Evaluation of a street medicine based post-discharge care program for patients experiencing homelessness.

Abstract

BACKGROUND: People experiencing homelessness face significant barriers to healthcare access, resulting in elevated hospital readmission and emergency department (ED) revisit rates. To address this, Cedars-Sinail Medical Center partnered with Healthcare in Action, a street medicine provider, to create a post-discharge care program offering 30 days of mobile medical and social support to unhoused patients. METHODS: This observational study evaluated the program's impact on 30-day hospital utilization. Between March 2022 and August 2023, 272 patients (289 episodes) were enrolled. Patients were clinically stable, unhoused at discharge, and eligible for follow-up care. Participants were categorized into an intervention group (received at least one post-discharge visit, n = 177 episodes) and a comparison group (unable to be contacted, n = 112 episodes). Outcomes included 30-day revisit rates and revisits per 100 episodes. Additional analysis examined pre- and post-intervention revisit patterns and patient characteristics associated with revisits. RESULTS: Revisit rates were slightly lower in the intervention group than the comparison group (35.5% vs 38.3%, p = 0.63), with fewer revisits per 100 episodes (76 vs 129, p = 0.08). Patients in the intervention group had fewer revisits post-enrollment compared to the prior year (149 vs 225 per 100 episodes), though differences were not statistically significant. Factors associated with higher revisit risk included older age, white race, English language preference, and ED referral. CONCLUSION: This street medicine-based post-discharge program shows promise in reducing ED utilization and supporting recovery among unhoused patients, though further rigorous studies are needed to demonstrate impacts on healthcare utilization and long-term outcomes.