Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults

Abstract

DDRESSING THE HEALTH NEEDSof the homeless population is a challenge to physicians, health institutions, and federal, state, and local governments. Homelessness is pervasive in the United States, and an estimated 3.5 million individuals are likely to experience homelessness in a given year. 1 To address this problem, 860 cities and counties have enacted 10-year plans to end homelessness, and 49 states have created Interagency Councils on Homelessness. 2 Rates of chronic medical illness are high among homeless adults. With the exception of obesity, stroke, and cancer, homeless adults are far more likely to have a chronic medical illness such as human immunodeficiency virus (HIV), hypertension, and diabetes mellitus and more likely to experience a complication from the illness because they lack adequate housing and regular, uninterrupted treatment. [3][4][5][6] Homeless adults are frequent users of costly emergency department and hospital services, largely paid for by public dollars. [7][8][9][10][11][12][13][14] The combination of chronic medical illnesses and poor access to primary health care has substantial health and economic consequences.Prior intervention research has focused on subgroups of the homeless For editorial comment see p 1822. Context Homeless adults, especially those with chronic medical illnesses, are frequent users of costly medical services, especially emergency department and hospital services. Objective To assess the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical illnesses. Design, Setting, and Participants Randomized controlled trial conducted at a public teaching hospital and a private, nonprofit hospital in Chicago, Illinois. Participants were 407 social worker-referred homeless adults with chronic medical illnesses (89% of referrals) from September 2003 until May 2006, with follow-up through December 2007. Analysis was by intention-to-treat.Intervention Housing offered as transitional housing after hospitalization discharge, followed by placement in long-term housing; case management offered onsite at primary study sites, transitional housing, and stable housing sites. Usual care participants received standard discharge planning from hospital social workers.Main Outcome Measures Hospitalizations, hospital days, and emergency department visits measured using electronic surveillance, medical records, and interviews. Models were adjusted for baseline differences in demographics, insurance status, prior hospitalization or emergency department visit, human immunodeficiency virus infection, current use of alcohol or other drugs, mental health symptoms, and other factors. ResultsThe analytic sample (n=405 [n=201 for the intervention group, n=204 for the usual care group]) was 78% men and 78% African American, with a median duration of homelessness of 30 months. After 18 months, 73% of participants had at least 1 hospitalization or emergency department visit. Compared with the usual care group, the inter...

Efficacité de l’approche « logement d’abord » : une revue systématique

“…Ils varient selon les mesures utilisées ou selon les sous-groupes comparés à l'intérieur d'une même étude (Latimer et al, 2013 ;Sadowski et al, 2009). …”

“…D'autres résultats montrent plutôt que l'approche « logement d'abord » n'a pas davantage d'effets sur la santé mentale (Hwang et al, 2011 ;Latimer et al, 2013 ;Mares & Rosenheck, 2011 ;Sadowski et al, 2009), la santé physique (Hwang et al, 2011 ;Latimer et al, 2013 ;Mares & Rosenheck, 2011 ;Sadowski et al, 2009), la consommation de substances (Hwang et al, 2011 ;Latimer et al, 2013 ;Mares & Rosenheck, 2011) et le soutien social (Mares & Rosenheck, 2011) que l'accès aux services usuels (tableau 6). Les résultats de l'étude de Hwang et al (2011) peuvent porter à confusion : les participants ayant eu accès au programme basé sur l'approche « logement d'abord » présentaient un moins bon état de santé mentale et une consommation moins probléma-tique de substances que ceux qui avaient eu accès aux services usuels seulement.…”

Things Fall Apart: Preventing High Readmission Rates Among Homeless Adults

“…This study randomized homeless participants with chronic medical illnesses hospitalized at a safety-net hospital to usual care versus an intervention that included post-hospitalization case management, temporary housing and permanent housing. 8 By design, this study examined the effect of ending homelessness post-hospitalization. Because the logistics of offering permanent supportive housing (subsidized housing with on-site, or closely linked, supportive services) immediately following hospitalization was too difficult, the investigators combined several different interventions that address homelessness: medical respite care, intensive case management and permanent supportive housing.…”

News from the CDC: using web-based training to translate evidence on the value of community health workers into public health action

“…CHWs can serve in multiple roles, as they can be cultural mediators between individuals and health-care providers, informal counselors and educators, facilitators to help people access health care, advocates for individuals and communities, and navigators of health-care systems [1]. Through these roles, CHWs help individuals to adopt and sustain behaviors that prevent and manage their chronic diseases, including asthma, cardiovascular disease, cancer, and depression and other forms of mental illness [1][2][3]. In addition, these workers can help individuals and families with important issues such as immunizations, maintaining child health, and the prevention and treatment of HIV/AIDS and tuberculosis [1].…”