Resource-Limited, Collaborative Pilot Intervention for Chronically Homeless, Alcohol-Dependent Frequent Emergency Department Users

摘要

We introduced case management and homeless outreach to chronically homeless, alcohol-dependent, frequent emergency department (ED) visitors using existing resources. We assessed the difference in differences of ED visits 6 months pre- and postintervention using a prospective, nonequivalent control group trial. Secondary outcomes included changes in hospitalizations and housing. The differences in differences between intervention and prospective patients and retrospective controls were ?12.1 (95% CI?=??22.1, ?2.0) and ?12.8 (95% CI?=??26.1, 0.6) for ED visits and ?8.5 (95% CI?=??22.8, 5.8) and ?19.0 (95% CI?=??34.3, ?3.6) for inpatient days, respectively. Eighteen participants accepted shelter; no controls were housed. Through intervention, ED use decreased and housing was achieved. Chronically homeless and alcohol-dependent patients are overrepresented among frequent emergency department (ED) users and account for disproportionate health care visits and costs. 1–22 Interventions that address their complex psychosocial issues through case management, supportive housing, or both have reduced their use of costly public resources. 1,7,11,18,21,23–34 These models, though likely cost effective, are expensive, precluding widespread dissemination. 7,11,18,21,23,25,31 Our aim was to assess the impact of coordinated case management and facilitated access to homeless outreach services, using existing resources, on ED utilization by chronically homeless, alcohol-dependent adults with persistently frequent ED use.