Mixed methods analysis of a national implementation of a medical respite program in transitional housing settings for veterans experiencing homelessness

Hospital to Housing (H2H) is a Department of Veteran Affairs (VA) program providing medical respite care to veteran's experiencing homelessness. The program partners community organizations providing transitional housing with local VA facilities delivering medical care for post-hospitalization veterans for clinical stabilization and ultimately, permanent housing. The program was launched October 2017 at 43 sites. Using mixed methods, we aim to assess participant health services utilization and community partner perceptions and experiences with the implementation of the program. We collected 90-day pre/post-enrollment health care utilization data for the first 200 H2H enrollees and conducted semi-structured interviews with six community organizations. Veterans enrolled in H2H had a significant decline in utilization of emergency department and inpatient care (67.0% vs. 39.5%, p < 0.01) and a significant increase in primary care utilization (47.5% vs. 78.0%, p < 0.01). The greatest barrier to implementation was concern of patient complexity while the greatest enabler was the perceived value/benefit of the program. Our findings suggest a community-partnered low intensity medical respite model for select lower acuity populations is feasible to operate and can substantially redirect care away from acute care settings and increase primary care and social services engagement.