Housing as a Remedy for Chronic Homelessness

Katz, Mitchell H.

doi:10.1001/jama.2015.1277

Cited by 3 publications

(6 citation statements)

References 6 publications

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“…Although the Patient Protection and Affordable Care Act expanded Medicaid eligibility and increased funding for outpatient health centers that care for homeless persons, our findings suggest that policy initiatives should also focus on supporting hospitals that primarily serve this population. Providing additional resources to safety-net hospitals-whether financial or in-kind-to implement multidisciplinary care pathways, enhance care coordination, facilitate transitions to medical respite units, 43 and provide intensive case management specifically for homeless individuals, coupled with ongoing efforts to enhance longitudinal access to ambulatory health care services and promote housing stability through a "housing first" approach, [44][45][46][47] could collectively help improve health outcomes in this highly vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions

et al. 2020

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IMPORTANCE Cardiovascular disease is a major cause of death among homeless adults, with mortality rates that are substantially higher than in the general population. It is unknown whether differences in hospitalization-related care contribute to these disparities in cardiovascular outcomes.OBJECTIVE To evaluate differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for cardiovascular conditions (ie, acute myocardial infarction, stroke, cardiac arrest, or heart failure). DESIGN, SETTING, AND PARTICIPANTSThis retrospective cross-sectional study included all hospitalizations for cardiovascular conditions among homeless adults (n = 24 890) and nonhomeless adults (n = 1 827 900) 18 years or older in

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Section: Discussionmentioning

confidence: 99%

Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions

et al. 2020

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“…Of these, an estimated 27% lived in California, and this rate has increased by 16 percent from 2018 to 2019 38 . The availability of pragmatic yet reliable approaches to identifying homelessness in administrative data is crucial for the allocation of resources to address the needs of the homeless, including the provision of permanent supportive housing 10–12,39,40 …”

Section: Discussionmentioning

confidence: 99%

“…Improving the health of individuals living with homelessness is challenging because harsh living conditions reduce the effectiveness of medical interventions 8,9 . Therefore, efforts to improve the health of this population frequently focus on providing housing support services and permanent housing 10–14 . Increasingly, payers and health care providers are engaged in more intensive outreach and the incorporation of housing services into medical benefits.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Therefore, efforts to improve the health of this population frequently focus on providing housing support services and permanent housing. [10][11][12][13][14] Increasingly, payers and health care providers are engaged in more intensive outreach and the incorporation of housing services into medical benefits. Effective strategies require systematic and accurate approaches using broadly available and up-to-date administrative data.…”

Section: Introductionmentioning

confidence: 99%

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Easy to use and validated predictive models to identify beneficiaries experiencing homelessness in Medicaid administrative data

Pourat

Yue

Chen³

et al. 2023

Health Services Research

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Objective: To develop easy to use and validated predictive models to identify beneficiaries experiencing homelessness from administrative data.Data Sources: We pooled enrollment and claims data from enrollees of the California Whole Person Care (WPC) Medicaid demonstration program that coordinated the care of a subset of Medicaid beneficiaries identified as high utilizers in 26 California counties (25 WPC Pilots). We also used public directories of social service and health care facilities.Study Design: Using WPC Pilot-reported homelessness status, we trained seven supervised learning algorithms with different specifications to identify beneficiaries experiencing homelessness. The list of predictors included address-and claims-based indicators, demographics, health status, health care utilization, and county-level homelessness rate. We then assessed model performance using measures of balanced accuracy (BA), sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (area under the curve [AUC]).Data Collection/Extraction Methods: We included 93,656 WPC enrollees from 2017 to 2018, 37,441 of whom had a WPC Pilot-reported homelessness indicator.Principal Findings: The random forest algorithm with all available indicators had the best performance (87% BA and 0.95 AUC), but a simpler Generalized Linear Model (GLM) also performed well (74% BA and 0.83 AUC). Reducing predictors to the top 20 and top five most important indicators in a GLM model yields only slightly lower performance (86% BA and 0.94 AUC for the top 20 and 86% BA and 0.91 AUC for the top five).Conclusions: Large samples can be used to accurately predict homelessness in Medicaid administrative data if a validated homelessness indicator for a small subset can be obtained. In the absence of a validated indicator, the likelihood of homelessness can be calculated using county rate of homelessness, address-and claim-based indicators, and beneficiary age using a prediction model presented here. These approaches are needed given the rising prevalence of homelessness and the focus of Medicaid and other payers on addressing homelessness and its outcomes.

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“…27 Thus, rather than placing homeless persons in temporary or transitional housing until those persons address their mental illness or substance addiction, these programs supply permanent housing first . 28 That housing is accompanied by a full range of social and medical supports to address other needs of the homeless person, but those services are not a condition of receiving housing.…”

Section: Medicaid's Existing Funding For Housingmentioning

confidence: 99%