Evaluation of Housing First Initiative for Chicago Homeless With Chronic Medical Illness (CHHP)

Evaluation of the Housing First Initiative of Chicago Housing for Health Partnership

The study hypothesizes that early housing after hospitalization with case management integrated into the health and housing systems, will results in decreased use of costly health services (i.e., hospitalizations and Emergency Room visits) with no negative affect on health. To address this hypothesis the investigators implemented a Randomized controlled trial of 407 homeless adults with chronic medical illness in Chicago. Eligible homeless adults were enrolled during a hospitalization to intervention - Early housing with case management - or usual care - usual case management and housing options. The investigators followed the sample for 18 months with assessments at baseline, 1,3,6,9,12 and 18 months are enrollment. Study measures include Quality of Life, Health service use, Alcohol and Substance Use, housing and social and demographic characteristics.

Study Overview

• Status: Completed
• Conditions: Unstable Housing
• Intervention / Treatment: Other: case management and supportive housing

Detailed Description

The Chicago Housing for Health Partnership (CHHP) was developed to meet the challenge of providing housing to the most disadvantaged homeless people in the city: those with chronic illnesses who are being discharged from a hospital. The program model was community based and collaboratively created and monitored by an oversight committee composed of the leadership of all involved partner agencies. The CHHP was a group of 8 nonprofit agencies that provided supportive housing and 2 agencies that provided interim housing or respite care. Supportive housing was defined by the intervention as housing without time limits combined with services to help participants to live more stable, productive lives.

To evaluate this new service model, a prospective randomized trial was designed to examine the effect of supportive housing and intensive case management on health service utilization. The investigators enrolled homeless patients with at least 1 of 15 chronic illnesses from 2 urban hospitals that were members of the partnership and known to have large numbers of unstably housed patients. The chronic illnesses were associated with increased mortality in the homeless21 and were verified through review of physician hospital notes. This trial is the health outcomes portion of CHHP.

• Study Type: Interventional
• Enrollment (Actual): 407
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60612
      • John Stroger Hospital of Cook County

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 18 years of age or older
• English or spanish speaking
• Presence of at least one chronic medical illness
• Unstable housing

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Study group; These patients are assigned to the intervention of early supportive housing with case management integrated into the medical system. These subjects are offerred respite care/interim housing upon discharge from enrolling hospitalizations, followed by stable housing within 90 days. They have a case manager at each stage (hospital, respite/interim housing, and stable housing)	Other: case management and supportive housing; patients randomized to the study group are offerred respite care/interim housing and case management upon discharge from enrolling hospitalization. They are also offerred stable housing within 90 days of enrolling hospital discharge, with case management at all 3 stages - hospital, respite care/interim housing, and stable housing.
No Intervention: Usual Care; These patients receive usual social services for hospital discharge planning.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospitalized days - length of stay Emergency Room visits	All days admitted to an inpatient acute care intuition from time of enrollment to study end	18 months

Collaborators and Investigators

• Sponsor: Cook County Health
• Collaborators: Research and Education Foundation of Michael Reese Hospital
• Investigators: Principal Investigator: laura s sadowski, md, mph, Collaborative Research Unit, Stroger Hospital of Cook County

Publications and helpful links

General Publications

• Basu A, Kee R, Buchanan D, Sadowski LS. Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Serv Res. 2012 Feb;47(1 Pt 2):523-43. doi: 10.1111/j.1475-6773.2011.01350.x. Epub 2011 Nov 18.
• Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA. 2009 May 6;301(17):1771-8. doi: 10.1001/jama.2009.561.

Study record dates

Study Major Dates

• Study Start: September 1, 2003
• Primary Completion (Actual): December 1, 2007
• Study Completion (Actual): June 1, 2008

Study Registration Dates

• First Submitted: June 20, 2007
• First Submitted That Met QC Criteria: June 20, 2007
• First Posted (Estimated): June 22, 2007

Study Record Updates

• Last Update Posted (Actual): July 12, 2023
• Last Update Submitted That Met QC Criteria: July 10, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Early housing after hospitalization
• Other Study ID Numbers: 03-107B JHSH2003-107 IRB