Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial

Latimer, Éric; Rabouin, Daniel; Cao, Zhirong; Ly, Angela; Powell, Guido; Aubry, Tim; Distasio, Jino; Hwang, Stephen W.; Somers, Julian M.; Bayoumi, Ahmed M.; Mitton, Craig; Moodie, Erica E. M.; Goering, Paula; Investigators, Chez Soi

doi:10.1176/appi.ps.202000029

Cited by 21 publications

(9 citation statements)

References 30 publications

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“…[40][41][42] Integrating PSH (shown to reduce the average number of shelter, psychiatric hospitalization, and incarceration days) with ACT (shown to reduce hospitalizations, improve housing stability and symptom management, and increase quality of life) may address housing needs while providing highintensity supportive services. 36,43,44 Our results reflect the well-known need for more MH and SUD services in San Francisco, resulting in recent reform efforts. 45,46 Subgroup 2 had low SUD service use compared to the prevalence of SUD comorbidities; however, most patients exclusively used medical services.…”

Section: Discussionsupporting

confidence: 63%

Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco

et al. 2022

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Background In the City and County of San Francisco, frequent users of emergent and urgent services across different settings (i.e., medical, mental health (MH), substance use disorder (SUD) services) are referred to as high users of multiple systems (HUMS). While often grouped together, frequent users of the health care system are likely a heterogenous population composed of subgroups with differential management needs. Objective To identify subgroups within this HUMS population using a cluster analysis. Design Cross-sectional study of HUMS patients for the 2019–2020 fiscal year using the Coordinated Care Management System (CCMS), San Francisco Department of Public Health’s integrated data system. Participants We calculated use scores based on nine types of urgent and emergent medical, MH, and SUD services and identified the top 5% of HUMS patients. Through k -medoids cluster analysis, we identified subgroups of HUMS patients. Main Measures Subgroup-specific demographic, comorbidity, and service use profiles. Key Results The top 5% of HUMS patients in the study period included 2657 individuals; 69.7% identified as men and 66.5% identified as non-White. We detected 5 subgroups: subgroup 1 ( N = 298, 11.2%) who were relatively younger with prevalent MH and SUD comorbidities, and MH services use; subgroup 2 ( N = 478, 18.0%), who were experiencing homelessness, with multiple comorbidities, and frequent use of medical services; subgroup 3 ( N = 449, 16.9%), who disproportionately self-identified as Black, with prolonged homelessness, multiple comorbidities, and persistent HUMS status; subgroup 4 ( N = 690, 26.0%), who were relatively older, disproportionately self-identified as Black, with prior homelessness, multiple comorbidities, and frequent use of medical services; and subgroup 5 ( N =742, 27.9%), who disproportionately self-identified as Latinx, were housed, with medical comorbidities and frequent medical service use. Conclusions Our study highlights the heterogeneity of HUMS patients. Interventions must be tailored to meet the needs of these diverse patient subgroups. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07873-y.

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Section: Discussionsupporting

confidence: 63%

Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco

et al. 2022

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“…Fourteen studies performed a cost analysis of PSH interventions and reported mixed results regarding resource requirements. Seven studies showed that the PSH interventions were associated with increased cost to the payers and that the cost of the interventions were only partially offset by savings in medical‐ and social_services costs as a result of the intervention (Latimer et al, 2019; Latimer et al, 2020; Culhane et al, 2002; Dickey et al, 1997; Gilmer et al, 2009, 2010; Mares & Rosenheck, 2011). Six studies revealed that PSH interventions saved the payers money (Hunter et al, 2017; Larimer, 2009; Lenz‐Rashid, 2017; Chalmers McLaughlin, 2011; Schinka et al, 1998; Srebnik et al, 2013).…”

Section: Resultsmentioning

confidence: 99%

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Moledina

Magwood

Agbata

et al. 2021

Campbell Systematic Reviews

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Background: Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all.The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness.Objectives: The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.Search Methods: In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies.Selection Criteria: Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid

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“…Élargir l'accès à des logements supervisés permanents pendant la période de reprise postpandémique pourrait favoriser grandement la stabilité du logement chez cette population au cours des prochaines années. En général, les logements supervisés permanents, et l'approche Logement d'abord en particulier, sont rentables 42 .…”

Section: Nous Recommandons Fortement L'élargissement Des Programmes D...unclassified

Recommandations pour une reprise équitable après la pandémie de COVID-19 au Canada

Persaud

Woods

Workentin

et al. 2022

CMAJ

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Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial

Cited by 21 publications

References 30 publications

Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco

Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Recommandations pour une reprise équitable après la pandémie de COVID-19 au Canada

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