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Health

Effectiveness and cost-effectiveness of 'Usual Care' versus 'Specialist Integrated Care': A comparative study of hospital discharge arrangements for homeless people in England

Purpose

To explore different types of specialist services for homeless people leaving hospital; for example, some put patients in touch with a specialist GP, others employ a housing support worker to ensure people do not return to the streets after discharge. We have explored what homeless people think of different services, how they help them tackle the range of problems they may have, and if this support prevents them returning to hospital. To compare effectiveness and costs we have also studied hospital discharge arrangements where no specialist support for homeless people is in place.

Timescale

2015 – 2019

Research Team

Michelle Cornes and Jill Manthorpe (HSCWRU); Martin Whiteford (University of Liverpool); Andrew Hayward, Rob Aldridge, Fatima Wurie (University College London); Michela Tinelli and Mike Clark (LSE); Graham Foster (Queen Mary’s); Jo Neale (King’s College London’s Institute of Psychiatry, Psychology & Neuroscience); Nigel Hewett (Pathway); James Fuller and Alan Kilmister (Peer Researchers)

Funding

National Institute for Health Research (NIHR) Health Services and Delivery Research

Methods

The first part of this research was a realist evaluation designed to generate six case studies exploring the differences between sites with access to specialist discharge schemes and those without. The second part assessed effectiveness and cost effectiveness in a further 14 sites. It explored how specialist discharge schemes impact on outcomes and patterns of service use across the system and the cost implications. This project has been methodologically innovative in its approaches to data linkage.

Findings

The study found evidence that specialist approaches to homeless hospital discharge are more effective and cost effective than standard care, and yet people are still being discharged from hospital to the streets.

Partners

LSE

London School of Economics

Queen Mary University of London logo

Queen Mary University of London

Project status: Completed

Principal investigators

Michelle Cornes

Visiting Professor

Keywords

  • homelessness
  • hospitaldischarge

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