Brigham researchers found that participation in housing programs was associated with fewer outpatient visits, improved physical and mental health, and stronger connections to primary care clinics and nursing teams.
The lack of safe and affordable housing is a critical issue in the United States, posing significant challenges to patients’ health, well-being, and ability to access care. Researchers at Brigham and Women’s Hospital, a founding member of the Massachusetts General Hospital Brigham and Women’s Health System, evaluated data on the social determinants of a health screening and housing intervention program launched in 2018 to help prevent homelessness. Consolidation improves health care utilization and outcomes.
They found that in this primary care program for patients who were homeless, facing eviction, or living in unsafe housing conditions, patients who received comprehensive support from the program’s care team had fewer outpatient visits and reported lower physical and mental health are doing better and feel more connected to their health care clinic and clinical team.The results were published in health affairs.
If patients worry about where they will sleep, it will be difficult to control their blood pressure. If a person’s housing is unstable, his or her health is at great risk. Demand for housing has increased significantly since the pandemic. ”
MaryCatherine Arbour, MD, MPH, lead author of the study and medical director of the social care team at the Center for Primary Care at Brigham and Women’s Hospital
In 2018, Brigham and Women’s Hospital began screening every MassHealth patient to address social determinants of health (SDoH), a term that refers to non-medical conditions that affect an individual’s health, such as housing, education, employment and convenient transportation. , Brigham’s 14 primary care centers screen every MassHealth patient for SDoH annually. Four of the practices expanded screening to all primary care patients. The housing crisis was very evident at these screenings. The number of housing recommendations in this screening jumped from 20 per month in 2020 to 350 per month in 2023.
As part of the programme, social care teams, including housing advocates, work with clinicians to address patients’ social needs. Patients in need of housing who are referred by staff or their physician receive housing information from community resource specialists, while a subset of patients at imminent risk of eviction or in poor health receive more specialized and in-depth support from the Housing Advocacy Team . Housing advocates provide support to patients for six months by addressing their housing needs and assisting them with clinical care navigation and management. The care team works with a variety of community partners, including legal representatives, to help find housing solutions.
“What’s special about this program is that it’s embedded in primary care and uses a triage approach to identify the types of housing that are more likely to impact someone’s health,” Arbour said. “This is a unique, integrated approach that partners community resource specialists and community health workers with primary care teams, and primary care teams with community partners, including legal partners.”
To assess the program’s impact, Arbor and co-authors conducted a mixed-methods, retrospective cohort evaluation study of 1,139 people aged 18 and older with housing-related needs who enrolled in the program between October 2018 and March 2021. Patients are samples. The cohort consisted primarily of female, nonwhite, and non-English-speaking MassHealth patients, who had more chronic conditions and higher rates of emergency room use than the general population. The evaluation looked at the association between patients’ participation in the program and their utilization of health care services and chronic disease management. It also reviewed data on housing issues, services and outcomes from patients’ charts and conducted interviews that included questions about their living situation, health and social support.
Participation in the program resulted in 2.5 fewer primary care visits and 3.6 fewer outpatient visits per year, including reductions in social work, behavioral health, psychiatry and urgent care visits. Patients also reported improved mental and physical health as a result of being placed in new housing, and many felt more connected to their primary care clinics and teams, in part due to the compassionate guidance provided by housing advocates. Another result is that patients’ first housing solutions are often unstable or unhealthy, illustrating the complexity of unaffordable housing situations.
“The decrease in ambulatory care was primarily due to decreases in urgent care, behavioral health and social work utilization, indicating the program’s significant impact on mental health and behavioral health,” Arbour said. “Our housing advocates are incredible. Their ability to connect with patients and provide them with empathy, respect and compassion during stressful situations makes a big difference.”
Limitations of the study include small sample size, short follow-up period, limited data set, and self-reported data. Investigators also recognized that the program’s interventions did not address the root causes of housing insecurity and health disparities.
With burnout on the rise in primary care, the research team plans to next explore the impact of housing programs on clinical staff and providers to see if it may also be related to feeling more supported when facing painful situations for patients.
“Being homeless or at risk of homelessness is extremely stressful and detrimental to mental health,” Arbour said. “For me, the most compelling aspect of this study was hearing Stories and reflections from patients. Not only did they feel their physical and mental health had improved as a result of the program, but they felt a sense of belonging and being truly cared for by their primary caregivers at the Nursing Clinic.”
brigham and women’s hospital
Arbor, MC, et al. (2024) Primary care-based housing program reduces outpatient visits; patients report mental and physical health benefits. Health Affairs. doi.org/10.1377/hlthaff.2023.01046.