Housing homeless reduces readmits
Case management component included
An intervention that provided housing and case management to homeless adults with chronic medical illnesses reduced hospitalizations and ED visits in two Chicago-area hospitals, according to a study recently published in The Journal of the American Medical Association.1 The intervention included transitional housing after hospitalization discharge, followed by placement in long-term housing.
Case managers facilitated the participant's housing placement and coordinated appropriate medical care, with substance abuse and mental health treatment referrals coordinated as needed.
Over the 18-month period of the study, there were 2.61 ED visits per person per year in the intervention group, compared with 3.77 visits per person per year in the usual care group. There were 583 hospitalizations in the intervention group (1.93 hospitalizations per person per year) and 743 in the usual care group (2.43 hospitalizations per person per year).
The researchers interviewed patients who had been admitted to Stroger Hospital or Mount Sinai Medical Center. They had to have been homeless for the 30 days prior to admission, and they had to have one of 15 chronic medical illnesses, such as hypertension, diabetes, or chronic pulmonary disease, explains Romina Kee, MD, MPH, a senior attending physician at Stroger and a co-author of the paper. Of those who agreed to participate in the program, half were selected to receive the assistance.
"We worked with social workers who tried to determine their needs, and they went into either respite care or another form of housing — usually a shelter," she reports.
Rebecca Roberts, MD, an ED physician at Stroger, says, "What they did was unique in focusing on patients who had chronic serious illnesses. That's why people in the past have not found benefits [from programs like these]. These were patients whose conditions were bad enough for them to be hospitalized. The effect of finding them housing makes perfect sense to me, and I'm glad to see it."
Kee says, "I think that housing is such a critical piece to a patient's general health picture. If we discharge a patient on medications that have to be refrigerated, like insulin, and they do not have a roof over their head, they can't really do what we ask. They miss follow-up visits, they get sicker, and they have to come in through the ED."
The case managers were an important element of the intervention, says Kee, because the care had to be tailored to the individual, and that care extended beyond housing needs. "Some of them needed a lot of support, while others had family members or friends who could help," she says. The case managers helped patients to adhere to their nonurgent care, she says. "If the patient had a follow-up appointment, part of their role was to remind them and facilitate it, so this also promotes good preventive care."
Reference
- Sadowski LS, Kee RA, VanderWeele TJ, et al. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults. JAMA 2009; 301:1,771-1,778.
Government funds support program A successful intervention that reduced hospital admissions and ED readmits by finding housing for chronically ill homeless patients could not have been undertaken without funding from the Department of Housing and Urban Development (HUD), says Romina Kee, MD, MPH, a senior attending physician at Stroger Hospital in Chicago, and a co-author of a paper in The Journal of the American Medical Association describing the intervention. "It was paid through HUD. The patients were assigned a case manager through a network of several agencies in Chicago through the AIDS Foundation," explains Kee, who notes that the foundation identified and acquired all the resources for housing. "They have contracts with the case managers," she adds. While Kee won't say this model will work everywhere, "I can say it is well suited to urban facilities that have a large degree of patients who are underinsured and have a large number of chronic medical needs," she notes. The AIDS Foundation "is trying to turn this study into common practice," she says. Accordingly, if an ED manager is interested in developing a similar program in their city, "They are a great resource on how to set up the specifics of the intervention." For more information, Kee suggests contacting Arturo Bendixen, vice president for programs and partnerships, AIDS Foundation of Chicago, at [email protected]. "He can certainly give them the blueprint for doing what we did," she says. |
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