CoChat
Sign Up
Cited by 77Homelessness and Social IssuesEmergency and Acute Care StudiesHIV, Drug Use, Sexual Risk

Housing first is associated with reduced use of emergency medical services

Open access
Mackelprang, Jessica L., Collins, Susan E., Clifasefi, Seema L.·2014·Prehospital Emergency Care
DOI 10.3109/10903127.2014.916020PMC PMC5102506
Open this paper in CoChat — free account

Abstract

OBJECTIVE: Chronically homeless adults with severe alcohol problems are disproportionately burdened with health-care problems and are high utilizers of emergency medical services (EMS). Single-site Housing First (HF), which provides immediate, permanent, low-barrier, nonabstinence-based, supportive housing, has been associated with reduced publicly funded service utilization. The aims of the current study were to determine whether time spent in single-site HF predicted decreases in EMS contacts 2 years subsequent to single-site HF move-in, and to describe medical conditions and injuries associated with EMS contacts in a sample of chronically homeless individuals with severe alcohol problems. METHODS: Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington. We obtained administrative data on exposure to HF and EMS utilization for the 2 years prior to and the 2 years subsequent to participants' move-in date. EMS utilization variables included patient type (i.e., primary presenting problem), trauma/injury mechanism (i.e., EMS classification of the cause of the trauma or injury), level of care (i.e., basic life support, advanced life support), and transport destination. RESULTS: After controlling for baseline EMS contacts, participants evinced 3% fewer EMS contacts for each additional month of single-site HF exposure. From the baseline to follow-up period, the mean number of EMS contacts declined from 15.85 (SD = 22.96) to 9.54 (SD = 15.08), representing a 54% reduction in the number of EMS contacts. Most calls were responded to by EMTs providing basic life support, and the majority resulted in transport to a local level I trauma center. The most common presenting difficulties were medical illness and trauma. Substance use and psychiatric difficulties were infrequently documented as the primary problem. CONCLUSIONS: Our findings support recent assertions that housing is health care and indicate that the amount of time spent in single-site HF is associated with significant reductions in EMS utilization for at least 2 years subsequent to move-in. These findings also underscore the high levels of medical illness and trauma exposure among chronically homeless adults with severe alcohol problems.

Integrity signals

Registry

Crossref · 10.3109/10903127.2014.916020

Cites

46 of 46 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    EMS contacts decreased significantly from baseline to follow-up (Z(N = 81) = 3.40, p < .001).

    “We conducted a Wilcoxon signed-rank test which indicated that EMS contacts decreased significantly from baseline to follow-up, Z(N = 81) = 3.40, p < .001”
    Quote in the paperSubstantial claim
  • Findingown data

    Twelve percent of the sample accounted for 50% of all EMS contacts during both the baseline and follow-up periods.

    “Twelve percent of the sample accounted for 50% of the total number of EMS contacts during both the baseline and follow-up periods.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Substance use and psychiatric symptoms were infrequently documented by EMS personnel as the primary difficulties.

    “Conversely, substance use and psychiatric symptoms were infrequently documented by EMS personnel as the primary difficulties (see Table 3).”
    • Also stated in: § Discussion · plain
      “On the other hand, substance abuse and psychiatric conditions were recorded relatively infrequently as the primary problem prompting contact with EMS.”
    Quote in the paperNot a substantial claim
  • Findingown data

    After controlling for baseline EMS contacts, each additional month of single-site HF exposure was associated with 3% fewer EMS contacts (IRR = 0.97, 95% CI 0.94, 0.99).

    “After controlling for baseline EMS contacts, single-site HF exposure was associated with 3% fewer EMS contacts for each additional month of single-site HF exposure (IRR = 0.97, 95% CI 0.94, 0.99).”
    Quote in the paperSubstantial claim
  • Findingown data

    The mean number of EMS contacts decreased from 15.9 (SD = 23.0) at baseline to 9.5 (SD = 15.1) at follow-up.

    “with the mean number of EMS contacts decreasing from 15.9 (SD = 23.0) to 9.5 (SD = 15.1), respectively.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 20
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants spent an average of 18.1 months (SD = 8.3) in single-site HF during the follow-up period.

    “Participants resided in single-site HF for an average of 18.1 months (SD = 8.3) during the follow-up period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of EMS contacts (61%) resulted in transport to a local level I trauma center that serves indigent populations.

    “Across time points, the majority of EMS contacts (61%) resulted in transport to a local level I trauma center that provides care to indigent populations (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The ZINB model was significant, χ2 (2, N = 81) = 41.2, p < .001, with Nagelkerke pseudo R2 = 0.47.

    “The ZINB model was significant, χ2 (2, N = 81) = 41.2, p < .001, Nagelkerke pseudo R2 = 0.47.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The study sample was 91 chronically homeless adults with severe alcohol problems who entered a single-site HF program in Seattle, Washington, between December 2005 and March 2007.

    “Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sample was 91 participants, 6.6% female, aged 26 to 75 years (M = 48.4, SD = 9.6).

    “Participants were 91 (6.6% female) chronically homeless adults with severe alcohol problems who ranged in age from 26 to 75 years (M = 48.4, SD = 9.6).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During the 2-year baseline period, 87% (79/91) of participants had documented EMS contacts, with a total of 1,576 EMS contacts.

    “During the 2-year baseline period, EMS contacts were documented for 87% (79/91) of participants and, overall, participants had a total of 1,576 EMS contacts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most EMS calls (75%) were responded to by emergency medical technicians providing basic life support, while 25% were responded to by paramedics providing advanced life support.

    “Across the baseline and follow-up periods, EMS dispatched emergency medical technicians to provide basic life support for most calls (75%), with far fewer (25%) paramedics dispatched to provide advanced life support (see Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The outcome variable was positively skewed, overdispersed, and zero-inflated.

    “The outcome variable was positively skewed, overdispersed, and zero-inflated.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    During the 2-year follow-up period, 86% (78/91) of participants had at least one EMS contact, and these participants had 852 EMS contacts in total.

    “During the 2-year follow-up period, 86% (78/91) of participants had at least one contact with EMS. These individuals amassed 852 EMS contacts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Falls (50%) and assault (23%) were the leading injury mechanisms both before (n = 320) and after (n = 199) single-site HF enrollment.

    “Concerning trauma, falls (50%) and assault (23%) were the leading mechanisms of injury both before (n = 320) and after (n = 199) single-site HF enrollment (Table 4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Homeless adults are among the most common repeat visitors to emergency departments.

    “Homeless adults are among the most common repeat visitors to EDs.15,20,21”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Kushel MB, 2002, Am J Public Health. source

      Not checked in the free run.

    • cites [20] Mandelberg JH, 2000, Acad Emerg Med. source

      Not checked in the free run.

    • cites [21] Moore G, 2011, Emerg Med.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Chronically homeless adults with severe alcohol problems have disproportionately many health problems and make heavy use of emergency medical services.

    “Chronically homeless adults with severe alcohol problems are disproportionately burdened with healthcare problems and are high utilizers of emergency medical services (EMS).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Baggett TP, 2010, Am J Public Health. source

      Not checked in the free run.

    • cites [25] Dunford JV, 2006, Ann Emerg Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The homeless population is disproportionately affected by alcohol-related injuries and medical conditions.

    “The homeless population is disproportionately affected by alcohol-related injuries and medical conditions, and more than 60% of homeless adults acknowledge a history of alcohol-related problems.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Alcohol dependence affects a mean of 38% of homeless adults, which is more than 10 times the prevalence in the U.S. general population.

    “A meta-analysis of studies conducted in the United States and worldwide showed that alcohol dependence affects a mean of 38% of homeless adults,7 which exceeds the prevalence in the U.S. general population by more than 10-fold.8”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Fazel S, 2008, PLOS Med. source

      Not checked in the free run.

    • cites [8] Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: summary of national findings. Rockville, MD: SAMHSA; 2012 Sept. Available at: www.samhsa.gov/ data/nsduh/2k11results/nsduhresults2011.htm

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Chronically homeless people with severe alcohol dependence have a high need for health care.

    “Given their high rates of medical and psychiatric comorbidity, chronically homeless people with severe alcohol dependence have a high need for health care.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Baggett TP, 2010, Am J Public Health. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More than 60% of homeless adults report a history of alcohol-related problems.

    “The homeless population is disproportionately affected by alcohol-related injuries and medical conditions, and more than 60% of homeless adults acknowledge a history of alcohol-related problems.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Time spent in HF is associated with reduced jail time and bookings.

    “and that time spent in HF is associated with reduced jail time and bookings.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Clifasefi SL, 2013, Int J Drug Policy. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The observed decrease in EMS use was not solely due to regression to the mean; actual time spent in single-site HF also significantly predicted reductions in EMS use.

    “This finding was not solely due to regression to the mean: actual time spent in single-site HF also significantly predicted reductions in EMS use.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The single-site Housing First model has been used for chronically homeless people with alcohol dependence and has received empirical support.

    “The single-site Housing First (HF) model has been used to address the needs of chronically homeless people with alcohol dependence and has garnered empirical support.27–31”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [27] Collins SE, 2012, Am J Public Health. source

      Not checked in the free run.

    • cites [28] Srebnik D, 2012, Am J Public Health. source

      Not checked in the free run.

    • cites [29] Larimer ME, 2009, JAMA. source

      Not checked in the free run.

    • cites [30] Collins SE, 2012, Int J Drug Policy. source

      Not checked in the free run.

    • cites [31] Clifasefi SL, 2013, Int J Drug Policy. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationcitation

    Alcohol use likely precipitated or contributed to a large proportion of the medical illness and traumatic injury documented in this study.

    “Although this study did not involve data directly addressing its role, alcohol use likely precipitated or contributed to a large proportion of the medical illness and traumatic injury documented in this study.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Ku BS, 2010, Public Health Rep. source

      Not checked in the free run.

    • cites [24] Pearson DA, 2007, Ann Emerg Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Housing may also be protective against victimization, thereby reducing traumatic injuries due to assault.

    “Housing may also be protective against victimization, which is endemic among homeless individuals, and thereby reduce traumatic injuries due to assault.46–48”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [46] Lam JA, 1999, Psychiatr Serv. source

      Not checked in the free run.

    • cites [47] Kushel MB, 2003, Arch Intern Med. source

      Not checked in the free run.

    • cites [48] Larney S, 2009, Aust N Z Public Health. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Alcohol dependence is linked to acute harms such as unintentional injuries and victimization, and to chronic medical conditions such as liver disease, cancer, and cardiovascular disease.

    “Alcohol dependence is associated with both acute harm (e.g., unintentional injuries, victimization) and chronic, alcohol-related medical conditions (e.g., liver disease, cancer, cardiovascular disease).1,2”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Eyrich-Garg KM, 2008, Soc Psychiatry Psychiatr Epidemiol. source

      Not checked in the free run.

    • cites [2] Podymow T, 2006, CMAJ. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Alcohol use is linked with injuries among people who use emergency medical services.

    “It has also been linked with injuries among individuals utilizing emergency medical (i.e., ambulance) services.3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Administrative data may include typographic errors or inaccurate information, such as spelling errors, data-entry errors, or missing EMS contacts.

    “First, data describing EMS contacts were obtained from local county records, and administrative data may include typographic errors or inaccurate information (e.g., spelling errors, errors introduced during electronic data entry, missing EMS contacts).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research has found that alcohol use is commonly associated with emergency department utilization among homeless populations.

    “That said, prior research has found that alcohol use is commonly associated with emergency department utilization among homeless populations.14,24”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Ku BS, 2010, Public Health Rep. source

      Not checked in the free run.

    • cites [24] Pearson DA, 2007, Ann Emerg Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Patient type and injury mechanism data were based on EMS personnel classifications made swiftly in the field, and diagnostic codes were not available, so these data may not reflect formal clinical diagnoses.

    “Patient type and mechanism of injury data points were based on EMS personnel classifications, which are made swiftly in the field. Further, diagnostic codes were not available. As a result, these data points may not reflect formal diagnoses made subsequently in clinical settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The findings may not extrapolate to communities that criminalize chronic public intoxication.

    “Thus, our findings may not extrapolate to communities whose approach criminalizes such behavior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings may not generalize to other subgroups of the homeless population, other geographical locations, or other types of housing.

    “As a result, these findings may not generalize to other subgroups of the larger homeless population, other geographical locations, or other types of housing (e.g., scattered-site HF, continuum-of-care housing).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Emergency Service Patrol utilization was not measured, and it is possible that this resource affected rates of EMS utilization.

    “Emergency Service Patrol utilization was not measured in the current study, and it is possible that this resource impacted rates of EMS utilization.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Homeless individuals have high rates of chronic psychiatric and medical conditions and elevated mortality rates.

    “Homeless individuals have high rates of chronic psychiatric and medical conditions7,9,10,42,43 and elevated rates of mortality.44”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [7] Fazel S, 2008, PLOS Med. source

      Not checked in the free run.

    • cites [9] Goldstein G, 2009, Psychiatr Q. source

      Not checked in the free run.

    • cites [10] Lundy JW, 1999, JAAPA.

      Not checked in the free run.

30 of 30

  • The paper relies on this without support.

    No studies to date have examined longer-term associations between single-site HF and EMS contacts.

    “Despite these promising initial findings, no studies to date have examined longer-term associations between single-site HF and EMS contacts.”

  • The paper relies on this without support.

    No studies have examined the types of injuries and illnesses that precipitate EMS contacts among chronically homeless individuals with severe alcohol problems.

    “Further, no studies have examined the types of injuries and illnesses that precipitate EMS contacts among chronically homeless individuals with severe alcohol problems.”

  • The paper relies on this without support.

    The circumstances surrounding homelessness complicate management of both acute and chronic conditions.

    “The circumstances surrounding homelessness complicate management of both acute and chronic conditions.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In chronically homeless adults with severe alcohol use problems, a significant decrease was found in EMS contacts (any reason) after HF entry, but changes in EMS use due to substance use were not reported.

    “A significant decrease was found in EMS contacts (any reason) after HF entry, but changes in EMS use due to substance use not reported”

    From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Mackelprang et al. (2014)

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(2) = 41.2reported p < .001 · recomputed p < .001

    “χ2 (2, N = 81) = 41.2, p < .001”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Lundy JW, 1999, JAAPA., 12, 32
  2. Moore G, 2011, Emerg Med., 28, 422
  3. Mackelprang JL, 2013, Int J Inj Contr Saf Promot., 1
  4. Lozier J, 2006, Homeless in Europe., 10
  5. O'Connell JJ. Premature mortality in homeless populations: a review of the literature. Nashville, TN: National Health Care for the Homeless Council, Inc.; 2005 Dec. Available at: santabarbarastreetmedicine.org/wordpress/wp-content/ uploads/2011/04/PrematureMortalityFinal.pdf

Cited by

Sorted by citations

Related

Authors
Mackelprang, J. L., Collins, S. E., & Clifasefi, S. L.
Affiliations
University of Washington (US)
Corresponding author
Mackelprang, Jessica L.
ORCID
Venue
Prehospital Emergency Care
Publisher
Informa UK Limited
Published
2014-05-30
Volume
18
Issue
4
Pages
476-482
ISSN
  • 1090-3127 (ISSN-L)
  • 1545-0066
DOI
10.3109/10903127.2014.916020
PMC
PMC5102506
OpenAlex
W2091995252
Semantic Scholar
729fdddd1271970c8a36c1dcd92003d0b98699a4
Cited by
77
References
46
Citations by year
2026: 3 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 13 · 2020: 9 · 2019: 8 · 2018: 8 · 2017: 5 · 2016: 7
FWCI
7.22
Type
journal article
Language
en
Open access
Locations
  • Prehospital Emergency Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Swinburne figshare (Swinburne University of Technology) (submittedVersion)
Funders
  • National Institutes of Health (T32‐HD057822, 2t32hd057822-16)
  • National Institute on Alcohol Abuse and Alcoholism (K22AA018384, K01AA021147)
  • National Institute of Child Health and Human Development (T32-HD057822)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32, HD057822)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
Housing First, chronic homelessness, emergency medical services utilization, supported housing, trauma (physical injury), disease, trauma center transport
MeSH terms
Adult, Aged, Emergency Medical Services, Female, Ill-Housed Persons, Humans, Male, Middle Aged, Public Housing, Time Factors, Washington, Alcohol-Related Disorders, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review