{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:42:49Z","timestamp":1793508169831,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T00:00:00Z","timestamp":1600992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether randomization to permanent supportive housing (PSH) versus usual care reduces the use of acute health care and other services among chronically homeless high users of county\u2010funded services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>Between 2015 and 2019, we assessed service use from Santa Clara County, CA, administrative claims data for all county\u2010funded health care, jail and shelter, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>We conducted a randomized controlled trial among chronically homeless high users of multiple systems. We compared postrandomization outcomes from county\u2010funded systems\u00a0using multivariate regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection<\/jats:title>\n                    <jats:p>We extracted encounter data from an integrated database capturing health care at county\u2010funded facilities, shelter and jails, county housing placement, and death certificates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>We enrolled 423 participants (199 intervention; 224 control). Eighty\u2010six percent of those randomized to PSH received housing compared with 36 percent in\u00a0usual care. On average, the 169 individuals housed by the PSH intervention have remained housed for 28.8\u00a0months (92.9 percent of the study follow\u2010up period). Intervention group members had lower rates of psychiatric ED visits IRR 0.62; 95% CI [0.43, 0.91] and shelter days IRR 0.30; 95% CI [0.17, 0.53], and higher rates of ambulatory mental health services use IRR 1.84; 95% CI [1.43, 2.37] compared to controls. We found no differences in total ED or inpatient use, or jail. Seventy (37 treatment; 33 control) participants died.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The intervention placed and retained frequent user, chronically homeless individuals in housing. It decreased\u00a0psychiatric ED visits and shelter use, and increased outpatient mental health care, but not medical ED visits or hospitalizations. Limitations included more than one\u2010third of usual care participants received another form of subsidized housing, potentially biasing results to the null, and loss of power due to high death rates. PSH can house high\u2010risk individuals and reduce emergent psychiatric services and shelter use. Reductions in hospitalizations may be more difficult to realize.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.13553","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T16:10:37Z","timestamp":1601050237000},"page":"797-806","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6767-8404","authenticated-orcid":false,"given":"Maria C.","family":"Raven","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of California, San Francisco San Francisco CA USA"},{"name":"Philip R. Lee Institute for Health Policy Studies University of California, San Francisco San Francisco CA USA"},{"name":"Mathematica Policy Research Oakland CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9005-9054","authenticated-orcid":false,"given":"Matthew J.","family":"Niedzwiecki","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California, San Francisco San Francisco CA USA"},{"name":"Philip R. Lee Institute for Health Policy Studies University of California, San Francisco San Francisco CA USA"},{"name":"Center for Vulnerable Populations University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot","family":"Kushel","sequence":"additional","affiliation":[{"name":"Mathematica Policy Research Oakland CA USA"},{"name":"Department of Medicine University of California, San Francisco San Francisco CA USA"},{"name":"UCSF Benioff Homelessness and Housing Initiative San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.5.778"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13070"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302693"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2000.tb02037.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2018.9.38954"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301421"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15504263.2017.1392055"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00082"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/ser0000110"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201300261"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30371-2"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.916020"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-006-9083-0"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.414"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-011-9592-3"},{"key":"e_1_2_8_17_1","unstructured":"New York State Office of Mental Health.Assertive Community Treatment (ACT).https:\/\/omh.ny.gov\/omhweb\/act\/. Accessed November 5 2019"},{"key":"e_1_2_8_18_1","unstructured":"CT Homeless Management Information Systems.VI\u2010SPDAT.https:\/\/www.cthmis.com\/info\/detail\/vi\u2010spdat\/13. Accessed November 14 2019"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11126-017-9490-2"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.12843"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674371506001103"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1608326"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.9782"},{"key":"e_1_2_8_24_1","unstructured":"Destination: Home.Ending Chronic Homelessness through Collective Impact.https:\/\/destinationhomesv.org\/. Accessed November 14 2019"},{"key":"e_1_2_8_25_1","unstructured":"National Alliance to End Homelessness.Housing First.https:\/\/endhomelessness.org\/resource\/housing\u2010first\/. Accessed November 5 2019"},{"key":"e_1_2_8_26_1","unstructured":"Center for Disease Control and Prevention.National homeless person\u2019s memorial day.Centers for Disease Control and Prevention.https:\/\/www.cdc.gov\/features\/homelessness\/. Accessed November 14 2019"},{"issue":"9","key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1001\/jamainternmed.2018.2924","article-title":"Mortality among unsheltered homeless adults in Boston, Massachusetts, 2000\u20102009","volume":"178","author":"Roncarati JS","year":"2018","journal-title":"JAMA Intern Med"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.16.2152"},{"issue":"8","key":"e_1_2_8_29_1","first-page":"525","article-title":"The impact of Housing First on criminal justice outcomes among homeless people with mental illness: a systematic review","volume":"64","author":"Leclair MC","year":"2019","journal-title":"Can J Psychiatry"},{"issue":"10","key":"e_1_2_8_30_1","first-page":"718","article-title":"Interactions between police and persons who experience homelessness and mental illness in Toronto, Canada: findings from a prospective study","volume":"64","author":"Kouyoumdjian FG","year":"2019","journal-title":"Can J Psychiatry"},{"key":"e_1_2_8_31_1","unstructured":"National Low Income Housing Coalition.Criminalization of Homelessness Increases in U.S. Cities.https:\/\/nlihc.org\/resource\/criminalization\u2010homelessness\u2010increases\u2010us\u2010cities. Accessed November 5 2019"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.13553","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.13553","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.13553","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T20:59:47Z","timestamp":1693947587000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.13553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,25]]},"references-count":30,"journal-issue":{"issue":"S2","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1111\/1475-6773.13553"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.13553","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,25]]},"assertion":[{"value":"2020-09-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}