To foster the identification of Emergency Department patients at significant risk for future homelessness, and develop effective preventive interventions, by conducting survey research and cross-system data analysis supporting development of a first-of-its-kind risk screening tool, protocols for future ED-based homelessness prevention interventions, and a Social Determinants of Health (SDH) registry that will connect survey and hospital utilization data to assess the effects of SDH on hospitalizations.
While effective homelessness prevention programs are available in New York City, identifying who is most likely to become homeless is challenging, and the majority of at-risk people do not know how to access services. Emergency Departments (EDs) serve a particularly vulnerable population of individuals experiencing both health and life crises, and may be optimal locations for screening for homelessness risk and connecting individuals and families to needed prevention services.
New York University School of Medicine (NYU) will develop a brief homelessness risk-screening tool for use in EDs; protocols for future ED homelessness prevention interventions; and a Social Determinants of Health (SDH) Registry. The project represents an interdisciplinary collaboration between researchers from NYU, the New York City Center for Innovation through Data Intelligence, and New York City's Department of Homeless Services (DHS). The project director, Dr. Kelly Doran of the NYU School of Medicine, is the Principal Investigator on a National Institutes of Health/National Institute on Drug Abuse 5-year K23 Career Development Grant award to identify and prevent homelessness among the substance-using population. UHF support will extend the research population to individuals without substance use disorders, and support the creation of the social determinants registry.
Adult Bellevue Hospital ED patients who are not already homeless will complete a survey assessing a broad range of health determinants, including health status, socioeconomic status, substance use, and social support. Survey results will be linked with DHS data, tracking patients to determine who becomes homeless within six months of an ED visit. Statistical analyses will assess how variables from the patient surveys are associated with future homelessness, and will inform the development of a brief homelessness risk-screening tool. A small sample of ED patients who have recently become homeless will be asked for feedback on a proposed ED homelessness prevention intervention.
Researchers will create a Social Determinants of Health Registry by linking ED patient survey results with the New York all-payer hospital claims database, SPARCS. This Registry will provide a unique vehicle for determining the impact of multiple SDHs on health care utilization over time.