Illinois Medicine

32 | S U M M E R 2 0 1 7 unique area of care for the homeless and other vulnerable populations since 2007," she notes. "Our goal is to foster the development of leaders and change agents who understand the value of compassionate and humanistic care, taking into account the social determinants of health. We try to teach our students to balance the art and science of medicine with public health priorities, so that they can address the needs of Chi- cago's diverse and evolving patient populations and develop multidisci- plinary approaches to complex health care problems." This spring, Smith, Collofello and Hasnain celebrated their first Chicago Street Medicine milestone: an Arnold P. Gold Foundation grant with matching funds from the department of family medicine to cover startup costs. With funding in hand and more than 20 medical students lined up to help them address some of the health care needs of Chicago's un- sheltered homeless, Smith and Collofello will be moving forward with their first student-led street rounds this summer. From the Hospital to a Home WHILE SMITH AND COLLOFELLO are taking health care to the streets, UI Health, through the department of emergency medicine's Better Health Through Housing (BHH) program, is helping chronically homeless Chicagoans achieve stability—and better health—by getting them off the streets and into homes of their own. Here's how the program works: UI Health, which committed $250,000 to help launch the pilot in 2015, pays Chicago's Center for Housing and Health $1,000 per month to house and provide sup- porting services for each chronically homeless patient. The Center for Housing and Health, in turn, partners with social service agencies to help the patients furnish their apartments, manage their money, set up medical appointments, access mental health services or addiction treatment, and obtain other services that enhance their health and well-being. A housing initiative for the homeless may seem a little off-mission for a department of emergency medicine—until you consider the backsto- ry. That story begins with Chicago's emergency room "super-utilizers"— patients who each account for more than seven emergency room visits annually. According to a 2017 report on Healthcare and Homelessness issued by UI Health, 45 percent of the top 100 emergency department super-utilizers are homeless, and 80 percent of their trips to the ER could have been avoided if their health care needs had been managed in an outpatient setting. While many of these homeless patients are in legitimate need of care, others land in the ER out of sheer desperation. At an average cost of $1,000 per ER visit, that's a steep price to pay for a warm bed and a hot meal. Contrast that with the daily cost of $57 per patient to provide per- manent supportive housing, and that's money well-invested. With little or no follow-up care between ER visits, health care for the homeless is not only expensive, but fragmented and often inefficient. "As providers of emergency care, we are at the interface between the health care system and the community," says Terry Vanden Hoek, MD, chair of the department of emergency medicine. "This gives us a unique perspective—and a unique opportunity to use what we see in the ER to help us think about how to improve the health care system and address unmet needs in the community. Housing is one of those unmet needs. Through our Better Health Through Housing pilot, we have provided housing and supportive services for approximately two dozen chronically homeless patients. The bottom line is that their health is better, and the cost of their care is substantially lower. We are now working with other hospitals in the Chicago area to help them set up similar programs." So far, outcomes have been promising: The cost of care for the first 15 patients enrolled in the pilot decreased by 42 percent while the number of hospital visits dropped by 34 percent. Stephen Brown, MSW, LCSW, proj- ect director for BHH, who leads the department's Preventive Emergency Medicine initiative, notes that the homeless are some of the most expen- sive patients in health care. "We've found 575 patients who are homeless, and 32 percent are in the highest cost decile, with annual costs that are 15 to 40 times our average annual patient costs," he says. Enrolled in the COM's Patient- centered Medicine Program, Smith and Collofello recently received grant funding from the Arnold P. Gold Foundation and the department of family medicine to cover startup costs for student-led street rounds.

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