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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


1036 — Patient and Process Outcomes of Homeless in VA and Community Housing Programs

Author List:
Gordon AJ (VA Pittsburgh Healthcare System)
Conigliaro J (VA Pittsburgh Healthcare System)
Thompson K (University of Pittsburgh)
Kelley ME (Emory University)

Objectives:
Compared to community outreach programs (CHP), VA domiciliary programs (VADP) differ in approaches to improve housing outcomes for the homeless. The objectives of this study are to compare the social and housing endpoints of homeless clients at admission and at program completion of a VADP and a CHP.

Methods:
A chart review was conducted of consecutive clients who were admitted to a VADP and a CHP from 1999 through 2001. Client characteristics, medical morbidity, and housing status were abstracted. Outcome assessments included social, housing, and homeless severity at program completion. Baseline and outcome comparisons were performed via categorical and logistical regression analyses.

Results:
Of the 459 clients, 320 (69.7%) were admitted to the VADP and 139 (30.3%) to the CHP. Upon admission, VDLP clients compared to CHP clients were significantly (p<0.01) older (44 vs. 39 years old) and with higher rates of male gender (96% vs. 47%), ever-married status (66% vs. 36%), alcohol use (91% vs. 67%), and any drug use (81% vs. 54%). Rates of clients’ minority status, employment, criminality, and drugs of choice were similar between programs. Within the VADP, medical diseases were more often recognized than psychiatric diseases. CHP duration was longer than VADP (mean days: 409 vs. 99 days, p<0.01). At discharge, less CHP clients (28%) than VADP clients (58%) completed the program (p<0.001), but rates of subsidized housing at discharge were similar (19% vs. 21%). At completion, VADP and CHP clients were discharged to unsheltered (6% vs. 2%), transitional housing (20% vs. 11%), and housed (33% vs. 34%) domiciles. More minority clients were housed at discharge (61% vs. 39%, p<0.051) compared to Caucasian clients. Other client characteristics and site of care were not associated with domicile at discharge.

Implications:
A VADP and CHP serve homeless with different housing and medical characteristics. At discharge from a VADP, homeless had had higher rates of completion of services, less duration of program involvement but comparable housing outcomes compared to a CHP.

Impacts:
Site of care is associated with different social and medical characteristics of the homeless. Despite these differences, a VADP and CHP have similar housing outcomes at discharge.


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