PCORnet Partner Network Launches Creative Strategy to Reduce Homelessness in Chicago

In the winter months, when freezing temperatures overtake Chicago, people without homes cradle themselves in makeshift tents to shelter from Chicago’s infamous frigid wind. They are young and old, educated and uneducated, men, women, and children. And they are not alone—in fact, on an average night in 2017, nearly 7,000 people could be found on Chicago’s streets and shelters, and thousands more are just one unexpected setback away from joining them. Recently, the Chicago Department of Public Health has been encouraging health institutions to contribute to a housing pool that would provide rental assistance to these individuals, but the proposal has lacked the data to support a solid economic argument that patients with chronic illnesses would benefit from permanent supportive housing. With the help of a collaboration between the Chicago-based clinical research network CAPriCORN (a partner network of PCORnet, the National Patient-Centered Clinical Research Network), All Chicago, the Alliance to End Homelessness in Suburban Cook County, and Chicago’s public health agencies, that tide may be about to turn.

“Public health advocates have
long theorized that people
experiencing homelessness are
among health systems’ most expensive patients because their living condition puts them at
risk for so many health problems.”

Bill Trick – Principal Investigator, Cook County Health & Hospitals System

“Public health advocates have long theorized that people experiencing homelessness are among health systems’ most expensive patients because their living condition puts them at risk for so many health problems,” said Bill Trick, site principal investigator for the Cook County Health & Hospitals System, a participant in CAPriCORN. “If that is true, a housing pool funded by health systems would be a win-win in that it would not only help these individuals, but also treat the fundamental factor impeding successful management of chronic medical conditions, which is homelessness, effectively reducing overall healthcare costs.”

The challenge until now has been that there is little hard data to support advocates’ claim that homelessness is linked to higher expense for health systems. That’s because people without homes are difficult to track. Few have insurance and most have no reliable address on record. The temporary nature of homelessness also means patients tend to move between different health systems whose health records are not shared, resulting in uncoordinated delivery of healthcare.

That’s why advocates working with Chicago’s Homeless Management Information System, a federally funded and locally administered technology system that is used to collect client-level data on homeless individuals and families, collaborated with CAPriCORN, a clinical research network that boasts a high level of engagement with Chicago’s homeless population. The goal was to link homeless agency data to the CAPriCORN network’s clinical data to generate some real numbers to show how people experiencing homelessness access and use different healthcare facilities. If, as expected, the data reveals a high degree of fragmentation or excessive use of hospitalization, these numbers would be influential in motivating health systems’ leaders to contribute to the housing pool.

Maintaining individuals’ privacy is critical, which is why the project team used the Medical Research Analytics and Informatics Alliance (MRAIA) as its third-party data hub. Using the hub’s expertise, the researchers ran hashing software to de-identify sensitive information like names and date of birth. A hash is a mathematical function: you give it an input value and the function emits a complex and unique output value, with the same input always yielding the same output. In this way, the research team was able to preserve privacy, while still linking the data of individuals experiencing homelessness among five of CAPriCORN’s clinical sites. Because CAPriCORN, like all PCORnet partner networks, uses the Common Data Model to standardize its data, the team was able to pull health utilization data in an efficient way.

The project is currently in its final stages as researchers analyze the data. Results are expected in about a month, and the team has high hopes for compelling results.

“…it’s a challenge worth fighting for, and we will be thrilled if our effort can facilitate a safe and stable
living environment for even one person experiencing homelessness in the Chicago area.”

Bill Trick – Principal Investigator, Cook County Health & Hospitals System

“Unfortunately, the number of people without a home in Chicago is substantial, and even if this project achieves its aims of influencing health systems in favor of the housing pool, it will only be a small dent in a much larger challenge,” said Trick. “However, it’s a challenge worth fighting for, and we will be thrilled if our effort can facilitate a safe and stable living environment for even one person experiencing homelessness in the Chicago area.”

 

About PCORnet

PCORnet, the National Patient-Centered Clinical Research Network, is an innovative initiative of the Patient-Centered Outcomes Research Institute (PCORI). The goal of PCORnet is to improve the nation’s capacity to conduct clinical research by creating a large, highly representative network that directly involves patients in the development and execution of research. More information is available at www.pcornet.org.

 About PCORI

The Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continuously seeking input from a broad range of stakeholders to guide its work. More information is available at www.pcori.org.