Impact of Street Medicine on Emergency Department Use: A Three-Year Evaluation of People Experiencing Homelessness.

Abstract

Introduction: People experiencing homelessness (PEH) frequently utilize the emergency department (ED) for acute and primary healthcare needs. Loyola Street Medicine is a multidisciplinary team comprised of physicians, students, and other professionals who provide weekly healthcare services to PEH at a train station in Chicago. The objective of the study was to identify the specific patient demographics, chief complaints, and clinical interventions associated with increased odds of these patients reporting that they would have sought care at an ED had Loyola Street Medicine been unavailable.

Methods: We conducted a retrospective review of patients seen by Loyola Street Medicine between September 2021 and September 2024, with 2,121 total encounters and a subset of 1,565 with identifying data. The primary outcome measure was whether the patient reported they would have gone to the ED for care, and the secondary outcome measures were patient demographics, chief complaints, and interventions provided. We estimated odds ratios with univariable logistic regression mixed models, with random intercept accounting for multiple patient visits in the subset of patients with identifiers.

Results: For 63% of all encounters (N = 1,293), people experiencing homelessness indicated they would have gone to the ED without street medicine, with the most common demographics including Black race (77%), male sex (80%), and a mean age of 46.7 years. Among patients who indicated they would have gone to the ED, the most prevalent chief complaints were wound check (22%), musculoskeletal issues (17%), and podiatry concerns (14%). Black and "other" race patients had decreased odds of indicating they would have gone to the ED compared to White patients (0.69 [95% CI, 0.49-0.97], P = .03 and 0.39 [95% CI, 0.22-0.69], P = .001, respectively). Patients with wound-related complaints and those needing wound care as an intervention had greater odds of indicating they would go to the ED versus any other location such as a clinic or a primary care physician (1.46 [95% CI, 1.07-1.99], P = .02 and 1.5 [95% CI, 1.11-2.03], P = .009, respectively).

Conclusion: The findings demonstrate that street medicine can play a vital role in addressing the complex needs of people experiencing homelessness. By providing consistent, low-barrier care, street medicine has the potential to reduce nonemergent ED use and improve continuity of care.