Public Health Care Utilization in a Cohort of Homeless Adult Applicants to a Supportive Housing Program
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Supportive housing is subsidized housing with on-site or closely linked services for chronically homeless persons. Most literature describing the effects of supportive housing on health service utilization does not describe use across multiple domains of services. We conducted a retrospective cohort study of 249 applicants to a supportive housing program; 114 (45.7%) were housed in the program. We describe the pattern of service use across multiple domains (housing, physical health care, mental health care, substance abuse treatment). We examine whether enrollment in supportive housing was associated with decreased use of acute health services (emergency department (ED) and inpatient medical hospitalizations) and increased use of ambulatory services (ambulatory medical and generalist care, mental health, and substance abuse treatment) as compared to those eligible but not enrolled. Participants in both groups exhibited high rates of service utilization. We did not find a difference in change in utilization patterns between the two groups [those that received housing (intervention) and those that applied, were eligible, but did not establish residency (usual care group)] comparing the two years prior to the intervention to the two years after. The finding of high rates of maintenance of housing is, in itself, noteworthy. The consistently high use of services across multiple domains and across multiple years speaks to the level of infirmity of this population and the costs of caring for its members.
KeywordsHealth Homeless persons Housing Retrospective studies San Francisco Services.
This research was supported by funds from the California Program on Access to Care (CPAC), California Policy Research Center, University of California, Grant Number #02GT13. The views and opinions expressed do not necessarily represent those of the Regents of the University of California, CPAC, its advisory board, or any State or County executive agency represented thereon. Other support included: San Francisco Department of Public Health (SFDPH) which provided salary support for Rajiv Bhatia and Eric Kessell (during the study design, data collection and analysis phases)
and the Agency for Healthcare Research and Quality grant K08 HS011415-03 and the Hellman Family Award for early career development provided salary support for Margot Kushel.
We acknowledge the assistance of the following individuals for assistance with obtaining the data used in the study:
Margot Antonetty, Daisy Leyva, Marc Trotz, SFDPH: Client Data, Supportive Housing Program data.
Bill McConnell, SFDPH, Mental Health Services and Substance Abuse Services Utilization data.
Mario Trevino, SFFD: Ambulance Service data.
Joe Goldenson, MD, SFDPH: Jail data.
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