Impact of Low-Barrier Shelter and Street Medicine on Emergency Department Utilization and Days of Hospitalization of Persons Experiencing Homelessness

OBJECTIVE: To assess the impact of Housing First (HF) shelter and Street Medicine (SM) outreach on emergency department (ED) utilization and hospitalization of persons experiencing homelessness (PEH). DESIGN: Using data from the Indiana Health Information Exchange, we conducted a retrospective chart review of 95 individuals who accessed both HF shelter and SM outreach in South Bend, Indiana. These dates ranged from September 2019 to November 2024. ED visits and hospitalization days were compared 1 year before and after first date of housing and first SM encounter using a 2-sided paired t test. SETTING: SM drop-in clinics located at an HF facility and the EDs and hospitals in the surrounding St. Joseph County area. PARTICIPANTS: Ninety-five PEH who received housing at the HF facility and care at the SM clinic in the clinic's first year of operations. INTERVENTION: Participation in both HF and SM programs. MAIN OUTCOME MEASURE: Number of ED visits and days of hospitalization. RESULTS: ED visits decreased by 30% (322-226, P = .02) following HF shelter entry and by 35% (437-284, P = .04) after initial SM engagement. Hospitalization days also declined (259-146 post-HF shelter, P = .14; 324-148 post-SM, P = .10), although not statistically significantly. CONCLUSIONS: These findings highlight that low-barrier shelter and healthcare initiatives significantly reduce ED utilization and may also decrease hospitalization. POLICY IMPLICATIONS: Expanding and integrating HF and SM interventions could maximize benefits for PEH and the communities they live in.