74 - Changes in healthcare utilization among children receiving permanent supportive housing

Poster Number: 74
Publication Number: 74.210

James Bohnhoff, UPMC, Pittsburgh, PA, United States; Lingshu Xue, University of Pittsburgh, Pittsburgh, PA, United States; Mara Hollander, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Jacqueline M. Burgette, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, United States; Evan S. Cole, University of Pittsburgh, Pittsburgh, PA, United States; Kristin Ray, University of Pittsburgh, Pittsburgh, PA, United States; Julie Donohue, University of Pittsburgh Health Policy and Management, Pittsburgh, PA, United States; Eric Roberts, University of Pittsburgh, Pittsburgh, PA, United States

Background: Permanent supportive housing (PSH) integrates long-term housing and supports for families and disabled individuals experiencing homelessness. Although PSH is frequently provided to families with children, little is known about the impacts of PSH among children.

Objective: We examined changes in health care use among children enrolled in the Pennsylvania Medicaid program up to three years after PSH entry vs. changes among similar children who did not receive PSH.

Design/Methods: We analyzed administrative Medicaid data from 2008-2016 for children entering PSH between 2011 and 2016. We matched children entering PSH to a comparison cohort of children who 1) had similar demographic and clinical characteristics and 2) received housing services (excluding PSH) for homeless individuals within 6 months of a child entering PSH. We conducted propensity score-weighted difference-in-differences (DID) analyses to compare changes in emergency visits, inpatient hospitalizations, preventive care, and dental care use before and after children entered PSH vs. changes in the comparison cohort.

Results: We matched 705 children receiving PSH to 3,141 in the comparison cohort. Over three years following PSH entry, dental visits among children entering PSH increased differentially vs. the comparison cohort (DID: 12.54 visits/1000 person-months, 95% CI:3.55,21.54, Table 1). We did not find differential changes in inpatient hospitalizations or health maintenance visits. Over three years following PSH entry, children ≤5 years old at PSH entry experienced a greater decrease in emergency visits vs. the comparison cohort (DID: -13.26 visits/1000 person-months, 95% CI:-26.34,-0.18). However, emergency visit trends prior to PSH entry differed between the PSH-receiving and comparison cohorts (Figure 1).Conclusion(s): Entry into PSH was associated with increases in dental care, suggesting that PSH improves children’s use of care that is important for long-term health. Younger children entering PSH experienced reductions in emergency department use, but whether this change occurred as a result of PSH is unclear because we also found trend differences preceding PSH entry. Research is needed to assess the long-term effects of PSH on children’s health.
Bohnhoff CVBohnhoff CV 20220104.pdf
Figure 1. Unadjusted utilization by year.This figure plots unadjusted trends in our main utilization outcomes before and after entry into PSH (intervention cohort) and before and after the index date (comparison cohort). PSH entry or index date is represented as a red, vertical line. Negative numbers on the x-axis indicate years prior to PSH entry or the index date, positive numbers indicate years following PSH entry or the index date, and 0 indicates the year beginning upon PSH entry or the index date. Estimates plotted on the y-axis represent unadjusted mean rates of utilization per 1000 person-months. The error bars represent 95% confidence intervals which account for clustering within individuals.