How NYC Health + Hospitals uses data to provide care to the city's homeless population

New York City-based NYC Health + Hospitals is using data science to implement several initiatives to help better identify and serve its homeless population, according to a Harvard Business Review article co-authored by four of the health system's executives.

To help match homeless patients to the correct hospital and community-based resources, including housing, NYC Health + Hospitals developed a composite definition of homelessness by analyzing registration records, EHRs and insurance claims from its one million patients. The health system matched addresses for each of its patients to homeless shelters and hospitals, searched for words such as "homeless" and "shelter" in the records and flagged patients whose zip code changed 10 or more times in a single year.

As a result of its search efforts, NYC Health + Hospitals was able to capture more than 20,000 adult homeless patients served within one year. Since then, the health system has opened an outpatient care clinic, which offers walk-in appointments and longer visits, at NYC Health + Hospitals/Bellevue. The location treats the health system's largest number of homeless patients. The clinic's staff are trained on issues homeless patients face, such as substance abuse disorder and navigating the public housing system.

Additionally, NYC Health + Hospitals/Lincoln launched a pilot program to identify patients at risk of eviction or who are homeless. The program connects these individuals to resources, including health insurance navigation, public shelters, food benefit programs and local housing organizations.

The health system also uses its patient data to organize lists of homeless patients who meet requirements for local supportive housing complexes and coordinates housing applications.

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