The intersection of Physical Disability and Homelessness: A Community-Engaged Research Initiative

TL;DR

This study examines how homelessness and physical disability intersect, showing that homeless individuals with disabilities face worse healthcare outcomes than housed individuals.

Contribution

The study introduces a community-engaged research model to analyze healthcare outcomes among homeless individuals with physical disabilities.

Findings

Homeless individuals with physical disabilities had higher 30-day readmission rates after traumatic brain injury compared to housed individuals.

The study identified 746 homeless individuals with physical disabilities out of 16,024 participants.

Collaboration with the homeless community helped prioritize outcomes like shelter use duration and readmission rates.

Abstract

People experiencing homelessness (PEH), compared to their housed peers, experience higher rates of chronic conditions and accelerated disease progression, which can result in a physical disability (e.g., stroke). This project co-designed and executed an examination of homelessness and healthcare service use and outcomes of PEH with a physical disability compared to their peers. This project was a collaboration between the PEH community and academic researchers, which was guided by a co-created shared governance structure and the 10-Step Framework for Continuous Community Engagement. Collaborative prioritization efforts identified outcomes of interest (e.g., duration of homeless shelter use, 30-day readmissions). To examine homelessness service use among PEH, we leveraged Medicaid claims to identify those who had an index stroke, traumatic brain injury (TBI), or amputation as a surrogate for physical disability and linked to the Homelessness Management Information Systems. To examine healthcare utilization and outcomes we used electronic medical records (EMR) to create a cohort of patients with an index physical disability, stratified by housing status (i.e., PEH vs. housed). The PEH cohort (n = 16,024) included those with an index homeless service event between July 2015 and June 2023, of which 5% (n = 746) had a physical disability. Our one-year EMR cohort included patients experiencing an index physical disability—stroke (n = 9,547), TBI (n = 6,708), or amputation (n = 3,494). PEH had more 30-day readmissions (e.g., 46% vs. 32%, P value=0.01, after TBI) than their housed peers. This collaboration highlights the importance of community partnerships to identify populations to target in future quality initiatives.