Optimising health outcomes for people experiencing homelessness (HOPE): evidence and gap map, mixed-methods systematic review and systems mapping of interventions to optimise emergency care for people experiencing homelessness.

Background People experiencing homelessness or who are vulnerably housed have significantly poorer health outcomes and reduced life expectancies compared to the general population. Emergency care is used more frequently than by the general population and hospital stays are usually longer. Understanding what approaches have resulted in successful health outcomes, such as increased contact with health services, reduced length of hospital stays, reductions in hospital attendance, and in particular use of emergency care, is critical to help reduce the inequity of people experiencing homelessness. Aims & objectives To understand what is known about interventions in homelessness that impact on health (and make the existing research evidence more accessible to the people who can use it to design and deliver services), and to evaluate interventions that aim to optimise emergency care for people experiencing homelessness. Research Questions • What is the volume, nature and diversity of research on interventions in homelessness that impact on health? • What interventions help prevent health emergencies in people experiencing homelessness? • What interventions facilitate attendance of people experiencing homelessness who need emergency care? • What interventions help reduce repeat appearances at emergency departments by people experiencing homelessness? • What are the barriers preventing people experiencing homelessness from attending emergency departments when care is needed? • How do people experiencing homelessness and health workers perceive interventions aimed at improving appropriate attendance at emergency departments? Methods We will address these questions via three work packages (WPs): WP1: An evidence and gap map on the volume, nature and diversity of quantitative and qualitative research on interventions for people with lived experience of homelessness that impact on health WP2: A mixed-methods systematic review of interventions to improve appropriate attendance at Emergency Departments for people experiencing homelessness. We will take the synthesised quantitative and qualitative research findings from both evidence sets and bring them together into an overarching synthesis using a logic model approach. WP3: Participatory systems mapping of the processes and pathways for people with lived experience of homelessness and health issues. The mapping will be informed in the first instance by the findings from WP1 and WP2 Anticipated impact and dissemination In addition to publications in peer-reviewed academic journals, we will produce accessible dissemination materials including briefing papers, podcasts, blog posts and plain language summaries. These will be shared via pathways developed with health and social care co-applicants and the PPIE team. In the short term, this research will provide rapid access to research evidence about homelessness and health, and will raise awareness of the impact of hospital and community interventions on health and social care services, highlighting where new needs emerge elsewhere in the care and support pathway. In the medium to longer term, this work has the potential to inform the commissioning, design and delivery of care pathways for people experiencing homelessness, especially with regards to emergency care services. Both short and long-term outcomes have important potential implications for health outcomes of people experiencing homelessness and cost-savings for health services.