The Importance of Context in Understanding Homelessness and Mental Illness: Lessons Learned From a Research Demonstration Project

Research reports on the housing outcomes for persons who are homeless and mentally ill have focused on client characteristics, program type, and services as independent variables, with mixed results. From social work practice, evaluation theory, and public policy perspectives, context is an important variable. Yet, it has received scant research attention in studies of the outcomes of persons who are mentally ill and homeless. This article summarizes research results from a demonstration project providing outreach or linkage services to this target population, illustrating the significant impact of context variables (site and recruitment source) on client characteristics, implementation, qualitative and quantitative service assessments, and housing outcomes. The discussion suggests how these contextual factors may operate, and it goes on to make recommendations to improve social work research and practice concerning the important dimensions of context that should be assessed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69136/2/10.1177_104973159800800203.pd

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy