Grant: Catalyst Grant: SPOR Innovative Clinical Trials (iCT)

People who experience homelessness are more likely than the general population to have a mixture of serious illnesses that include mental and physical disorders. As a result, they attend emergency departments and hospitals at far higher rates than the general population. Repeat presentations are common where patients who are homeless have about 2.5 times the rate of emergency admissions and ED visits compared to a general population group with similar health problems. Discharging people experiencing homelessness is often difficult, with premature and prolonged discharges being common. Lack of knowledge about available services, the patient's medical history or current medication are barriers to high-quality care. People who are homeless are often traumatized by previous hospital admissions, so they are reluctant to stay. They may also lose benefits or possessions or withdraw from substances when they are in the hospital. Evidence shows that providing care that bridges the hospital community gap improves outcomes and prevents readmissions. However, the evidence is not strong and we don't know how to implement and sustain such care in different settings. We are proposing to develop a transitional care program with people who have lived experience of homelessness and pilot this as a quality improvement project in a large teaching hospital. This would help us to apply for subsequent funding to roll this out in other hospitals. This would allow us to test the effectiveness of the quality improvement project and work out how best to implement it in different settings.