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Using data to end homelessness. Joshua D. Bamberger, MD, MPH Josh.bamberger@sfdph.org San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine. Housing and Homeless Studies. Cost Before and after studies - PowerPoint PPT Presentation

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Hot Spotters: Prioritizing HIV Positive High Users for Supportive Housing to Contain Public Health Costs

Using data to end homelessnessJoshua D. Bamberger, MD, MPHJosh.bamberger@sfdph.org

San Francisco Department of Public HealthUniversity of California, San Francisco, Dept. of Family and Community Medicine

1Housing and Homeless StudiesCostBefore and after studiesRandomized controlled trialsMortalityRetrospective case controlQuality of LifeRetrospective cohort studiesPopulations based homeless prevalenceCreating a Narrative2Creating a NarrativeHousing is less expensive than homelessnessFor people w/ homelessness and AIDS, ARVs are necessary but not sufficient to improve mortalityThe right treatment for the condition

3Direct Access to Housing- 1600 units in 40 buildingsTailor housing to needs of individualInitially SRO, now new buildingsPriority to people with multiple disabilities93% with Axis I mental illnessAt least 18% HIV+

SF Health Depts Housing4DAH Portfolio

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12Cost: Plaza Retrospective Before and After106 Chronically homeless adultsCost year before housing: $3,132,856 Cost year after housing: $906,228Reduction in healthcare costs: $2,226,568 Cost of program: $1.1million/yearReduction in public cost in first year: $1.1 millionMore than 90% of reduction among 15 tenants who cost more than $50,000/year prior to being housedRegression to the mean

13Brand new building with 174 unitsHomeless, high users of a managed care systemComprehensive healthcare utilizationRandomly assigned to treatment or regular careFollowed prospectively for 5 yearsOutcomes included: Healthcare cost, mortality, jail

Cost: KCC Random assignment trial14Cost- 1811 Eastlake, Seattle

Compared to controls, housed Ps showed greater reductions in overall costs

Cost offsets of housing > $4m for 1st year

More time in housing associated with greater reduction in costs

6-mo within-subjects reductions in typical alcohol useFigure and findings from Larimer et al. (2009)15

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Mortality17

18Ranking of housing from worst to best housingPrivate bath better than shared bathNew building better than renovatedNursing better than no nursingSenior better than non-senior

Quality of Housing and Outcome19202122

The more beautiful the housing the better the outcome

23Population Snapshot

24Veteran PIT Counts, 2009-2012* CoCs only required to conduct a new count of unsheltered homelessness in odd numbered years; in 2012, only 32% of CoCs opted not to do a new unsheltered count, providing an incomplete picture of trends in the number of unsheltered homeless VeteransSource: PIT data, 2009 - 2012*25Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-201226272829Common values and philosophy of practice, strong leadership, housing firstTargetingHigh level of communication (HIPPA busters)Use of data to inform policy and measure success

Common aspects of positive outliers30

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41Creating a NarrativeHousing is less expensive than homelessnessFor people w/ homelessness and AIDS, ARVs are necessary but not sufficient to improve mortalityThe right treatment for the condition

42Using data to end homelessnessJoshua D. Bamberger, MD, MPHJosh.bamberger@sfdph.org

San Francisco Department of Public HealthUniversity of California, San Francisco, Dept. of Family and Community Medicine

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