Resource-limited, collaborative pilot intervention for chronically homeless, alcohol-dependent frequent emergency department users

Abstract

We introduced case management and homeless outreach to chronically homeless, alcohol-dependent, frequent emergency department (ED) visitors using existing resources. We assessed the difference in differences of ED visits 6 months pre- and postintervention using a prospective, nonequivalent control group trial. Secondary outcomes included changes in hospitalizations and housing. The differences in differences between intervention and prospective patients and retrospective controls were -12.1 (95% CI = -22.1, -2.0) and -12.8 (95% CI = -26.1, 0.6) for ED visits and -8.5 (95% CI = -22.8, 5.8) and -19.0 (95% CI = -34.3, -3.6) for inpatient days, respectively. Eighteen participants accepted shelter; no controls were housed. Through intervention, ED use decreased and housing was achieved.

FIGURE 1—

CONSORT patient flow diagram: January 2011–March 2012. ^aIdentified patients had 5 or more visits in each of 2 consecutive years and an alcohol-related diagnosis. ^bCharts of the highest ED users were reviewed, and all those added to the recruitment pool and alert system had 20 or more visits in 2 years.