Emergency Department Linkage to Care for Patients Experiencing Homelessness

Denver Health and Hospital Authority

Status: Enrolling

Conditions: Homelessness

Treatments: Behavioral: Street medicine follow up

Study type: Interventional

Funder types: Other

Identifiers

NCT07209072

COMIRB 24-1764

F32HS030344 (U.S. AHRQ Grant/Contract)

Details and patient eligibility

About

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.

Full 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.

Enrollment: 390 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

390 participants in 2 patient groups

Standard of Care

No Intervention group

Description:

Patients will receive a referral to a rapid follow up clinic at time of discharge

Street medicine

Experimental group

Description:

Patients will receive a referral to street medicine at time of discharge

Treatment:

Behavioral: Street medicine follow up