Linking emergency department patients experiencing homelessness to primary care

Emergency Department Linkage to Care for Patients Experiencing Homelessness

This project will try enhanced follow-up by a street medicine team versus routine clinic referral to see if people experiencing homelessness discharged from the ED get more primary care.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 390 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Denver Health and Hospital Authority (Academic / other)
• Locations: 1 site (Denver, Colorado)
• Trial ID: NCT07209072 on ClinicalTrials.gov

What this trial studies

This quasi-experimental equivalent time sample study enrolls adult ED patients experiencing unsheltered homelessness who require short-term follow-up for conditions such as pneumonia, COPD/asthma exacerbation, wound or diabetic infections, dehydration, burns, pregnancy, or opioid overdose. Eligible patients discharged from Denver Health ED will be allocated to either routine referral to the Comprehensive Care Clinic or enhanced outreach by the Colorado Coalition for the Homeless Stout Street medicine team, which locates and provides primary care on the street. Investigators will compare primary care follow-up rates at 1 and 3 months and secondary outcomes including subsequent ED visits, hospitalizations, and mortality using Denver Health and CCH electronic health records plus the regional health information exchange (CORHIO). The study tests whether street-based follow-up increases engagement with primary care after ED discharge.

Who should consider this trial

Good fit: Adults (≥18) who are unsheltered in Denver County, are being discharged from the Denver Health ED with a condition needing short-term follow-up (for example COPD/asthma exacerbation, pneumonia, CHF exacerbation, SSTI, diabetic complications, pregnancy, or opioid overdose), and have a stable location where the street team can find them for at least two weeks.

Not a fit: People without a predictable location in Denver County, those with altered mentation who cannot communicate their location, patients requiring inpatient care, or those outside the service area are unlikely to benefit from the street-medicine intervention.

Why it matters

Potential benefit: If successful, this approach could increase primary care follow-up and reduce repeat ED visits, hospitalizations, and potentially mortality among people experiencing homelessness.

How similar studies have performed: Observational programs of mobile and street-based primary care have shown improved care engagement and reduced unmet needs, but randomized or quasi-experimental evidence on ED linkage is limited.

Eligibility criteria

Inclusion Criteria:

1. adult (≥18 years of age) DHMC ED patient,
2. currently unsheltered, defined as living on the streets, in a vehicle, or in another place not fit for human habitation,
3. anticipating ED discharge, with
4. a diagnosis listed below that requires short-term follow up:

   * COPD or asthma exacerbation
   * Bacterial or viral pneumonia
   * CHF with volume overload
   * SSTI
   * Dehydration requiring IV fluids
   * Hyperglycemia secondary to DM
   * Frostbite
   * First- and second-degree burns
   * Bacterial ENT infections
   * Diabetic foot infection
   * Traumatic head injury
   * Pregnancy
   * Opioid overdose
5. a stable location (i.e., an intersection, landmark, or encampment where they can be located by the street medicine team) within Denver County for at least 2 weeks.

Exclusion Criteria:

1. have altered mentation (e.g., intoxication, or secondary to medical, psychiatric, or behavioral conditions) that are unable to communicate their location, contact information, or agree to follow up.
2. are prisoners,
3. previously enrolled.

Where this trial is running

Denver, Colorado

• Denver Health Medical Center — Denver, Colorado, United States (Recruiting)

Study contacts

• Study coordinator: Kathleen M Joseph, MD MPH

Conditions Homelessness; primary care; emergency department; homelessness