Identifying homelessness at a community health center

Homelessness is a social determinant of health associated with multiple comorbidities, higher mortality rates, and elevated cost of care. Accurately identifying homelessness is a prerequisite to improving health care delivery, bettering outcomes, and bending the cost curve. This 30-minute presentation offers a narrative description of a quality improvement project implementing homelessness screening at a FQHC with Community Health Center designation located in Minneapolis. Initial findings will compare point-of-care screening to existing and emerging methods, followed by a facilitated discussion on translating findings to practice. It is assumed that participants have clinical experience working with these communities, researching homeless health, or serving in an administrative or leadership role. Most providers do not screen for homelessness at the point of care, and there is no gold standard for identifying homelessness in clinical practice. Instead, many care providers rely on pattern recognition, a practice that can exclude patients who do not fit the stereotype of adults experiencing chronically homelessness. In Minnesota, 40,000 people a year experience homelessness, the majority of whom are children. Most report using an outpatient provider to meet health care needs, yet limited research is available on health care utilization patterns or health outcomes for those utilizing traditional primary care sites. Research is also limited by non-uniform definitions that poorly capture episodic homelessness or the experiences of youth, families, and migrant communities. This quality improvement project compares three methods of identifying homelessness: 1) existing practice where receptionists record housing status, 2) address-based identification, and 3) provider-based screening at the point of care, documenting positive findings with diagnostic codes. Using HRSA's definition of homelessness and a suggested script, providers are encouraged to screen every patient at each encounter. Point of care screening represents a system change, supported through education and capacity building. Providers were surveyed pre-intervention to identify training and resource needs. In addition to traditional face-to-face and print resources, clinicians were taken on guided tours of service sites. Rolling data analysis informs quality assurance. Baseline counts are compared to post-intervention findings, identifying new cases and examining agreement between methods. Initial descriptive analysis compares demographic characteristics, service utilization patterns, and documented medical and mental health diagnoses. Accurately identifying homelessness is a priority for clinicians hoping to improve care delivery and outcomes, administrators hoping to capture patient complexity in a way that influences reimbursement, and researchers who want to understand social determinants of health on a population level. As people experiencing homelessness have more options for accessing care, traditional care providers have much to learn from HCH sites. Identifying homelessness is an important step to bridging gaps between systems.