Homelessness
Conditions
Keywords
primary care, emergency department, homelessness
Brief summary
In an effort to improve access to primary care at time of discharge, patients who are homeless will be given either enhanced follow up through a street medicine team or routine follow up in clinic.
Detailed description
Patients who experience homelessness frequently utilize the ED, but lack follow up primary care. In an effort to augment access to post-ED primary care, the investigators propose a quasi-experimental equivalent time sample study in which patients fitting certain diagnostic and inclusion criteria are allocated to either a) a referral to the Comprehensive Care Clinic at Denver Health, or b) a referral to Colorado Coalition for the Homeless (CCH) Stout Street medicine clinic. The street medicine clinic aims to lower barriers to access by locating patients on the street and providing primary care rather than asking patients to present to clinic. All patients will still receive the hospital appointment line number at time of discharge. 1 month and 3 months after index visit, the investigators will examine follow up rates at both clinics as well as secondary outcomes including ED visits, hospitalizations, and mortality through chart review of Denver Health and CCH electronic health records and CORHIO.
Interventions
BEHAVIORALStreet medicine follow up
This intervention will use electronic health record builds to automatically send a referral to a street medicine clinic, who will attempt to contact the patient within 2 weeks.
Sponsors
Denver Health and Hospital Authority
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. adult (≥18 years of age) DHMC ED patient, 2. currently unsheltered, defined as living on the streets, in a vehicle, or in another place not fit for human habitation, 3. anticipating ED discharge, with 4. a diagnosis listed below that requires short-term follow up: * COPD or asthma exacerbation * Bacterial or viral pneumonia * CHF with volume overload * SSTI * Dehydration requiring IV fluids * Hyperglycemia secondary to DM * Frostbite * First- and second-degree burns * Bacterial ENT infections * Diabetic foot infection * Traumatic head injury * Pregnancy * Opioid overdose 5. a stable location (i.e., an intersection, landmark, or encampment where they can be located by the street medicine team) within Denver County for at least 2 weeks.
Exclusion criteria
1. have altered mentation (e.g., intoxication, or secondary to medical, psychiatric, or behavioral conditions) that are unable to communicate their location, contact information, or agree to follow up. 2. are prisoners, 3. previously enrolled.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ED visits | 1 and 3 months | Repeat visits to the ED |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Inpatient hospitalizations | 1 and 3 months | Inpatient hospitalizations at this same hospital |
| Mortality | 3 months | Death |
Countries
United States
Contacts
CONTACTKathleen M Joseph, MD MPH
CONTACTCarolynn Lyle, PAC MPH
STUDY_DIRECTORJason Haukoos, MD MSc
Denver Health Medical Center
Outcome results
None listed