Medical and Emergency Medical Use by People

Experiencing Homelessness before and

after Placement in Supportive HousingJames Petrovich, PhD, LMSW

TCU Department of Social Work

Kwynn Gonzalez-Pons, BS

UNTHSC Department of Behavioral and Community Health

Emily Spence-Almaguer, PhD, MSW

UNTHSC Department of Behavioral and Community Health

Subhash Aryal, PhD

UNTHSC Department of Biostatistics and Epidemiology

Joel Hunt, PA

JPS Health Network Care Connections

Presenter Disclosure

The following personal financial relationships with commercial interests

relevant to this presentation existed during the past 12 months:

No Relationships to Disclose

This StudyAssessed use of services in the 18 month

periods before and after provision of supportive housing

ED, Inpatient, outpatient clinic, urgent care, psych ED

Examined service charges accrued before and after housing

A component of the larger evaluation of Directions Home (directionshome.org)

Provide a perspective on community-level impacts of supportive housing

Directions HomeFort Worth’s ten-year plan to make

homelessness rare, short-term, and non-recurring

Included housing, supportive services, outreach, employment training, and more

Plan adopted in 2008Programs initiated 2009Funded at 2.9 millionLargest program – permanent supportive

housing200 PSH units fundedJustified based on the costs of reacting to

homelessness

Research Questions Does the use of health care

services change after placement in Directions Home supportive housing?

If service use changes are observed, what are the accompanying fiscal costs / savings of these changes?

MethodsPurposive sample of 100 individuals

residing in Directions Home housingOut of 154 housed during PY ICompleted demographics

questionnaireObtained homelessness-related

information from local HMIS Obtained official health care records

from John Peter Smith Health Network

Sample100 individuals enrolled in the study61 males / 39 females Mean age 51 years oldAlmost two-thirds (62%) African-

American3% HispanicMean homelessness 5.8 yearsMean income $687 per month65 (65%) reported no income

Sample

52%

26% 82%

Percent reporting

high school diploma,

GED, some college

5 people reported military service

Percent SSI or SSDI

Percent reporting

JPS as primary

source of health care

Self-Reported Health Conditions

Heart disease

Asthma

Hepatitis C

Liver disease

Emphysema

Diabetes

Kidney disease

HIV/AIDS

0 5 10 15 20 25 30 35 40

36

30

23

15

13

13

9

4

Percent

Based on the Vulnerability Index

Self-Reported Behavioral Health Conditions 72% report a substance abuse

problem68% report receiving mental

health treatment54% report receiving substance

abuse treatment31% report injection drug use18% report being committed for

mental health care

Healthcare System Use

All ED Inpatient Clinic Urgent Care

Psych ED0

200

400

600

800

1000

1200

14001293

276

49

776

108 84

983

11323

721

76 50

Pre-Hous-ing

Healthcare System Use

Healthcare Charges

Pre-Housing Post-Housing$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000$2,619,152

$1,574,761

Aggregate and Mean Charges

40% Reduction

M=$26,456

M=$15,907

Outliers

$1,103,812N=542% of all pre-housing charges

$605,187N=5

$38% of all post-

housing charges

10%

$435,458 N=1

Both Pre and Post Housing

Pre-HousingPost-Housing

Healthcare Service charges – Outliers Removed

Pre-Housing Post-Housing$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000 $1,515,340

$969,572

Aggregate and Mean Charges

M=$16,120

M=$10,314

Summary: Service UseService use changes after

housingService reductions observed for:

◦ED use (60%)◦Inpatient admissions (53%)◦Psychiatric Ed (40%)◦Urgent care (30%)◦Overall JPS (24%)◦Outpatient clinic visits (7%)

Summary: Service ChargesTotal charges accrued post-

housing decreased by $1,044,391(40%)

Mean post-housing charges decreased by $10,549 (40%)

With outliers removed, total charges decreased by $545,768 (36%)

Mean post-housing charges decreased by $5,806 (36%)

Cost Offset?Cost of Directions Home Housing:

◦Total = $397,500 ($3,975 x 100)◦Rent = $1,078,200 ($10,782 x 18)

Total program cost = $1,475,700Service charge reduction =

$1,044,391Net change = +431,309

Net Change= +431,309 (healthcare + housing + services)

Patients diagnosed with chronic conditions increased after housing

0

20

40

60

4253

3046

16

30

18 27

714

High blood pressure High CholestrolDiabetes AsthmaEpilepsy/Seizures

+100%

+53%

+88%

+26%

+50%

Implications: PolicyServices for people who are homeless

are contestedHowever, Homelessness stresses larger

public service systemsIt is important to understand how

interventions may impact these systemsStudy adds to existing knowledge baseInforms local decision making around

supportive housing

Implications: Practice

Improved screening for chronic health conditions

Identify and support “frequent-flyers”

Improved, integrated health-careFacilitate linkage to primary /

preventative careSupport housing placementSupport housing retention

Implications: Future Research

Much more to be examinedPreliminary examination of

diagnostic dataOutliers?Additional service use

measurements (24, 36….)Predictors of service use?

LimitationsNon-probability sampling approach

(100/154)Participants scored high on VI so not

considered representative of general homeless population

Unable to control for extraneous variables impacting service use

Charges typically inflated but true costs not available

Only obtained data from JPS, other providers not included

Questions / Comments?