2009/03/31 by Mary E. Larimer · 2 citations
Health Professions · Medicine · Nursing · #Homelessness and Social Issues #Substance Abuse Treatment and Outcomes #Alcoholism and Thiamine Deficiency #Medicine #Housing First #Interquartile range #Supportive housing #Medicaid #Confidence interval #Population #Rate ratio #Environmental health #Public health #Poisson regression #Health care #Gerontology #Demography #Psychiatry #Emergency medicine #Mental health #Mental illness #Nursing #Surgery
paper · pdf · doi:10.1001/jama.2009.414
openalex publication_date 2009/03/31 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
CONTEXT: Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates. OBJECTIVE: To evaluate association of a "Housing First" intervention for chronically homeless individuals with severe alcohol problems with health care use and costs. DESIGN, SETTING, AND PARTICIPANTS: Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington. MAIN OUTCOME MEASURES: Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls. RESULTS: Housing First participants had total costs of 8,175,922 in the year prior to the study, or median costs of 4066 per person per month (interquartile range [IQR], 2067-8264). Median monthly costs decreased to 1492 (IQR, 337-5709) and 958 (IQR, 98-3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged 2449 per person per month after accounting for housing program costs. CONCLUSIONS: In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.