What side effects are associated with this type of intervention?

Case management interventions for homelessness, such as those studied in the Navigator Program, generally aim to improve healthcare access and continuity. Known challenges include the complexity of coordinating multiple services, potential difficulties in maintaining consistent communication with clients, and the need for significant resources to address diverse and complex health and social needs. While case management can improve short-term outcomes and reduce relapse rates, it may also face barriers such as clients' competing priorities and systemic issues that hinder sustained engagement and long-term success.

What prior FDA approvals exist?

There are no specific FDA-approved drugs for the treatment of homelessness. However, interventions similar to the Navigator Program, which focuses on case management to improve healthcare access and continuity, have been studied. These interventions typically involve coordinated care efforts rather than pharmacological treatments. The Navigator Program aims to address the complex health and social needs of homeless individuals by providing case management to ensure follow-up with primary care providers, reduce acute healthcare utilization, and improve overall health outcomes.

What other types of research exist?

Promising alternatives to the Navigator Program for homelessness patients in 2024 include: 1) Mobile health units that bring medical services directly to homeless populations, reducing barriers to access. 2) Telemedicine services that provide remote consultations and follow-ups, ensuring continuity of care despite geographic instability. 3) Integrated care models that combine medical, mental health, and social services in a single program to address the comprehensive needs of homeless individuals. These approaches leverage technology and holistic care strategies to improve healthcare access and continuity for homeless patients.

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Navigator Program for Homeless Adults

N/A

Recruiting

Led By Stephen W Hwang, MD, MPH

Research Sponsored by Unity Health Toronto

Eligibility Criteria Checklist

Specific guidelines that determine who can or cannot participate in a clinical trial

Must have

18 years of age or older

Have an unplanned admission for any medical cause to the General Internal Medicine service, any Medicine subspecialty service, the Cardiac Intensive Care Unit, and the Medical Surgical Intensive Care Unit

Must not have

Unable to provide informed consent to the study

Timeline

Screening 3 weeks

Treatment Varies

Follow Up during index admission

Awards & highlights

Summary

This trial tests the Navigator program, which helps homeless individuals manage their healthcare and social needs after leaving the hospital. It aims to reduce hospital visits and improve overall health over several months.

Who is the study for?

This trial is for adults over 18 who are homeless at the time of an unplanned hospital admission. It includes those without shelter, in emergency shelters, or in temporary housing. Participants must not have used Homeless Outreach services within 90 days and must be able to consent to the study.

What is being tested?

The Navigator Program is being tested as a case management intervention for homeless individuals after hospital discharge. The trial will track follow-up with primary care, re-hospitalization rates, quality of care transitions, and overall health over six months.

What are the potential side effects?

Since this trial involves a social support program rather than medication, there aren't typical medical side effects; however, participants may experience stress or anxiety from changes in their healthcare routine.

Eligibility Criteria

Inclusion Criteria

You may be eligible if you check “Yes” for the criteria below

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I am 18 years old or older.

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I was unexpectedly admitted to the hospital for a medical reason.

Exclusion Criteria

You may be eligible for the trial if you check “No” for criteria below:

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I am unable to understand and agree to the study's details on my own.

Timeline

Screening ~ 3 weeks3 visits

Treatment ~ Varies

Follow Up ~ within 30, 90, and 180 days of discharge

Screening ~ 3 weeks

Treatment ~ Varies

Follow Up ~within 30, 90, and 180 days of discharge

This trial's timeline: 3 weeks for screening, Varies for treatment, and within 30, 90, and 180 days of discharge for reporting.

Treatment Details

Study Objectives

Study objectives can provide a clearer picture of what you can expect from a treatment.

Primary study objectives

Follow-Up with Primary Care Provider (PCP)

Secondary study objectives

Change in Competing Priorities

Change in Health Status

Composite All-Cause Hospital Readmission or Mortality

+3 more

Other study objectives

Attendance of non-PCP Health Care Appointment

Connection to Case Manager

Leave Against Medical Advice

+2 more

Trial Design

2Treatment groups

Experimental Treatment

Active Control

Group I: Navigator ProgramExperimental Treatment1 Intervention

In addition to receiving Standard Care, participants in the intervention arm will be assigned to a Homeless Outreach Counsellor. The Homeless Outreach Counsellor will connect with the participant as soon as possible during the admission and will provide support during the hospital admission and for approximately 90 days after hospital discharge.

Group II: Standard CareActive Control1 Intervention

Standard Care consists of support from Care Transition Facilitators who work with patients during their hospital stay to arrange discharge plans and make follow-up arrangements. Care Transition Facilitators do not routinely work with patients after hospital discharge. As part of the routine discharge process, the health care team provides patients with medical recommendations, appointments for follow-up care as needed, a written discharge summary, and prescriptions as needed. If the patient has an identified primary care provider, a copy of the discharge summary is sent electronically to the primary care provider.

0 / 3Eligibility criteria met

Research Highlights

Information in this section is not a recommendation. We encourage patients to speak with their healthcare team when evaluating any treatment decision.

Mechanism Of Action

Side Effect Profile

Prior Approvals

Other Research

Case management interventions for homelessness, such as those studied in the Navigator Program, typically involve personalized support to help individuals navigate healthcare and social services. These interventions include an initial assessment of needs, development of a tailored care plan, and ongoing support through regular follow-ups. The mechanisms of action involve connecting patients with primary care providers, coordinating medical and social services, and addressing barriers such as lack of transportation or documentation. This approach is crucial for homeless patients as it helps ensure continuity of care, reduces acute healthcare utilization, and improves overall health outcomes by addressing both medical and social determinants of health.

The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review.A multi-site comparison of supported housing for chronically homeless adults: "Housing first" versus "residential treatment first"A systematic review of interventions to increase the uptake of opiate substitution therapy in injecting drug users.