or other opioids as their primary drug of choice (n = 20,021). We defined positive treatment response as a reduction in opioid use between admission and discharge. We used multivariable logistic regression to model treatment response. We included an interaction between housing at discharge (remained homeless [reference], dependent living, or independent living) and race/ethnicity, and adjusted for relevant confounders. Results: Transitioning from homeless to dependent living was positively associated with treatment response among White (aOR = 3.57, 95% CI = 3.15-4.06), Hispanic (aOR = 2.11, 95% CI = 1.55-2.86), and Black clients (aOR = 1.79, 95% CI = 1.41-2.27), but no association was observed for homeless American Indian/Alaska Native clients. Transitioning from homeless to independent living was strongly associated with treatment response among all groups with the strongest association observed among White clients (aOR = 4.70, 95% CI = 4.26-5.19). Conclusions: Interventions aimed at improving OUD treatment outcomes among homeless clients should identify individual and structural factors that support moving into fully housed and independent living environments. Dependent living offers needed support during crises, but should be temporary and priority should be placed on independent, permanent, and autonomous living environments.
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Affiliation(s)
- George Pro
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melissa Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, Arizona, USA
| | - Mark Remiker
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brooke E E Montgomery
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nickolas Zaller
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Conroy K, Samnaliev M, Cheek S, Chien AT. Pediatric Primary Care-Based Social Needs Services and Health Care Utilization. Acad Pediatr 2021; 21:1331-1337. [PMID: 33516898 DOI: 10.1016/j.acap.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the relationship between use of primary care-based social needs services and subsequent utilization of ambulatory, emergency, and inpatient services. METHODS This retrospective 2012 to 2015 cohort study uses electronic medical record data from an academic pediatric primary care practice that screens universally for social needs and delivers services via in-house social work staff. Logistic regression (N = 7300) examines how patient characteristics relate to practice-based social service use. Negative binomial models with inverse probability of treatment weights (N = 4893) estimate adjusted incidence rate ratios for ambulatory, emergency, and inpatient service use among those who used social services compared to those who did not. RESULTS Forty-five percent of patients used primary care-based social needs services. This use was significantly greater among those with disabling or complex medical conditions than those without (adjusted odds ratio and 95% confidence interval (CI) of 9.81 [7.39-13.01] and 2.76 [2.44-3.13], respectively); those from low-income versus high-income backgrounds (1.40 [1.21-1.61]); and Blacks and Latinos than Whites (1.33 [1.09-1.62] and 1.29 [1.05-1.59], respectively). Patients who used social services subsequently utilized ambulatory, emergency, and inpatient services at significantly higher rates than those who did not (adjusted incidence rate ratios and 95% CI of 1.54 [1.45-1.63], 1.50 [1.36-1.65], and 3.23 [2.31-4.51], respectively). CONCLUSIONS Primary care-based social needs service use was associated with increased utilization of ambulatory services without reductions in emergency or inpatient admissions. This pattern suggests increased health care needs or access and could have payment model-dependent financial implications for practices.
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Affiliation(s)
- Kathleen Conroy
- Division of General Pediatrics, Boston Children's Hospital (K Conroy, M Samnaliev, S Cheek, and AT Chien), Boston, Mass; Harvard Medical School (K Conroy, M Samnaliev, and AT Chien), Boston, Mass.
| | - Mihail Samnaliev
- Division of General Pediatrics, Boston Children's Hospital (K Conroy, M Samnaliev, S Cheek, and AT Chien), Boston, Mass; Harvard Medical School (K Conroy, M Samnaliev, and AT Chien), Boston, Mass
| | - Sara Cheek
- Division of General Pediatrics, Boston Children's Hospital (K Conroy, M Samnaliev, S Cheek, and AT Chien), Boston, Mass
| | - Alyna T Chien
- Division of General Pediatrics, Boston Children's Hospital (K Conroy, M Samnaliev, S Cheek, and AT Chien), Boston, Mass; Harvard Medical School (K Conroy, M Samnaliev, and AT Chien), Boston, Mass
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Gondi S, Berchuck SI, Brown RT, Hinderlie M, Easton L, Smith L, Berchuck JE, Burden HS, Berchuck CM. A Community Partnership to House and Care for Complex Patients with Unstable Housing. NEJM CATALYST INNOVATIONS IN CARE DELIVERY 2021; 2:10.1056/cat.21.0158. [PMID: 34514431 PMCID: PMC8425482 DOI: 10.1056/cat.21.0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Rising homelessness, especially among older adults, has significant ramifications for our health care system. People experiencing homelessness tend to experience worse health and poorer access to needed health care than people with stable housing. Commonwealth Care Alliance (CCA), a not-for-profit payer and provider that offers health plans to people dually eligible for Medicare and Medicaid, sought to address homelessness among its beneficiaries through a partnership with a local community-based housing organization, Hearth. This partnership led to many CCA members gaining access to permanent supportive housing in a setting in which CCA and Hearth could monitor and address their medical, social, and behavioral needs. It also provided an opportunity to examine health care utilization and cost trends associated with permanent supportive housing. Our experience demonstrates that a community-based partnership can effectively address homelessness among older adults with significant medical needs and may be associated with reduced health care expenditures.
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Affiliation(s)
- Suhas Gondi
- Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel I. Berchuck
- Duke University, Department of Statistical Science, Durham, North Carolina, USA
| | - Rebecca T. Brown
- Assistant Professor, University of Pennsylvania Perelman School of Medicine, Division of Geriatric Medicine, Philadelphia, Pennsylvania, USA
- Member, Board of Directors, Hearth, Inc., Boston, MA, USA
| | | | - Lauren Easton
- Commonwealth Care Alliance Inc., Boston, Massachusetts, USA
| | - Leah Smith
- Commonwealth Care Alliance Inc., Boston, Massachusetts, USA
| | - Jacob E. Berchuck
- Harvard Medical School and Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Henry S. Burden
- Medical Economics, Commonwealth Care Alliance Inc., Boston, Massachusetts, USA
| | - Caroline M. Berchuck
- Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Lachaud J, Mejia-Lancheros C, Durbin A, Nisenbaum R, Wang R, O'Campo P, Stergiopoulos V, Hwang SW. The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial. J Urban Health 2021; 98:505-515. [PMID: 34181180 PMCID: PMC8382791 DOI: 10.1007/s11524-021-00550-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified as having high (HN) or moderate need (MN) for mental health support services. Each group was randomized into intervention (HF) and treatment as usual groups, and 567 (98.6%) consented to link their data to health administrative databases. HF participants received a monthly rent supplement of $600 (Canadian) and assertive community treatment (ACT) support or intensive care management (ICM) support based on need level. Treatment as usual (TAU) participants had access to social, housing, and health services generally available in the community. Outcomes included all-cause and mental health-specific hospitalization, number of days in hospital, and ED visit. We used GEE models to estimate ratio of rate ratios (RRR). The results showed HF with ACT had no significant effect on hospitalization rates among HN participants, but reduced the number of days in hospital (RRR = 0.32, 95% CI 0.16-0.63) and number of ED visits (RRR = 0.57, 95% CI 0.34-0.95). HF with ICM resulted in an increase in the number of hospitalizations (RRR = 1.69, 95% CI 1.09-2.60) and ED visit rates (RRR = 1.42, 95% CI 1.01-2.01) but had no effect in days in hospital for MN participants. Addressing the health needs of this population and reducing acute care utilization remain system priorities. Trial registration: http://www.isrctn.com/identifier: ISRCTN42520374.
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Affiliation(s)
- James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Anna Durbin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Topmiller M, McCann J, Rankin J, Hoang H, Bolton J, Sripipatana A. Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres. Fam Med Community Health 2021; 9:fmch-2020-000853. [PMID: 34215670 PMCID: PMC8256755 DOI: 10.1136/fmch-2020-000853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This paper explores the impact of service area-level social deprivation on health centre clinical quality measures. Design Cross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres. Settings HRSA-funded health centres in the USA. Participants Our analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country. Results Higher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care. Conclusions This research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jessica McCann
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jennifer Rankin
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Hank Hoang
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Joshua Bolton
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Alek Sripipatana
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
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13
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Abstract
Objectives To identify ICD-10-CM diagnostic codes associated with the social determinants of health (SDOH), determine frequency of use of the code for homelessness across time, and examine the frequency of interrupted periods of Medicaid eligibility (ie, Medicaid churn) for beneficiaries with and without this code. Design Retrospective data analyses of New York State (NYS) Medicaid claims data for years 2006-2017 to determine reliable indicators of SDOH hypothesized to affect Medicaid churn, and for years 2016-2017 to examine frequency of Medicaid churn among patients with and without an indicator for homelessness. Main Outcome Measures Any interruption in the eligibility for Medicaid insurance (Medicaid churn), assessed via client identification numbers (CIN) for continuity. Methods Analyses were conducted to assess the frequency of use and pattern of New York State Medicaid claims submission for SDOH codes. Analyses were conducted for Medicaid claims submitted for years 2016-2017 for Medicaid patients with and without a homeless code (ie, ICD-10-CM Z59.0) in 2017. Results ICD-9-CM / ICD-10-CM codes for lack of housing / homelessness demonstrated linear reliability over time (ie, for years 2006-2017) with increased usage. In 2016-2017, 22.9% of New York Medicaid patients with a homelessness code in 2017 experienced at least one interruption of Medicaid eligibility, while 18.8% of Medicaid patients without a homelessness code experienced Medicaid churn. Conclusions Medicaid policies would do well to take into consideration the barriers to continued enrollment for the Medicaid population. Measures ought to be enacted to reduce Medicaid churn, especially for individuals experiencing homelessness.
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Affiliation(s)
- Isaac Dapkins
- Family Health Centers at NYU Langone, Brooklyn, NY.,Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Saul B Blecker
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
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14
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Bovell-Ammon A, Yentel D, Koprowski M, Wilkinson C, Sandel M. Housing Is Health: A Renewed Call for Federal Housing Investments in Affordable Housing for Families With Children. Acad Pediatr 2021; 21:19-23. [PMID: 32619545 DOI: 10.1016/j.acap.2020.06.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Diane Yentel
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Mike Koprowski
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Chantelle Wilkinson
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Megan Sandel
- Boston Medical Center (A Bovell-Ammon and M Sandel), Boston, Mass
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15
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Treglia D, Johns EL, Schretzman M, Berman J, Culhane DP, Lee DC, Doran KM. When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers. Health Aff (Millwood) 2020; 38:1458-1467. [PMID: 31479375 DOI: 10.1377/hlthaff.2018.05308] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases. In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits-particularly ED visits-began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.
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Affiliation(s)
- Dan Treglia
- Dan Treglia is a postdoctoral fellow in the School of Social Policy and Practice, University of Pennsylvania, in Philadelphia
| | - Eileen L Johns
- Eileen L. Johns is director of policy and research at the New York City Center for Innovation through Data Intelligence
| | - Maryanne Schretzman
- Maryanne Schretzman is executive director of the New York City Center for Innovation through Data Intelligence
| | - Jacob Berman
- Jacob Berman is a research analyst at the New York City Center for Innovation through Data Intelligence
| | - Dennis P Culhane
- Dennis P. Culhane holds the Dana and Andrew Stone Chair in Social Policy at the University of Pennsylvania
| | - David C Lee
- David C. Lee is an assistant professor in the Departments of Emergency Medicine and Population Health, New York University School of Medicine, in New York City
| | - Kelly M Doran
- Kelly M. Doran ( ) is an assistant professor in the Departments of Emergency Medicine and Population Health, New York University School of Medicine
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16
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Clark RE, Weinreb L, Flahive JM, Seifert RW. Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six. Health Aff (Millwood) 2020; 38:721-728. [PMID: 31059358 DOI: 10.1377/hlthaff.2019.00090] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.
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Affiliation(s)
- Robin E Clark
- Robin E. Clark ( ) is a professor of family medicine and community health and of population and quantitative health sciences, University of Massachusetts Medical School in Worcester
| | - Linda Weinreb
- Linda Weinreb is a professor of family medicine and community health, University of Massachusetts Medical School, and vice president and medical director for Medicaid at Fallon Health, in Worcester
| | - Julie M Flahive
- Julie M. Flahive is a biostatistician in the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School in Worcester
| | - Robert W Seifert
- Robert W. Seifert is executive director of the Center for Health Law and Policy, University of Massachusetts Medical School in Shrewsbury
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17
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Affiliation(s)
- Jordan Tyris
- Children's National Hospital, Washington, District of Columbia; and .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of ColumbiaDrs Tyris and Parikh conceptualized, drafted, and approved the final manuscript as submitted
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of ColumbiaDrs Tyris and Parikh conceptualized, drafted, and approved the final manuscript as submitted
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18
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Bovell-Ammon A, Mansilla C, Poblacion A, Rateau L, Heeren T, Cook JT, Zhang T, de Cuba SE, Sandel MT. Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized Trial. Health Aff (Millwood) 2020; 39:613-621. [DOI: 10.1377/hlthaff.2019.01569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Allison Bovell-Ammon
- Allison Bovell-Ammon is director of policy strategy at Children’s HealthWatch in the Department of Pediatrics, Boston Medical Center, in Massachusetts
| | - Cristina Mansilla
- Cristina Mansilla is a senior research assistant at Children’s HealthWatch, Department of Pediatrics, Boston Medical Center
| | - Ana Poblacion
- Ana Poblacion is a research scientist at Children’s HealthWatch, Department of Pediatrics, Boston Medical Center
| | - Lindsey Rateau
- Lindsey Rateau is a statistical data analyst in the Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, in Massachusetts
| | - Timothy Heeren
- Timothy Heeren is a professor of biostatistics at the Boston University School of Public Health
| | - John T. Cook
- John T. Cook is an associate professor of pediatrics at the Boston University School of Medicine
| | - Tina Zhang
- Tina Zhang is a medical student at the Boston University School of Medicine
| | - Stephanie Ettinger de Cuba
- Stephanie Ettinger de Cuba is executive director of Children’s HealthWatch, Department of Pediatrics, Boston University School of Medicine
| | - Megan T. Sandel
- Megan T. Sandel is an associate professor of pediatrics at the Boston University School of Medicine and is co–lead principal investigator at Children’s HealthWatch and codirector of the Grow Clinic in the Department of Pediatrics, Boston Medical Center
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19
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Clark RE, Weinreb L, Flahive JM. Homelessness And Health: The Authors Reply. Health Aff (Millwood) 2019; 38:1412. [PMID: 31381385 DOI: 10.1377/hlthaff.2019.00653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robin E Clark
- University of Massachusetts Medical School Worcester, Massachusetts
| | - Linda Weinreb
- University of Massachusetts Medical School Worcester, Massachusetts
| | - Julie M Flahive
- University of Massachusetts Medical School Worcester, Massachusetts
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20
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Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness Contributes To Pregnancy Complications. Health Aff (Millwood) 2019; 38:139-146. [DOI: 10.1377/hlthaff.2018.05156] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robin E. Clark
- Robin E. Clark is a professor of family medicine and community health, University of Massachusetts Medical School, in Worcester
| | - Linda Weinreb
- Linda Weinreb is a professor of family medicine and community health, University of Massachusetts Medical School, and vice president and medical director for Medicaid at Fallon Health, in Worcester
| | - Julie M. Flahive
- Julie M. Flahive is a biostatistician in the Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Robert W. Seifert
- Robert W. Seifert is interim director of the Center for Health Law and Economics, University of Massachusetts Medical School
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21
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Schickedanz A, Chung PJ. Addressing Family Homelessness in Pediatrics: Progress and Possibility. Pediatrics 2018; 142:peds.2018-2328. [PMID: 30177512 PMCID: PMC6702124 DOI: 10.1542/peds.2018-2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 01/31/2023] Open
Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA and
| | - Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine
at UCLA, Los Angeles, CA,Department of Health Policy & Management, UCLA Fielding
School of Public Health, Los Angeles, CA
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