HOSPITAL-TO-HOUSING: UNDERSTANDING THE IMPACT AND IMPLEMENTATION OF A MEDICALLY SUPPORTED TRANSITIONAL HOUSING MODEL TO ADDRESS OPIOID USE DISORDER, HOMELESSNESS, AND MEDICAL COMPLEXITY - PROJECT SUMMARY/ABSTRACT: This application requests funding to rigorously study the effectiveness and implementation of Hospital-to-Housing, a large-scale intervention that provides medically supported transitional housing for people experiencing homelessness with opioid use disorder (OUD) following hospitalization. Homelessness is associated with poor health outcomes, many of which stem from consequences of substance use. In addition, homelessness complicates access to medical care, including substance use treatment, and increases acute care utilization. Medical hospitalization represents a critical, reachable moment for patients with OUD to initiate treatment with highly effective medications such as methadone and buprenorphine. However, patients hospitalized with complications from OUD have complex ongoing needs for medical care, substance use treatment, and mental health conditions after hospital discharge that are challenging to manage without stable housing. Hospital-to-Housing (H2H) is community-academic partnership between Project HOME, a nationally recognized housing organization, and three large Philadelphia health systems to transform care for people with OUD, medical complexity, and unsheltered homelessness. The H2H model includes several evidence-based components, including post-discharge transitional support, respite housing with integrated medical care and integrated OUD treatment, case management support, and transition to permanent supportive housing, all in a low-barrier model that does not require abstinence for continued housing and treatment. The program, funded through a philanthropic investment, does not include a formal evaluation, creating a time- sensitive opportunity to advance our understanding of strategies to address social needs of people experiencing homelessness, OUD, and medical complexity. The aims of this proposal are to: 1) Estimate the effect of H2H on engagement in outpatient substance use treatment and acute care use (primary outcomes), housing stability, engagement in primary care, and overdose and all-cause mortality (secondary outcomes); 2) Explore active components of H2H and identify barriers and facilitators to implementation and scale; and 3) Conduct a cost and cost-effectiveness analysis of the H2H model. To complete the aims, we will leverage partnerships between Project HOME, participating health systems, and Philadelphia city agencies to access administrative data and use target trial emulation and quasi-experimental techniques to compare individuals enrolled in H2H during hospitalization with a cohort of matched controls. The proposed work uses innovative methods to estimate real- world effectiveness of a medically supported housing model, implemented at scale in a major city at the epicenter of the overdose crisis and without additional research-funded resources. Such models are critically important given the rise in OUD-related complications, such as infections and wounds, that are poorly managed in our current treatment system. Successful completion of this study will provide rigorous evidence about the effectiveness of H2H and critical information to inform implementation and scaling of future models.
