Health Care Utilization among Homeless-Experienced Adults Who Were Seen by a Mobile Addiction Health Clinic in Boston, Massachusetts: A Quasi-Experimental Study

Abstract

Background: Mobile health clinics improve access to care for marginalized individuals who are disengaged from the healthcare system. This study evaluated the association between a mobile addiction health clinic and health care utilization among people experiencing homelessness. Methods: Using Medicaid claims data, we evaluated adults who were seen by a mobile addiction health clinic in Boston, Massachusetts from 1/16/18–1/15/19 relative to a propensity score matched control cohort. We evaluated both cohorts from four years before to one year after the index visit date with the mobile clinic. The primary outcome was the number of outpatient visits; secondary outcomes were the number of hospitalizations and emergency department (ED) visits. We used Poisson regression to compare changes in outcomes from before to after the index date in a quasi-experimental design. Results: 138 adults were seen by the mobile clinic during the observation period; 29.7% were female, 16.7% were Black, 8.0% Hispanic, 68.1% White, and the mean age was 40.4 years. The mean number of mobile clinic encounters was 3.1. The yearly mean number of outpatient visits increased from 11.5 to 12.1 (p = 0.43; p_diff-in-diff = 0.15), the number of hospitalizations increased from 2.2 to 3.0 (p = 0.04; p_diff-in-diff = 0.87), and the number of ED visits increased from 5.4 to 6.5 (p = 0.04; p_diff-in-diff = 0.40). Conclusions: The mobile addiction health clinic was not associated with statistically significant changes in health care utilization in the first year. Further research in larger samples using a broader set of outcomes is needed to quantify the benefits of this innovative care delivery model.

Keywords:

• Vulnerable populations
• opioid use disorder treatment
• mobile health clinic

Acknowledgments

The authors wish to acknowledge the experienced staff from the Boston Public Health Commission’s AHOPE program and the Boston Health Care for the Homeless Program who contributed to the successful implementation of the Community Care in Reach^® initiative.

Authors’ contributions

DF and TB conceived of the project. DF, YC, ZS, and TB designed the study. DF, AJ, EL, and KW contributed to the acquisition of the data. DF, YC, EL, ZS, and TB contributed to the analysis of the data. DF, JW, JG, and TB interpreted the data. DF and AJ took the lead in writing the manuscript. YC, EL, KW, JW, JG, ZS, and TB revised the manuscript critically for important intellectual content. All authors approved the final version to be published.

Data availability

The data that support the findings of this study are available from MassHealth. Restrictions apply to the availability of these data, which were used under a data use agreement for this study. Data are available from the authors with the permission of MassHealth.

Declaration of interest

Dr. Travis Baggett receives royalties from UpToDate. The other authors have no conflicts of interest to disclose.

Additional information

Funding

This work was supported by the Kraft Center for Community Health; the National Institutes of Health (K12DA043490); the Division of General Internal Medicine at Massachusetts General Hospital (MGH); the MGH Research Scholars Program; and the National Institutes of Health (DP5-OD024564). The funding sources played no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.