The Impact of Homelessness on Mortality of Individuals Living in the United States: A Systematic Review of the Literature.

This systematic review assessed peer-reviewed research studies on mortality rates of the homeless population within the United States. Extrapolated data included definitions of homelessness, mortality data sources, findings on mortality rates, and causes of premature mortality. Results demonstrate that individuals experiencing homelessness die earlier than comparison groups not experiencing homelessness. Methodology and findings varied across studies. Subpopulations included veterans, families, youth, and unsheltered. Causes of death varied across subpopulations and changed over time. Top causes of death, predominantly determined by ICD codes, stemmed from neoplasms, heart disease, and substance use disorder. Sources used for mortality data included the National Death Index (NDI), the Social Security Death Index (SSDI), state death occurrence files, and city vital statistics. Important research foci include standardization, subpopulation variations, policy implications, and the influence of mortality risk factors, such as poverty and racism.

Deliberate Practice with Standardized Patient Actors and the Development of Formative Feedback for Advance Care Planning Facilitators.

OBJECTIVE: Multimodal curricular assessment after adding standardized patient (SP) actor-based simulation to an advance care planning (ACP) facilitator training course and development of a formative feedback tool. BACKGROUND: ACP represents a highly valued service requiring more and better trained facilitators. METHODS: Participants were primarily nurses and social workers in a large multisite health system. The course included a precourse video demonstration of ACP, traditional lectures, and four 30-minute simulations with SPs. Knowledge was tested with a multiple choice question (MCQ) test. In addition to standard postcourse/postsimulation evaluations, learners were surveyed pre/post/30-90 days delayed for self-perceived confidence. A linear mixed-effects model was used to analyze changes over time. Trained faculty rated performance in simulations with an observational mini-clinical examination (mini-CEX)-type rating form with a checklist, global competency, and global communication rating. Inter-rater reliability (IRR) was calculated on randomly selected paired ratings. RESULTS: Sixty-seven individuals consented to participate. MCQ scores improved from 83% ± 10% to 92% ± 8% (p < 0.001). Paired learner surveys of self-confidence across six domains were available for 65 pre, 65 post, and 40 delayed with a mean positive change on a 0 to 10 point scale from pre-post (2.32 ± 1.65; p < 0.001) and predelayed (2.34 ± 1.96; p < 0.001) time frames. For the faculty observation ratings of simulation performance, the average raw agreement for critical actions was 82% and IRR was 0.71. CONCLUSIONS: Learner feedback and self-assessment suggest that actor-based simulation contributed to improved confidence in conducting ACP. The mini-CEX observation form is adequate for formative feedback, with further testing needed to make judgments of competence.