Medical Respite Care and Changes in Acute Care Use Among People Experiencing Homelessness: A Matched‐Cohort Evaluation in Edmonton, Canada
M. H. Pulok, J. Van Nest, M. Ghosh, F. Mosaico, J. Nath, T. Smith, M. Roy, V. SainiABSTRACT
Rationale
Respite to Recovery (R2R), operated by Radius Community Health & Healing, is a Medical Respite Care Programme (MRCP) in Edmonton providing short‐term residential care to individuals experiencing homelessness who are medically stable but cannot safely recuperate in a shelter or on the street. Evidence from Canadian settings remains limited.
Objectives
This study evaluated the changes in acute care utilisation before and after participation in R2R (hereafter MRCP), relative to matched comparison individuals experiencing homelessness in Edmonton.
Methods
We conducted a retrospective matched cohort study comparing MRCP participants with matched controls. Descriptive and difference‐in‐differences (DiD) analyses focused on emergency department/urgent care centre (ED/UCC) visits, inpatient admissions, and length of stay for ED/UCC visits and hospitalisations.
Results
The cohort included 143 MRCP participants and 546 matched controls. MRCP participants had substantially higher pre‐index acute‐care utilisation despite a close balance on age and sex. DiD analyses showed larger reductions in the MRCP group for ED/UCC visits (DiD −1.22; 95% CI −2.03 to −0.42), inpatient admissions (−0.39; 95% CI −0.64 to −0.15), and inpatient days (−4.83; 95% CI −9.27 to −0.39). The ED/UCC length‐of‐stay and the person‐time‐adjusted estimates for ED/UCC and inpatient admission rates were not statistically significant.
Conclusions
MRCP participation was associated with larger reductions in several acute care and burden measures, although person‐time‐adjusted between‐group differences in ED/UCC visit and inpatient admission rates were not statistically significant. Substantial pre‐index utilisation differences and divergent pre‐index trends limit causal interpretation; the findings should therefore be considered exploratory. Continued evaluation of MRCP with refined methodologies and extended follow‐up is essential to confirm these findings and guide policy decisions.