Nadine Reid1, Joyce Mason1,2, Paul Kurdyak2,3,4,5, Rosane Nisenbaum6,7, Claire de Oliveira2,3,4,8, Stephen Hwang5,6,7,9, Vicky Stergiopoulos1,3,5,6. 1. 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 2. Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 4. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 5. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 6. Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. 7. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 8. Centre for Health Economics, Hull York Medical School, University of York, York, UK. 9. Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. METHODS: Provincial population-based administrative data from Ontario, Canada, were used in a pre-post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. RESULTS: Pre-post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. CONCLUSIONS: An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.
OBJECTIVE: This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. METHODS: Provincial population-based administrative data from Ontario, Canada, were used in a pre-post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. RESULTS: Pre-post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. CONCLUSIONS: An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.
Entities:
Keywords:
addiction; case management; critical time intervention; health care utilization; homeless; mental health services
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