Check out this article (and audio, linked in thread) from @hkanzaria about an integrated, proactive social medicine team to assist ED patients with complex needs. A brief thread (1/) https://twitter.com/hkanzaria/status/1341460736296423424

Here's a 30 min audio summary & interview that's worth a listen (and not just because I agree with basically everything @hkanzaria says, particularly when he gently pushed back when the host noted his psychiatrist friend said some homeless people just *want* to be homeless) (2/)

(Side note: nobody wants to be homeless. Some people prefer to be outside vs. options like shelters that feel unsafe to them. Housing First works well, incl. for those w/severe mental illness. We need to do a better job educating in medicine so the harmful tropes go away). (3/)

Back to the article/interview, I especially admired the multidisciplinary team that combined existing with new resources (yes, some money needs to be invested). Also, this was a *proactive* team -- they didn't sit around and wait for consults. (4/)

Buy in and involvement from the c-suite was also critical. They note that the c-suite folks actually visit their ED regularly (what?!? amazing!) -- this helps them see how critical it is to provide these resources and services in the ED (5/)

As @hkanzaria notes, homelessness is associated with awful health outcomes including mortality, and addressing people's housing needs is key. Would love to see in the next study housing-related outcomes (number placed and maintained in long-term housing). (6/)

Last, and not meant to diminish this important work, but since I suspect this article will (rightly) get a lot of attention it's very important for everyone to understand limitations of studies that lack comparison groups... (7/)

...this is especially true for studies of frequent ED users, where we know there is regression to the mean. There are many examples of initiatives that looked like they would save lots of visits or $ in pre-post trials where those outcomes didn't pan out in RCTs. (8/)

That's not to say we shouldn't do initiatives like these but that we should temper expectations appropriately -- and also appreciate the improvements in patient care, provider wellbeing (I suspect this might be huge), etc. etc. that may not be measurable in visits & dollars. (9/)

TL;DR: great work (and masterful implementation -- I'm sure it wasn't easy) by @hkanzaria. Looking forward to seeing more studies of this and similar #SocialEM initiatives. (end)