About CHRT

Evaluating the Shelter Association of Washtenaw County medical recuperative care program

January 2020 – September 2023
Client(s): Shelter Association of Washtenaw County, Packard Health, St. Joseph Mercy Health System, Michigan Medicine

The Shelter Association of Washtenaw County (SAWC) works to end homelessness one person at a time. Over the years, it has recognized the strong correlation between poor health and homelessness. To address this, SAWC is partnering with area health providers–Packard Health, St. Joseph Mercy Hospital, and Michigan Medicine–to provide onsite primary and behavioral health services to it clients and to strengthen connections with acute care hospital providers. However, SAWC clients continue to suffer from a gap in the local healthcare system, the need for recuperative care such as wound care, adherence to complicated medication regimens (including those delivered intravenously), and more. While this level of service is available for those with housing, it is not available for the homeless. SAWC believes this gap causes early mortality for its clients, increases the cost of their care for Medicaid and Medicare, and adds to ER and hospital bed congestion.

CHRT’s role:

SAWC’s medical recuperative care program will use an evidence-based model to improve health and housing outcomes for homeless individuals in Washtenaw County by ensuring that those who would otherwise be on the streets or in an extended hospital stay receive the recuperative care that they need on site. CHRT will conduct a mixed methods evaluation alongside SAWC’s implementation of this recuperative care program to determine if it achieves outlined objectives. CHRT proposed to clients a two phase project: 1) a pilot in 2019, with CHRT providing rapid feedback on implementation, data collection, and programmatic elements to refine the program, then 2) a rull intervention rollout in 2020.

CHRT will design, administer, and analyze results from nurse and patient surveys that explore severity illness index determination at program entry and exit, patient self-efficacy at exit, and patient trust and optimism. CHRT will conduct key informant interviews with clients, health system partners, and shelter staff and through thematic analysis will organize qualitative data into key categories such as perceived effectiveness of services by clients and providers, strengths and challenges of the program, barriers and facilitators to implementation, and potential for long-term sustainability. CHRT will also conduct a series of economic analyses to examine health care utilization at three months, six months, and one year plus pre- and post use of public benefits and supports, income variations, and housing changes. Based on key findings, CHRT will develop regular brief reports aligned with the goals of project funders along with strategies to improve the intervention.