Dataset Information

A Community Partnership to House and Care for Complex Patients with Unstable Housing.

ABSTRACT: Rising homelessness, especially among older adults, has significant ramifications for our health care system. People experiencing homelessness tend to experience worse health and poorer access to needed health care than people with stable housing. Commonwealth Care Alliance (CCA), a not-for-profit payer and provider that offers health plans to people dually eligible for Medicare and Medicaid, sought to address homelessness among its beneficiaries through a partnership with a local community-based housing organization, Hearth. This partnership led to many CCA members gaining access to permanent supportive housing in a setting in which CCA and Hearth could monitor and address their medical, social, and behavioral needs. It also provided an opportunity to examine health care utilization and cost trends associated with permanent supportive housing. Our experience demonstrates that a community-based partnership can effectively address homelessness among older adults with significant medical needs and may be associated with reduced health care expenditures.

SUBMITTER: Gondi S

PROVIDER: S-EPMC8425482 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A Community Partnership to House and Care for Complex Patients with Unstable Housing.

Gondi Suhas S Berchuck Samuel I SI Brown Rebecca T RT Hinderlie Mark M Easton Lauren L Smith Leah L Berchuck Jacob E JE Burden Henry S HS Berchuck Caroline M CM

NEJM catalyst innovations in care delivery 20210801 8

Rising homelessness, especially among older adults, has significant ramifications for our health care system. People experiencing homelessness tend to experience worse health and poorer access to needed health care than people with stable housing. Commonwealth Care Alliance (CCA), a not-for-profit payer and provider that offers health plans to people dually eligible for Medicare and Medicaid, sought to address homelessness among its beneficiaries through a partnership with a local community-base ...[more]

PMID: 34514431

Similar Datasets

Project description:BackgroundApproaches to address unmet mental health care needs in supportive housing settings are needed. Collaborative approaches to delivering psychiatric care have robust evidence in multiple settings, however such approaches have not been adequately studied in housing settings. This study evaluates the implementation of a shifted outpatient collaborative care initiative in which a psychiatrist was added to existing housing, community mental health, and primary care supports in a women-centered supportive housing complex in Toronto, Canada.MethodsThe initiative was designed and implemented by stakeholders from an academic hospital and from community housing and mental health agencies. Program activities comprised multidisciplinary support for tenants (e.g. multidisciplinary care teams, case conferences), tenant engagement (psychoeducation sessions), and staff capacity-building (e.g. formal trainings, informal ad hoc questions). This mixed methods implementation evaluation sought to understand (1) program activity delivery including satisfaction with these activities, (2) consistency with team-based tenant-centered care and with pre-specified shared lenses (trauma-informed, culturally safe, harm reduction), and (3) facilitators and barriers to implementation over a one-year period. Quantitative data included reporting of program activity delivery (weekly and monthly), staff surveys, and tenant surveys (post-group surveys following tenant psychoeducation groups and an all-tenant survey). Qualitative data included focus groups with staff and stakeholders, program documents, and free-text survey responses.ResultsAll three program activity domains (multidisciplinary supports, tenant engagement, staff capacity-building) were successfully implemented. Main program activities were multidisciplinary case conferences, direct psychiatric consultation, tenant psychoeducation sessions, formal staff training, and informal staff support. Psychoeducation for tenants and informal/formal staff support were particularly valued. Most activities were team-based. Of the shared lenses, trauma-informed care was the most consistently implemented. Facilitators to implementation were shared lenses, psychiatrist characteristics, shared time/space, balance between structure and flexibility, building trust, logistical support, and the embedded evaluation. Barriers were that the initial model was driven by leadership, confusion in initial processes, different workflows across organizations, and staff turnover; where possible, iterative changes were implemented to address barriers.ConclusionsThis evaluation highlights the process of successfully implementing a shifted outpatient collaborative mental health care initiative in supportive housing. Further work is warranted to evaluate whether collaborative care adaptations in supportive housing settings lead to improvements in tenant- and program-level outcomes.

Project description:PurposeHousing and food insecurity are social risk factors that can impact eye health outcomes. This study investigated the association of these social risk factors with vision and ophthalmic pathologic characteristics.DesignCross-sectional study from July 28, 2020, through July 27, 2021, for the free clinic and January 27, 2021, through January 26, 2022, for the Federally Qualified Health Center.ParticipantsMichigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine program first-year participants.MethodsData collected included sociodemographic features, housing and food insecurity status, and results from a comprehensive telemedicine assessment. Individual-level and neighborhood-level characteristics were summarized with descriptive statistics. Differences in participant characteristics between housing and food security status were tested by 2-sample t tests for continuous measures and chi-square or Fisher exact tests for categorical measures. Logistic regression was used to test the independent associations between housing and food insecurity and ophthalmic disease, adjusted for age. The Holm’s procedure was performed to adjust for multiple comparisons.Main outcome measuresVisual impairment (VI; presenting visual acuity [VA], < 20/40), uncorrected or undercorrected refractive error (PVA, < 20/40; and best-corrected VA, ≥ 20/40), glaucoma, diabetic retinopathy, cataract, and macular degeneration.ResultsParticipants (n = 1165) were mean ± standard deviation [SD] of 55 ± 14.5 years of age, 62% identified as female, 54% identified as Black or African American, 10% identified as Hispanic or Latino, 49.7% had annual household income of less than $20 000, and 20% reported no medical insurance. Presenting VA was mean ± SD of 0.12 ± 0.19 logarithm of the minimum angle of resolution units (Snellen equivalent, 20/26 ± 1.9 lines). Visual impairment and uncorrected or undercorrected refractive error were identified in 10.3% and 8.3% of participants, respectively. Participants reported housing insecurity (3.4%) and food insecurity (28.9%), and 2.2% reported both. Among participants with unstable housing, 26.3% showed VI and 23.7% showed uncorrected or undercorrected refractive error. Unstable housing was associated with higher odds of VI (odds ratio, 3.53; P = 0.006) and uncorrected or undercorrected refractive error (odds ratio, 3.74; P = 0.006). No associations were observed between unstable housing and other ocular pathologic features or food insecurity and any ocular pathologic features.ConclusionsBecause unstable housing is associated with VI and uncorrected refractive error, future initiatives could focus on interventions to address both unstable housing and the increased need for eye care among those with unstable housing.Financial disclosure(s)Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Project description:BackgroundDespite programs to address housing for Veterans, they continue to be at high risk of unstable housing. Interpersonal violence is also highly prevalent among Veterans and may contribute to unstable housing. Our study aimed to determine whether interpersonal violence was associated with unstable housing among Veterans, and how this association was influenced by common co-occurring conditions such as substance use and mental illness.MethodsVeterans in the Mind Your Heart Study (N = 741) completed survey data on history of interpersonal violence and access to housing in the prior year. Interpersonal violence was defined as experiencing sexual violence, physical violence, or mugging/physical attack using the Brief Trauma Questionnaire. Multivariable models examined associations between interpersonal violence and unstable housing. Primary models were adjusted for age and sex. Potential explanatory factors were added in subsequent models, including marital status, education, income, substance use disorder, PTSD, and other mental illness.ResultsVeterans who had experienced interpersonal violence had almost twice the odds of unstable housing after adjustment for age and sex (AOR 1.9, 95% CI 1.2-3.0). This association was attenuated in the fully adjusted model including substance use, PTSD, and other mental illness, illustrating the interdependence of these factors (AOR 1.5, 95% CI 0.91-2.5). Subtypes of interpersonal violence were individually associated with increased odds of unstable housing after adjustment for age and sex (physical abuse AOR 1.7, 95% CI 1.2-2.5; mugging/physical attack AOR 1.8, 95% CI 1.2-2.7; sexual violence AOR 1.4, 95% CI 0.89-2.2), but were no longer significant in the fully adjusted model.ConclusionsPrevious experiences of interpersonal violence were associated with unstable housing among Veterans. Substance use, PTSD, and other mental illness played an important role in this relationship-highlighting the potential to improve health outcomes through trauma informed approaches that address mental health, substance use, and housing concurrently.

Project description:Rationale & objectiveCommunity house hemodialysis is a submodality of home hemodialysis that enables patients to perform hemodialysis independent of nursing or medical supervision in a shared house. This study describes the perspectives and experiences of patients using community house hemodialysis in New Zealand to explore ways this dialysis modality may support the wider delivery of independent hemodialysis care.Study designQualitative semi-structured in-depth interview study.Setting & participants25 patients who had experienced community house hemodialysis. Participants were asked about why they chose community house hemodialysis and their experiences and perspectives of this.Analytical approachThematic analysis using an inductive approach.Results25 patients were interviewed (14 men and 11 women, aged 31-65 years). Most were of Māori or Pacific ethnicity and in part- or full-time employment. More than two-thirds dialyzed for 20 hours a week or more. We identified 4 themes that described patients' experiences and perspectives of choosing and using community house hemodialysis: reducing burden on family (when home is not an option, minimizing family exposure to dialysis, maintaining privacy and self-identity, reducing the costs of home hemodialysis, and gaining a reprieve from home), offering flexibility and freedom (having a normal life, maintaining employment, and facilitating travel), control of my health (building independence and self-efficacy, a place of wellness, avoiding institutionalization, and creating a culture of extended-hour dialysis), and community support (building social inclusion and supporting peers).LimitationsNon-Māori and non-Pacific patient experiences of community house hemodialysis could not be explored.ConclusionsCommunity house hemodialysis is a dialysis modality that overcomes many of the socioeconomic barriers to home hemodialysis, is socially and culturally acceptable to Māori and Pacific people, and supports extended-hour hemodialysis and thereby promotes more equitable access to best practice services. It is therefore a significant addition to independent hemodialysis options available for patients.

Dataset Information

A Community Partnership to House and Care for Complex Patients with Unstable Housing.

Publications

A Community Partnership to House and Care for Complex Patients with Unstable Housing.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets