{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:01:52Z","timestamp":1785402112958,"version":"3.56.0"},"reference-count":38,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"unspecified","delay-in-days":130,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X26104069_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People experiencing homelessness (PEH) and people who inject drugs (PWID) face disproportionate burdens of infection and poor clinical outcomes due to social determinants of health (SDOH) barriers such as unstable housing, limited medication access, and poor follow-up care. The study purpose was to evaluate the impact of a multi-model quality improvement (QI) bundle on outcomes of hospitalized PEH\/PWID.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104069_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A pilot QI initiative was implemented at an urban academic hospital in Detroit (June 2022\u2013April 2023) targeting hospitalized PEH\/PWID requiring \u22652 weeks of antimicrobials. Bundled prospective intervention included specialty consultation, tailored antibiotic education, medication cost inquiry, Meds-to-Beds delivery, enhanced case management coordination, and referrals to community-based organizations addressing SDOH needs. Ninety-day clinical outcomes were described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104069_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      42 patients were included: 26% PEH, 29% PWID. Patients were predominately men (62%), White (57%), and with a median (IQR) age of 43.5 (32.5\u201353) years. Common infections included bacteremia (60%), bone\/joint infections (50%), and endocarditis (31%);\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      was the leading pathogen. Over half of patients were discharged on oral antibiotics. Treatment adherence remained low: 29% self-discharged, 52% were unreachable postdischarge, and 21% attended scheduled follow-up. 43% of patients achieved clinical cure and 38% experienced disease progression within 90 days. Emergency department revisits (29%) and hospital readmissions (43%) were frequent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104069_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Despite a multi-model QI intervention, hospitalized PEH\/PWID with complicated infections experienced significant barriers to care, resulting in poor adherence and outcomes. Pragmatic, scalable interventions and community partnerships are needed to improve health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2026.10406","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T07:42:52Z","timestamp":1778485372000},"source":"Crossref","is-referenced-by-count":0,"title":["Implementation and outcomes of a multifaceted care model for people experiencing homelessness and people who inject drugs hospitalized with complicated infections"],"prefix":"10.1017","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5630-0104","authenticated-orcid":false,"given":"Geehan","family":"Suleyman","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1102-0157","authenticated-orcid":false,"given":"Dana M.","family":"Parke","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simran","family":"Brar","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caren","family":"El-Khoury","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Joshi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phina","family":"Ross","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynsey","family":"Halpin","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Kenney","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kwnkm68","id-type":"ROR","asserted-by":"publisher"}],"name":"Henry Ford Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5967-5211","authenticated-orcid":false,"given":"Michael P.","family":"Veve","sequence":"additional","affiliation":[{"name":"Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"S2732494X26104069_ref5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0179207"},{"key":"S2732494X26104069_ref19","unstructured":"19. Substance Abuse and Mental Health Services Administration. Advisory: low barrier models of care for substance use disorders. https:\/\/library.samhsa.gov\/sites\/default\/files\/advisory-low-barrier-models-of-care-pep23-02-00-005.pdf. Accessed October 3, 2025."},{"key":"S2732494X26104069_ref38","unstructured":"38. Michigan Department of Health and Human Services. (n.d.). Overview of CIE efforts. Overview of community information exchange 2022. https:\/\/www.michigan.gov\/mdhhs\/-\/media\/Project\/Websites\/mdhhs\/Inside-MDHHS\/Policy-and-Planning\/Social-Determinants-of-Health-Strategy\/CIE\/Resources\/Overview-of-CIE-Efforts.pdf. 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Office of Community Planning and Development, U.S. Department of Housing and Urban Development. The 2023 annual homelessness assessment report (AHAR) to congress. https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2023-ahar-part-1.Pdf. Accessed October 3, 2025."},{"key":"S2732494X26104069_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-023-00820-w"},{"key":"S2732494X26104069_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2017.03.002"},{"key":"S2732494X26104069_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlab123"},{"key":"S2732494X26104069_ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2013.00091"},{"key":"S2732494X26104069_ref1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac543"},{"key":"S2732494X26104069_ref8","unstructured":"8. Centers for Disease Control and Prevention. HIV infection risk, prevention, and testing behaviors among persons who inject drugs\u2014National HIV behavioral surveillance: injection drug use, 23 U.S. cities, 2018. HIV surveillance special report 24. https:\/\/stacks.cdc.gov\/view\/cdc\/106349. Accessed October 3, 2025."},{"key":"S2732494X26104069_ref31","unstructured":"31. Substance Abuse and Mental Health Services Administration. Screening and treatment of co-occurring disorders. https:\/\/www.samhsa.gov\/mental-health\/serious-mental-illness\/co-occurring-disorders. Accessed August 12, 2025."},{"key":"S2732494X26104069_ref25","unstructured":"25. Chou, R , Korthuis, PT , and Weimer, M. Medication-assisted treatment models of care for opioid use disorder in primary care settings. Technical brief no. 28. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK402352\/. Accessed September 17, 2025."},{"key":"S2732494X26104069_ref32","unstructured":"32. Allardice, K , von Bibra, S , Doyle, JS , et\u00a0al. Engaging PWID in community based treatment and care using a nurse-led, social network model. https:\/\/www.inhsu.org\/resource\/engaging-pwid-in-community-based-treatment-and-care-using-a-nurse-led-social-network-model\/. Accessed August 12, 2025."},{"key":"S2732494X26104069_ref16","doi-asserted-by":"publisher","DOI":"10.31478\/201710c"},{"key":"S2732494X26104069_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-024-00961-8"},{"key":"S2732494X26104069_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz274"},{"key":"S2732494X26104069_ref28","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2014.891615"},{"key":"S2732494X26104069_ref7","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1424"},{"key":"S2732494X26104069_ref34","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13888"},{"key":"S2732494X26104069_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101657"},{"key":"S2732494X26104069_ref37","unstructured":"37. National Health Care for the Homeless Council. Community information exchange using data to coordinate care for people experiencing homelessness: addressing COVID-19 and beyond 2020. https:\/\/nhchc.org\/wp-content\/uploads\/2020\/04\/NHCHC_Community-Information-Exchange2.pdf. 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