Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026
Implementation and outcomes of a multifaceted care model for people experiencing homelessness and people who inject drugs hospitalized with complicated infections.
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Suleyman Geehan, Parke Dana M, Brar Simran, El-Khoury Caren, Joshi Seema, Ross Phina, Halpin Lynsey, Kenney Rachel M, Veve Michael P
Аннотация
BACKGROUND: People experiencing homelessness (PEH) and people who inject drugs (PWID) face disproportionate burdens of infection and poor clinical outcomes due to social determinants of health (SDOH) barriers such as unstable housing, limited medication access, and poor follow-up care. The study purpose was to evaluate the impact of a multi-model quality improvement (QI) bundle on outcomes of hospitalized PEH/PWID.
METHODS: A pilot QI initiative was implemented at an urban academic hospital in Detroit (June 2022-April 2023) targeting hospitalized PEH/PWID requiring ≥2 weeks of antimicrobials. Bundled prospective intervention included specialty consultation, tailored antibiotic education, medication cost inquiry, Meds-to-Beds delivery, enhanced case management coordination, and referrals to community-based organizations addressing SDOH needs. Ninety-day clinical outcomes were described.
RESULTS: 42 patients were included: 26% PEH, 29% PWID. Patients were predominately men (62%), White (57%), and with a median (IQR) age of 43.5 (32.5-53) years. Common infections included bacteremia (60%), bone/joint infections (50%), and endocarditis (31%); Staphylococcus aureus was the leading pathogen. Over half of patients were discharged on oral antibiotics. Treatment adherence remained low: 29% self-discharged, 52% were unreachable postdischarge, and 21% attended scheduled follow-up. 43% of patients achieved clinical cure and 38% experienced disease progression within 90 days. Emergency department revisits (29%) and hospital readmissions (43%) were frequent.
CONCLUSIONS: Despite a multi-model QI intervention, hospitalized PEH/PWID with complicated infections experienced significant barriers to care, resulting in poor adherence and outcomes. Pragmatic, scalable interventions and community partnerships are needed to improve health outcomes.
METHODS: A pilot QI initiative was implemented at an urban academic hospital in Detroit (June 2022-April 2023) targeting hospitalized PEH/PWID requiring ≥2 weeks of antimicrobials. Bundled prospective intervention included specialty consultation, tailored antibiotic education, medication cost inquiry, Meds-to-Beds delivery, enhanced case management coordination, and referrals to community-based organizations addressing SDOH needs. Ninety-day clinical outcomes were described.
RESULTS: 42 patients were included: 26% PEH, 29% PWID. Patients were predominately men (62%), White (57%), and with a median (IQR) age of 43.5 (32.5-53) years. Common infections included bacteremia (60%), bone/joint infections (50%), and endocarditis (31%); Staphylococcus aureus was the leading pathogen. Over half of patients were discharged on oral antibiotics. Treatment adherence remained low: 29% self-discharged, 52% were unreachable postdischarge, and 21% attended scheduled follow-up. 43% of patients achieved clinical cure and 38% experienced disease progression within 90 days. Emergency department revisits (29%) and hospital readmissions (43%) were frequent.
CONCLUSIONS: Despite a multi-model QI intervention, hospitalized PEH/PWID with complicated infections experienced significant barriers to care, resulting in poor adherence and outcomes. Pragmatic, scalable interventions and community partnerships are needed to improve health outcomes.