Comparative Analysis of Models of Care for Homeless People

This report presents a comparative analysis of several models of care designed to assist homeless individuals. It begins with an overview of the concept of models of care and their importance in health service planning, emphasizing the need for integrated and specific approaches. The analysis then focuses on four recent models: the Quality and Outcomes Framework (QOF), The Cottage, Side by Side, and CODA-G4, detailing their characteristics, target populations, and outcomes. The report includes a comprehensive table summarizing key parameters such as age, gender, origin, substance abuse, and disease prevalence within each model. The comparative section highlights the similarities and differences between the models, evaluating their effectiveness in reducing hospitalizations, providing housing, and improving overall health outcomes. The conclusion summarizes the strengths and limitations of each model, offering insights into the challenges and opportunities for improving healthcare for the homeless population. The report uses data from various studies and emphasizes the importance of tailored interventions to address the complex needs of this vulnerable group.

COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
Name of the Student
Name of the University
Author’s Note

1COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
Table of Contents
Part 1..........................................................................................................................................2
Models of care........................................................................................................................2
Importance of models of care in health service planning......................................................2
Integration and specificity of models of care.........................................................................2
Published models of care.......................................................................................................3
Part 2..........................................................................................................................................5
Recent models of care for homeless people...........................................................................5
Quality and Outcomes Framework/ QOF (Bowen et al. 2019).............................................7
The Cottage (Gazey et al. 2019)............................................................................................8
Side by side (Fuller et al. 2019).............................................................................................9
CODA‐G4 (van Dongen et al. 2019)...................................................................................10
Comparative Analysis of the models of care.......................................................................11
Conclusion................................................................................................................................12
References................................................................................................................................13

2COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
Part 1
Models of care
The term “models of care” refers to the various ways services of health care are
delivered. It encompasses best care practice and health service for an individual or specific
population cohort. The main objective of these models of care is to ensure that the right care
is being delivered by the concerned team at right time and at the defined place. These models
of care are structured version of various integrated healthcare systems and are molded by
expectations and perspectives of the users in care system and establishing a unified system by
converging all the highlighted needs and concerns of a specific group or individual centric
base.
Importance of models of care in health service planning
The importances of models of care in the healthcare system are manifold. It includes
care facilities which are focused on individual or patient centric needs even in a group or
population based models, flexibility along with considerations of accession equity, along with
supporting integration of various healthcare systems while providing safe and quality support
for the individuals. It has a standardized robust set of measurements to evaluate and analyze
outcomes and act accordingly.
Integration and specificity of models
The integration of various care models and their specificity can be assessed based on
the implemented procedures of incorporation into the unified system. The multidimensional
temperament of the integrated model highlights the complexity required in developing the
integrated care model along with the multiple functions it plays. The integration concerns
individuals, specific diseases or population groups or an entire population.

3COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
Published models of care
Various models of care embracing different groups and individuals of the society are
already established and reviewed in articles and literatures highlighting a rich wealth of
already implemented care models. Group specific models are present namely the chronic care
model (CCM), the disease management programs along with integrated models for the
elderly and the frail. Examples of population based care models comprises of those
implemented by the Kaiser Permanente (KP), PRISMA (Canadian model) along with the
Veterans Health Administration (VA) care models.
The chronic care model also known as the CCM is a reputed and extensively applied
integrated health care model introduced in 1998 by the MacColl Institute of Healthcare
Innovation (Coleman et al. 2009). It was structured to assist chronically diseased individuals
and recognize their pattern of health failures so as to manage and check future occurrences of
detrimental health effects. CCM includes six critical domains namely the public front,
healthcare system, self management and sustenance, delivery and coordination design,
decision aid along with the clinical data systems. The outcome is then modified based on
widespread systematic review of literature in addition to the other evidence-based specifics
and feedback along with the impact on patient outcomes cost saving and recommended
improvements to the quality of healthcare.
The Kaiser Permanente model is a population-based model example which includes
several elements of management for chronic diseases for high-risk patients (Chen et al.
2009). KP is one of the largest model care organization developed in the USA and serves a
population of 9.6 million members. KP is virtually integrated care system embracing three
interrelated units namely a non-profit health care plan bearing insurance benefits called the
Kaiser Foundation Health Plan), a body of self-governed medical group of physicians called

4COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
the Permanente Medical Groups along with the non-profit hospital system known as the
Kaiser Foundation Hospital chain. Although the three units function in a unified fashion, they
are all mutually exclusive bodies working independently in purchasing and delivering
services with one common goal of uplifting and caring for the chronically diseased high-risk
patients.
The PRISMA care model is a Canada based health care model, designed to
incorporate delivery of service to the community dwelling financially constrained individuals
with physical impairments requiring coordination and managements between two or more
health services (Hébert et al. 2003). The model premeditates to serve the single entry-point to
access all the facilities of the system which coordinates all care and health plans across a
network including different providers.
The Veterans Health Administration (VA) provides integrated health services for
chronically diseased older individuals in the USA. The VA encompasses a comprehensive
framework of several health services so as to provide aids and improve the outcomes of the
individuals affected with chronic diseases (Bradley et al. 2006). VA houses its own
physicians and runs hospitals along with medical offices. VA has transformed from hospital
based system into an integrated healthcare system that functions in 21 states of the USA.
Part 2
Recent models of care for homeless people
A systemic review of literature focused on the recently developed models of care for
homeless individuals of the community highlights four models namely the Quality and
Outcomes Framework QOF (Bowen et al. 2019); the cottage (Gazey et al. 2019), side by side
(Fuller et al. 2019) along with CODA‐G4 (van Dongen et al. 2019). These models of care

5COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
facilities range from treatment and providing support to homeless individuals to helping them
with community shelters or independent low cost housing options. The parameters along with
comprehensive factors of the integrated models of care of the four chosen systems are
summarized below in table 1.
Table 1: Comprehensive table of the four models of care chosen
Analytical
parameters
The Cottage
(Gazey et al.
2019)
Side by side
(Fuller et al. 2019)
CODA‐G4 (van
Dongen et al. 2019)
Quality and
Outcomes
Framework/ QOF
(Bowen et al. 2019)
Country Australia England Netherlands England
Age 45 (SD = 13yrs) Mean age 38.3
years (SD =
11.5yrs)
Mostly 50 and above
(N = 97)
Mean age 45
Male 87% 89.5% 78.4% 77%
Female 23% 10.5% 21.6% 33%
Origin and
cultural
background
42% foreign
origin
22.1% white
British origin
47.9% foreign origin 52% foreign origin
Substance
abuse
25% 13.5% 15% 22%
Alcohol
dependence
19% 21.3% 27% 15.2%
Diseases
(Hepatitis C)
9% Hepatitis C 6.3% Hepatitis C 16.8% Hepatitis C 8.9% Hepatitis C
Multi-
morbidity
30% 21.3% 23.7% 32%
Sample size 312 homeless 200 participants 513 homeless people Data collection

6COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
(Population
participating)
people from Amsterdam,
Rotterdam, Hague
and Utrecht
from 928
participants.
Time period
of the study
period of one
year
period of one year period of 2.5 years period of 2 years
Evaluation of
the outcome
A total 7%
decrease in the
population of
unplanned
hospital days
was recorded in
12months after
starting the
programme.
A 12% decrease
was noted in
admission to the
emergency
department after
commencement of
the model.
A total of 57% of the
participants of the
model were provided
with independent
housing or
community shelter
location after 2.5
years of
commencement of
the programme.
This model
predicted that due
to high substance
and alcohol abuse
along with high
prevalence of
hepatitis C,
homeless people
were 60 times more
prone to visit the
hospital in
comparison to the
general population.
Quality and Outcomes Framework/ QOF (Bowen et al. 2019)
Estimation of the healthcare needs for the homeless population is coupled with
challenges in the eligible communities. To investigate the characteristics based on
demography, prevalence of disease, multimorbidity along with admissions to the emergency
department of the homeless individuals. The electronic database EMIS of the patient’s
medical records along with Quality and Outcomes Framework or the QOF data of the 928
patients participating in the programme registered were based in West Midlands of England.

7COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
Data was assorted to demarcate multimorbidity, prevalent conditions, and visits to hospitals
and compared to the datasets of the general population.
Most of the homeless people were identified as male with a mean age around 45 years
and 22.1% being of white British origin. Seventy seven of the homeless population
considered for the model was males. High prevalence of abuse of substance was noted along
with alcohol dependence, hepatitis C and multimorbidity when compared with the general
population. About (% of the population suffered from hepatitis C along with 32% of the
population suffering from chronic health issues. This model predicted that due to high
substance and alcohol abuse along with high prevalence of hepatitis C, homeless people were
60 times more prone to visit the hospital in comparison to the general population. Therefore,
it focused on attending the homeless and setting up suitable interventions to reduce
hospitalization of the homeless population.
This model predicted that due to high substance and alcohol abuse along with high
prevalence of hepatitis C, homeless people were 60 times more prone to visit the hospital in
comparison to the general population. Therefore, proper clinical management and timely
delivery of medical care is of absolute importance to reduce hospitalization amongst the
homeless population.
The Cottage (Gazey et al. 2019)
The Cottage was inspired on the Medical Respite Centre (MRC) model which had
gained substantial traction in the USA. Frequent hospital visit and poor health conditions are
omnipresent in poor homeless communities. Appropriate discharge care and compliance with
therapy are hard for homeless people post discharge. The aim of this model was to tackle the
gap by presenting a facility for short-stay of respite for the individuals living with
homelessness connected to an indoor health care unit and associated with an inner-city

8COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
hospital in Melbourne, Australia. The programme was first developed in 2015 and outcomes
were studied for a period d of twelve months. The outcomes of the programme were critically
analysed and compared with other health care model so as to reduce goverment hospital costs
in treating the homeless population. If the post discharge care is meted out properly in a
guided manner, re-hospitalization rates reduce manifold.
The study of the healthcare model named The Cottage used mixed methods of
examining case studies, interview data, qualitative research and administrative data from the
hospital and the facility for all the 312 participants of the cottage programme. The hospital
admission of the inpatients and the presentations of the emergency department were
evaluated for twelve month period before and after The Cottage programme also. The
participants had multiple health issues, often compounded and deteriorated with social
isolation along with precarious housing or homelessness. The qualitative data in addition to
the case studies illustrated the ways The Cottage coupled the medical care of the participants
and supported them in home-like surroundings. The average stay of the participants was of
about 8.8 days. The programme showcased a 7 percent reduction of the number
hospitalization amongst the participants in the support period of 12 months.
Clinical co-management for the homeless patients was provided for a period of seven
days post discharge from the associated hospital where medical follow up was taken care of
for the stipulated time. Nursing care along with allied medical management team was
available for quick response. Holistic healthcare integration was present so as to reduce
chances of rehospitalisation by incorporating medical management teams, nursing care and
associated health care support.
The main drawback of the programme was the small sample size and the data from
only one hospital. The social implication of the Cottage programme was beneficial which

9COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
provided them with a safe environment to recover post hospitaisation and assisted them with
the financial needs and resources and network to access aid when and as required. The
programme is still under development so as to incorporate larger population of homeless
people and deliver better care facilities.
Side by side (Fuller et al. 2019)
Side by side was a model care system introduced in England to assist about two
hundred homeless participants for a period of one year. The mean age of the homeless
population that was included was around 38.3 years with standard deviation of approximate
11.5yrs. 89.5% of the participants were males and only 22.1% were of British origin. The
main objective of Side by side model care was a seventy two hours of observation post
hospital discharge for the homeless people which reportedly decreased 12% cases of
readmission to the emergency department after commencement of the model.
The clinical management of the side by side programme consisted of patient follow
up along with medical assistance and networking along with resourcing for a period of one
year, post hospitalization. The clinical co management plan housed an integrated healthcare
scheme for the homeless people which included medical facilities and easy hospitalization if
required. Timely care was provided to the homeless patients when they reached out through
the medical scheme provided and the side by side programme made sure that the cost of
treatment was low and met basic quality standards so as to provide good healthcare at
nominal financial facilities.
Side by side model care programme also focused on guided intervention and
rehabilitation supports for participants ailing from substance and alcohol abuse. Chronic
health management plans were also discussed with them along with providing access to low
cost facilities and medical support when needed.

10COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
CODA‐G4 (van Dongen et al. 2019)
The CODA‐G4 programme focused on assisting the homeless with healthcare
facilities in the Netherlands. It included 513 homeless citizens in four Dutch cities over a
phase of 2.5 years, with initial registration as a social relief organization in 2011. Post 2.5
years, only few people claimed unmet health needs.
This model focused on identifying and understanding patterns in health issues that
aggravated with age and multiplied due to homelessness populations. The healthcare
cost of the nation increases due to the unchecked homeless population triggering a social
problem which must be address on a priority basis to reduce the burden on the development
of the country. As a result, if the homeless population is reduced and the needy are given
shelters, prevalence of disease and health issues would reduce, thereby reducing the overall
health budget of the nation. As the cost of health care facilities and medical support is
increasing day by day, providing shelters and locations at community centers for the
homeless population is a preferred option as it is more cost effective as an alternative to the
expensive healthcare.
The main objective of CODA‐G4 model focused clinical management of the
homeless people along with providing low cost medical assistance when required. It aimed at
categorizing the various patterns of health issues which intensified with age and
increased due to lack of care and financial constraints. Integrated healthcare
was accessible to the homeless participants included in this programme. Timely care was
delivered when contacted and a medical team of clinical management was dispatched to
provide healthcare to the homeless patient concerned along with access to medical facilities
or hospitalization if required.

11COMPARATIVE ANALYSIS OF MODELS OF CARE FOR HOMELESS PEOPLE
During the period of 2.5 years, 290 homeless people from Amsterdam, Rotterdam,
Hague and Utrecht of Netherlands were provided either low cost independent housing
facilities or community shelter location after commencement of the programme. The
individuals were selected based on their age and condition of health. Patient care was
regularly followed up with timely checkup and health monitoring camps and medical
interventions.
Comparative Analysis of the models of care
The above models of care are all focused on homeless population so as to reduce the
prevalence of health ailments and diseases which will thereby uplift the society and would
reduce the overall health budget. Quality and Outcomes Framework QOF (Bowen et al.
2019) highlighted the complexity of health issues amongst the homeless people whereas the
other integrated healthcare models namely The cottage (Gazey et al. 2019), side by side
(Fuller et al. 2019) and CODA‐G4 (van Dongen et al. 2019) were focused on developing
integrated health care models with significant highlight on clinical management and
providing medical assistance to the homeless population. Quality and Outcomes Framework
QOF model predicted that due to high substance and alcohol abuse along with high
prevalence of hepatitis C, homeless people were 60 times more prone to visit the hospital in
comparison to the general population (Bowen et al. 2019). It drew attention to the vital point
that reducing homelessness would significantly reduce the health cost of the country in
addition with improving the health map of the community and thereby the nation concerned.
On critical evaluation of the outcomes of the models of care it can be seen that a total of
seven percent decrease was noted in the population of unplanned hospital days was recorded
in 12 months after starting the programme named the cottage (Gazey et al. 2019). A 12%
decrease was noted in admission to the emergency department after commencement of the
model namely side by side (Fuller et al. 2019). A total of 57% of the participants of the model