摘要：Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. On a single night in January 2011, 640 000 people in the United States were estimated to be homeless; estimates are much higher for those experiencing homelessness in a given year. 1,2 The homeless population experiences more health problems than the general population, demonstrating high rates of acute and chronic medical illness. 3 Homeless adults report substantial unmet needs for multiple types of health care. 4 In a study involving 3000 people who were homeless, one fourth had not received needed medical care in the preceding year. 5 Multiple barriers make accessing health care, including dental care, difficult for individuals experiencing homelessness. Dental care has been reported as one of the top unmet needs among homeless adults, 10% reporting it as their most needed service. 6 Clinically significant dental problems have been identified in two thirds of homeless individuals, with a 58% prevalence of untreated caries among adults. 7 Previous work shows that homeless veterans have poor oral health according to all measurable parameters, including missing and decayed teeth and oral pain. 8 Poor dental health and poor dental appearance can also be significant quality of life issues. Among homeless veterans in rehabilitation programs, provision of dental care (relative to a lack of care or only emergent care) has been found to significantly increase self-perceived quality of life with respect to oral health. 9 Such results clearly demonstrate the need for adequate access to oral health care among people who are homeless. Questions remain however, as to how dental care affects more global outcomes of homeless intervention and rehabilitation programs. We attempted to address these uncertainties by examining the impact of dental care on outcomes among homeless veterans discharged from one of 538 Department of Veterans Affairs (VA) community-based transitional housing intervention programs. These programs provide housing for up to 2 years and are designed as transitional rehabilitation interventions leading to permanent housing. Our primary outcomes of interest were program completion, employment or stable financial status on program discharge, and transition to permanent housing. We specifically addressed differences in characteristics and outcomes between veterans who did and did not receive dental treatment, the impact on outcomes of self-perceived dental status at the time of program admission, and the relative importance of demographic characteristics, housing and occupational history, health and mental health status, and dental care with respect to all 3 primary outcomes.
