The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63679

James J. O'Connell, MD, Stacy Elizabeth Swain, MPH, Cheryl Kane, RN, Sharon Morrison, RN, and Jill Roncarati, PA-C. Boston Health Care for the Homeless Program, 729 Massachusetts Avenue, Boston, MA 02118, 617-414-7763, joconnell@bhchp.org

Objective: This study describes an innovative model of care by the Boston Health Care for the Homeless Program’s (BHCHP) Street Team for a sub-group of the chronically homeless population, and examines BHCHP’s ability to engage rough sleepers, provide continuity of care, and improve primary care outcome measures. Methods: The frequency and nature of street-based encounters and follow-up care have been systematically collected since January 1, 2000. Palm Pilots carried by clinicians, a respite care database, and BHCHP’s electronic medical record have been the primary sources of information. Results: Over 700 street individuals received acute and supportive care during each of the three years. A cohort of 136 individuals deemed at high risk for excess morbidity and mortality was engaged in intensive care management and followed closely. 98% of this cohort suffered at least one major medical illness, 95% actively abused at least one substance, and 95% coped with severe and persistent mental illness. A “triple diagnosis” of co-occurring major medical illnesses, severe persistent mental illness, and active substance use was present in 88%. Primary care outcome indicators found that 85% had a documented PPD status within the past year; 72% received pneumococcal vaccination within five years, and 48% of age-appropriate women had received a PAP smear within two years. Conclusion: Data demonstrate that BHCHP’s Street Team has been effective in engaging a historically difficult-to-serve street population in primary care services, and that traditional primary care outcome measures have been comparable to those of the sheltered population in Boston.

Learning Objectives:

Upon completion of the session the participant will be able to:
• Describe an innovative service delivery model for engaging the unsheltered street population in care;
• Discuss burden of illness in the unsheltered street population as evidenced by the prevalence of the "tri-morbidity;" and
• Evaluate the effectiveness of the Street Team model in the provision of primary care to the rough sleepers.

Keywords: Health Care Delivery, Homelessness

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Boston Health Care for the Homeless Program
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employee of Boston Health Care for the Homeless Program