Grant: Partnerships for Health System Improvement (PHSI)

Homelessness rates in Canada have increased dramatically over the last 20 years. Homeless people have high rates of mental and physical illness, substance use and a higher mortality rate than those who have housing. In the absence of appropriate community-based services, homeless people rely on hospital emergency department visits or inpatient hospitalizations for health care, associated with longer hospital stays and higher costs. To address health disparities and improve health system effectiveness, the Toronto Central Local Health Integration Network funded a brief intervention, Coordinated Access to Care for the Homeless (CATCH), for homeless people with unmet health needs. The proposed prospective mixed methods study aims to evaluate the impact of this intervention on health outcomes and health service use among CATCH participants. The study also aims to examine the continuity of care experienced though this intervention, from both participant and health system perspectives, to better understand the critical ingredients of this intervention, targeting frequent users of hospital services. For the purpose of the study, 225 homeless people will be recruited over an 18 month period among consecutive referrals to the CATCH program and followed for 6 months. Furthermore, we propose to complete individual interviews and focus groups with 54-60 stakeholders, including program participants. The study will add to the knowledge base in important ways, as service coordination, and its association with health outcomes, has seldom been examined in the context of homelessness. Given competing demands for limited healthcare resources, it is of great interest to policy makers, service providers, homeless individuals and their families, to determine which service delivery models are effective and for whom. The present study will reduce knowledge gaps in an important area and provide essential information to help guide program planning and resource allocation in Ontario.