From the 2019 HVPAA National Conference
Ms. Frances Gill (Tulane School of Medicine)
The Homeless Hospital Liaison Program (HHL) is a student-run hospital consult service established to provide additional support to hospitalized individuals experiencing homelessness and to provide medical students with practical experience navigating our complex health and social services systems as part of an interdisciplinary team. A primary aim of the HHL program is to bridge the gap between hospital-based services and community-based services by facilitating a ‘warm hand-off’ from hospital to outpatient services. The aim of this study is to assess the impact of HHL enrollment on patient healthcare utilization.
To assess the impact of participation in HHL on patients’ health care utilization, we conducted a chart review through the hospital’s electronic medical record comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs).
For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for the majority of our patients.
Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth.
Identifying the factors associated with successful warm hand-offs upon discharge and greater decreases in future healthcare utilization upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.