A study published in Health Affairs highlights the efficacy of a primary care-based housing instability program in reducing outpatient utilization and improving patient outcomes. Led by community health workers, the initiative addresses the critical link between housing and health, offering comprehensive support to individuals facing housing challenges. By facilitating access to stable accommodations and addressing social determinants of health, the program demonstrates significant reductions in healthcare overutilization and improvements in patient well-being.
In a groundbreaking study published in Health Affairs, the efficacy of a primary care-based housing instability program in reducing outpatient utilization and improving patient outcomes has been underscored. Led by community health workers, this innovative initiative has demonstrated the profound influence of addressing social determinants of health (SDOH), particularly housing instability, on clinical quality outcomes.
The research, conducted by Brigham and Women’s Hospital in Boston, sheds light on a program designed to assist individuals grappling with housing instability by connecting them with community health workers. These workers played a pivotal role in addressing diverse patient needs, from aiding in housing applications to facilitating access to suitable accommodations. However, the study also highlights a critical shortfall in the nation’s housing landscape: a severe shortage of affordable housing options, severely limiting healthcare’s ability to tackle housing instability effectively.
Increasingly, research underscores the intricate link between housing and health, with eviction linked to heightened all-cause mortality, and communities of color disproportionately affected by the housing affordability crisis. While the healthcare industry has begun to prioritize SDOH, including housing, significant challenges persist. Most interventions predominantly target unhoused individuals, overlooking those with housing instability, defined by frequent moves or concerns about housing security.
The program outlined in the study was tailored for patients—20% of those attending Brigham’s 15 primary care clinics—who screened positive for housing instability. Led by a multidisciplinary team, including housing advocates, community health workers, and legal partners, the program aimed to support individuals facing unstable housing situations through various interventions, such as securing shelter and resolving landlord disputes.
Over 1,000 patients, predominantly Medicaid-insured, female, non-White, and non-English-speaking, benefited from the program, exhibiting higher rates of chronic conditions and healthcare utilization. Despite these challenges, the program addressed a spectrum of housing issues, including homelessness, eviction risk, and unsafe living conditions.
The services provided were comprehensive, encompassing housing search assistance, support for accommodation requests, education on housing rights, and aid with funding applications. Notably, the program yielded tangible results, with a significant percentage of participants achieving improved housing stability.
Furthermore, program participants exhibited reduced healthcare overutilization, with fewer primary care and outpatient visits compared to those receiving standard care. This decline in outpatient visits, which included social work and psychiatric consultations, signifies enhanced self-management of health among patients outside clinical settings.
While the study did not establish a direct correlation between program participation and emergency department or inpatient care utilization, patients reported improved mental and physical well-being, as well as enhanced rapport with healthcare providers. They emphasized the invaluable support and empathy provided by housing advocates, emphasizing the need to recognize patient perspectives in assessing program effectiveness.
Looking ahead, the researchers advocate for alternative metrics, such as social return on investment, to evaluate housing programs comprehensively. However, they stress that the lack of affordable housing remains a formidable challenge, with nearly half of participants unable to secure housing resolutions—a poignant reminder of systemic deficiencies beyond healthcare’s purview.
Addressing this systemic issue requires multifaceted approaches, including advocacy for affordable housing and introspection within healthcare organizations regarding their role in exacerbating housing crises. Recognizing historical contributions to housing instability, such as medical debt collection and insufficient wages, underscores the need for systemic reform to effect lasting change.
The study underscores the transformative potential of primary care-based interventions in mitigating housing-related disparities and advancing health equity. By prioritizing social determinants of health and fostering collaborative approaches, healthcare organizations can play a pivotal role in addressing systemic issues like housing instability. However, sustained efforts are needed to tackle underlying structural barriers and ensure equitable access to safe and affordable housing for all individuals, thereby fostering healthier communities.
