title: A pilot study of the impact of housing first-supported housing for intensive users of medical hospitalization and sobering services.
abstract: OBJECTIVE
  We examined changes in service use in a Housing First (HF) pilot program for adults who were homeless with medical illnesses and high prior acute-care use relative to a similar comparison group.
  
  
  METHODS
  We used a 1-year pre-post comparison group design. The 29 participants and 31 comparison group members were adults who were homeless with inpatient claims of at least $10 000 or at least 60 sobering "sleep off" center contacts in the prior year.
  
  
  RESULTS
  Participants showed a significantly greater reduction in emergency department and sobering center use relative to the comparison group. At a trend level, participants had greater reductions in hospital admissions and jail bookings. Reductions in estimated costs for participants and comparison group members were $62 504 and $25 925 per person per year-a difference of $36 579, far outweighing program costs of $18 600 per person per year.
  
  
  CONCLUSIONS
  HF participants showed striking reductions in acute-care use relative to the comparison group, demonstrating that HF can be a successful model for people with complex medical conditions and high prior acute-care use. Despite notable methodological limitations, these findings could be used to inform a larger multisite study that would establish greater generalizability.
authors.affiliation: King County Mental Health and Chemical Abuse and Dependency Services, Seattle, WA 98104, USA. debra.srebnik@kingcounty.gov
authors.forename: Debra
authors.initials: D
authors.lastname: Srebnik
authors.forename: Tara
authors.initials: T
authors.lastname: Connor
authors.forename: Laurie
authors.initials: L
authors.lastname: Sylla
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000191:economics / Q000628:therapy; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006208:Halfway Houses / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011638:Public Housing / Q000706:statistics & numerical data*; D014861:Washington