Use of health care utilization as a metric of intervention success may perpetuate racial disparities: An outcome evaluation of a homeless transitional care program.
Date
2022-11
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Abstract
Objective
This study explored race-based differences in disease burden, health care utilization, and mortality for Black and White persons experiencing homelessness (PEH) who were referred to a transitional care program, and health care utilization and program outcomes for program participants.Design
This was a quantitative program evaluation.Sample
Black and White PEH referred to a transitional care program (n = 450). We also analyzed data from the subgroup of program participants (N = 122). Of the 450 referrals, 122 participants enrolled in the program.Measures
We included chronic disease burden, mental illness, substance use, health care utilization, and mortality rates for all PEH referred. For program participants, we added 6-month pre/post health care utilization and program outcomes. All results were dichotomized by race.Results
Black PEH who were referred to the program had higher rates of hypertension, diabetes, renal failure, and HIV and similar post-referral mortality rates compared to White PEH. Black and White PEH exhibited similar program outcomes; however, Black PEH revisited the emergency department (ED) less frequently than White PEH at 30 and 90 days after participating in the program.Conclusions
Health care utilization may be a misleading indicator of medical complexity and morbidity among Black PEH. Interventions that rely on health care utilization as an outcome measure may unintentionally contribute to racial disparities.Type
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Nohria, Raman, Donna J Biederman, Richard Sloane and Alyson Thibault (2022). Use of health care utilization as a metric of intervention success may perpetuate racial disparities: An outcome evaluation of a homeless transitional care program. Public health nursing (Boston, Mass.), 39(6). pp. 1271–1279. 10.1111/phn.13121 Retrieved from https://hdl.handle.net/10161/29999.
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Scholars@Duke

Raman Nohria
Raman Nohria, MD received his MD from the Lewis Katz School of Medicine at Temple University. He completed his residency training with the Lawrence Family Medicine Residency Program and hospital fellowship with the Duke Department of Family Medicine and Community Health. He currently serves as a teaching hospitalist on the Family Medicine Inpatient Service at Duke Regional Hospital as well as a core faculty member for the Duke Department of Family Medicine and Community Health. His expertise and scholarly interests include the social drivers of health, community-healthcare partnerships, and multi-stakeholder collaborations for health promotion and behavioral change.

Donna J. Biederman
Donna Biederman, DrPH, MN, RN, CPH, FAAN received her BSN and MN degrees from the University of Washington, Tacoma and her DrPH from the University of North Carolina at Greensboro. Her expertise and scholarly focus include health disparities, social determinants of health, and housing policy. Her clinical experience includes 17 years in Emergency Department nursing and management and case management for persons experiencing homelessness. Dr. Biederman is the Director of the DUSON Community Health Improvement Partnership Program (D-CHIPP) and Director of the Mobile Prevention and Care Team (M-PACT) Clinic (HRSA Cooperative Agreement UK1HP46054-01-00) where she and her team are developing nurse led models of care in urban underserved and rural communities. Dr. Biederman is a co-founder of Durham Homeless Care Transitions, a transitional care program for persons experiencing homelessness which received Edge Runner recognition from the American Academy of Nursing. She was a fellow in the inagural Robert Wood Johnson Foundation Interdisciplinary Research Leaders program where her focus was on Medicaid policy funding for tenancy support services for permanent supportive housing residents. Prior to her faculty appointment, Dr. Biederman was a Community Health Clinical Nurse Educator at DUSON.
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