Evaluation of Housing First Initiative for Chicago Homeless With Chronic Medical Illness

Study Overview
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Brief Summary
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The study hypothesizes that early housing after hospitalization with case management integrated into the health and housing systems, will results in decreased use of costly health services (i.e., hospitalizations and Emergency Room visits) with no negative affect on health. To address this hypothesis the investigators implemented a Randomized controlled trial of 407 homeless adults with chronic medical illness in Chicago. Eligible homeless adults were enrolled during a hospitalization to intervention - Early housing with case management - or usual care - usual case management and housing options. The investigators followed the sample for 18 months with assessments at baseline, 1,3,6,9,12 and 18 months are enrollment. Study measures include Quality of Life, Health service use, Alcohol and Substance Use, housing and social and demographic characteristics.

Detailed Description
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The Chicago Housing for Health Partnership (CHHP) was developed to meet the challenge of providing housing to the most disadvantaged homeless people in the city: those with chronic illnesses who are being discharged from a hospital. The program model was community based and collaboratively created and monitored by an oversight committee composed of the leadership of all involved partner agencies. The CHHP was a group of 8 nonprofit agencies that provided supportive housing and 2 agencies that provided interim housing or respite care. Supportive housing was defined by the intervention as housing without time limits combined with services to help participants to live more stable, productive lives. To evaluate this new service model, a prospective randomized trial was designed to examine the effect of supportive housing and intensive case management on health service utilization. The investigators enrolled homeless patients with at least 1 of 15 chronic illnesses from 2 urban hospitals that were members of the partnership and known to have large numbers of unstably housed patients. The chronic illnesses were associated with increased mortality in the homeless21 and were verified through review of physician hospital notes. This trial is the health outcomes portion of CHHP.

Official Title
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Evaluation of the Housing First Initiative of Chicago Housing for Health Partnership

Conditions
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Unstable Housing

Intervention / Treatment
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* Other: case management and supportive housing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age or older English or spanish speaking Presence of at least one chronic medical illness Unstable housing

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Study group<br>These patients are assigned to the intervention of early supportive housing with case management integrated into the medical system. These subjects are offerred respite care/interim housing upon discharge from enrolling hospitalizations, followed by stable housing within 90 days. They have a case manager at each stage (hospital, respite/interim housing, and stable housing) | Other: case management and supportive housing<br>* patients randomized to the study group are offerred respite care/interim housing and case management upon discharge from enrolling hospitalization. They are also offerred stable housing within 90 days of enrolling hospital discharge, with case management at all 3 stages - hospital, respite care/interim housing, and stable housing.<br>|
| No Intervention: Usual Care<br>These patients receive usual social services for hospital discharge planning. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospitalized days - length of stay Emergency Room visits | All days admitted to an inpatient acute care intuition from time of enrollment to study end | 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Early housing after hospitalization