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

Laura S. Sadowski, Romina A. Kee, Tyler J. VanderWeele, and David Buchanan

May 2009

The Chicago Housing for Health Partnership (CHHP) is a “hospital-to-housing” effort that identifies chronically ill homeless individuals at hospitals, moves them to permanent supportive housing, and provides them with intensive case management services so that they can maintain their health and secure long-term housing stability.   During an 18-month research phase for each participant, CHHP researchers used a randomized control trial design to study the number of hospital, emergency room, and nursing home visits incurred by two groups:  individuals who received CHHP supportive housing compared to those who received “usual care” – a piecemeal system of emergency shelters, family, and recovery programs. The information was used to track health outcomes and assess how much in medical expenses could be saved through stable housing and increasing access to primary care rather than relying on costly hospital visits and nursing home stays.  The Intervention Group participants had high rates of long-term substance abuse (86 percent), mental illness (46 percent), and medical issues such as HIV/AIDS (34 percent), and hypertension (33 percent), as well as a number of other chronic medical illnesses such as diabetes and cancer. The analytic sample (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.  Compared with the usual care group, the intervention group had unadjusted annualized mean reductions of 0.5 hospitalizations, 2.7 fewer hospital days, and 1.2 fewer emergency department visits.  Adjusting for baseline covariates, compared with the usual care group, the intervention group had a relative reduction of 29% in hospitalizations, 29% in hospital days, and 24% in emergency department visits.

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