Evaluation of a Supportive Housing Program for Adults Who Are Unhoused and Have Complex Health Needs

NCT06723093 | Recruiting

• 1 other identifier: 22-5519
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 2

Brief Summary

The study design is a cohort study with a propensity score-matched control group and difference-in-difference analysis to evaluate intervention effectiveness. A hybrid type 1 effectiveness-implementation study framework is used that incorporates mixed methods to determine clinical effectiveness and explore implementation and participant well-being. Participants are selected based on their utilization of health services. Selection favoured those individuals with the most health service utilization. A control group will be created by selecting individuals from administrative hospital records that are propensity-score matched to the individuals in the treatment group (1:4 pair). The hybrid type 1 effectiveness-implementation study framework was used to guide the selection of study aims and outcomes to focus primarily on clinical effectiveness, while also exploring implementation-related factors. The primary objective of the study is to evaluate the impact of the Initiative on the number of emergency department visits and days spent in the hospital. The secondary objectives are to 2) evaluate the impact of the Initiative on program participants' health and well-being, 3) evaluate the implementation of the Initiative and assess program fidelity and barriers, and 4) to calculate the cost avoidance and cost-effectiveness of the Initiative.

Conditions

Homeless Persons

Keywords

homelessness

Outcome Measures

Primary Outcomes (2)

• Number of emergency department visits

  The primary objective of the study is to evaluate the impact of the Social Medicine Housing Initiative on the number of emergency department visits for University Health Network super utilizers compared to a propensity score-matched cohort. It is hypothesized that study participants who participate in the Housing Initiative will show a reduction in acute care utilization (emergency department visits) during the 30-month outcome ascertainment period.

  30 Months

• Days spent in the hospital

  The primary objective of the study is to evaluate the impact of the Social Medicine Housing Initiative on the number of days spent in the hospital for UHN super-utilizers compared to a propensity score-matched cohort. It is hypothesized that study participants who participate in the Housing Initiative will show a reduction in acute care utilization (in-patient hospital days) during the 30-month outcome ascertainment period

  30 Months

Secondary Outcomes (4)

• Tenant Health status

  30 months

• Tenant Mental health

  30 months

• Tenant Substance Use

  30 months

• Tenant history of violence

  30 months

Other Outcomes (2)

• Health care expenditure analysis

  30 months

• Cost effectiveness analysis

  30 months

Study Arms (2)

University Health Network Standard Care

EXPERIMENTAL

The Social Medicine Housing Initiative is part of standard care and is not contingent on participating in any research activities. Patients who participate in the Housing Initiative will have the option to participate in the research study. The Social Medicine Housing Initiative provides a housing-first approach which offers housing to individuals without prerequisites (e.g., requiring cessation of substance use, adherence to treatment). Through the Initiative, patients will receive access to permanent supportive housing and support services based on the Social Medicine model. Participants will not only have access to housing but will also be provided with customized social and medical support within and beyond the University Health Network, tailored to their specific needs and preferences.

Behavioral: Social Medicine Housing Initiative

Propensity score matched cohort

NO INTERVENTION

The Institute of Clinical Evaluative Sciences of Canada database will provide health administrative data on the Housing Initiative individuals and similar individuals. Each individual in the treatment arm will be matched with four individuals (1:4 pair) in the control arm who are observationally similar. The propensity score-matched cohort method will control for demand-side characteristics that reflect the utilization of health care services, focusing on the use of emergency department visits and inpatient hospital days, nursing home use, and inpatient utilization for severe mental illness. To assess whether the propensity score model has adequately specified, the authors will examine whether the distribution of measured baseline covariates is similar between treated and untreated subjects with the same estimated propensity score.

Interventions

Social Medicine Housing Initiative BEHAVIORAL

Through the Social Medicine Housing Initiative, patients will receive access to permanent supportive housing and support services based on a social medicine model. The Housing Initiative provides a housing-first approach which offers housing to individuals without prerequisites (e.g., requiring cessation of substance use, adherence to treatment). Housing will be provided through a rent-geared-to-income model, with participants paying up to 30 percent of their income towards rent. Participants will also be provided with customized social and medical support within and beyond the University Health Network, tailored to their specific needs and preferences. Patient care will be a collaborative effort involving the housing provider, the Social Medicine team, and community agencies.

University Health Network Standard Care

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• The Housing Initiative is part of standard care and is not contingent on participating in any research activities. Patients that participate in the Housing Initiative will have the option to participate in the research study.
• To qualify for housing through the initiative, patients must have had 2 or more inpatient admissions or 6 or more visits to the emergency department in the past 6 months. They must also either identify as Indigenous or be currently without housing, which is defined as having spent at least one night in a shelter or having received assistance from city-funded street outreach providers in the past 90 days. Historically marginalized groups, including people with disabilities, women, gender-diverse individuals, and Indigenous people, are given priority for housing. Eligible patients are prioritized for housing offers based on their use of the University Health Network emergency departments in the past year.

Sponsors & Collaborators

• University Health Network, Toronto: lead

Study Sites (2)

University Health Network

Toronto, Ontario, M5G 2C4, Canada

RECRUITING

90 Dunn

Toronto, Ontario, M6K 2R6, Canada

RECRUITING

Study Officials

• Andrew Boozary, MD MPP CCFP

  University Health Network, Toronto

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Andrew S Boozary, MD MPP CCFP

CONTACT

416-704- 3263; Andrew.Boozary@uhn.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Executive Director, Population Health and Social Medicine Gattuso Centre for Social Medicine, University Health Network

Model Details: The study design is a cohort study with a propensity score-matched control group and difference-in-difference analysis to evaluate intervention effectiveness. A hybrid type 1 effectiveness-implementation study framework is used that incorporates mixed methods to determine clinical effectiveness and explore implementation and participant well-being.

Study Record Dates

• First Submitted: November 21, 2024
• First Posted: December 9, 2024
• Study Start: November 6, 2024
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): May 1, 2027
• Last Updated: December 9, 2024

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

CA (2)