Exploring the feasibility of conducting a multisite randomised controlled trial of the healthy and HomED model of care and its impact on representations among people experiencing homelessness in an Australian Emergency Department.

Abstract

To determine the feasibility of conducting a multisite randomised controlled trial of the Healthy and HomED model of care to determine its capacity to reduce emergency department (ED) representations among people experiencing homelessness. Feasibility randomised controlled trial with process evaluation. Single site public metropolitan ED. Our goal was to recruit 204 adults experiencing homelessness attending ED. In total, 190 participants were enrolled. The final sample comprised n=101 control and n=86 intervention. The Healthy and HomED model of care comprises screening for homelessness, assessing unmet needs via the Homeless Health Access to Care Tool and a Decision Assistance Guide that informs care planning. The intervention was applied by the Assessment Liaison Early Referral Team (ALERT), an ED-based multidisciplinary team specialised in supporting underserved populations. Clinician acceptability of the implementation of the model of care, improved identification of homelessness and a reduction in ED representations within 28 days among people experiencing homelessness. Implementation of the Healthy and HomED model of care was feasible to the ALERT clinicians and the research team. While the Healthy and HomED did not significantly reduce representations to the ED, it improved the identification of homelessness by a third (35.3%). Qualitative findings suggest that the Homeless Health Access to Care Tool provided helpful standardisation to assessments. The Decision Assistance Guide was seldom added to the plan of care for senior clinicians but was reportedly helpful to junior clinicians with less experience in homeless healthcare. The study provided assurance that running a multicentre hybrid trial to test the effectiveness and implementation of the Healthy and HomED is feasible. Process evaluation found that intervention adherence could be improved with greater contextualisation to local resources and increased engagement from ED medical and nursing teams. These factors could be addressed through the codesign of a future multisite trial. ANZCTR 12622001085763.