Linking HMIS With Mainstream Healthcare Databases

1
Linking HMIS With Mainstream Healthcare Databases

• Evan Scully, Homeward
• Michael Shank, Virginia DMHMRSAS

2
Greater Richmond Continuum of Care
Planning District 15 Independent City of Richmond
and counties of Charles City, Chesterfield,
Goochland, Hanover, Henrico, New Kent, and
Powhatan

• Population 1 million 84 urban, 16 rural
• 1,158 people found homeless January 25th,
• 149 found unsheltered

3
Commonwealth of Virginia

• Richmond Population 200,000 million, 100
  urban

• Factors in Virginia
• Little government funding for housing issues
• Independent cities isolate urban issues from
  surrounding counties
• Medicaid wont cover primary diagnosis of
  Substance Abuse

4
Homeward

• Richmonds Regional Response to Homelessness
• Non-profit founded in 1998 following the report
  of a city Task Force on Homelessness
• Original funding included HHS ACCESS
  demonstration grant
• Small planning and coordinating agency - no
  direct services
• Diverse board
• Manages the HMIS
• Coordinates the annual Point In Time count
• Convenes Continuum of Care committee and
  generates COC application

5
Early Findings

• Comparable to cities of similar size
• Most persons who are homeless in Greater Richmond
  have lived in the area for ten years or more.
• Under 1 year (21), 1-10 years (28), 11-20 years
  (11),
• 21-30 years (9), Over 30 years (31)
• A high proportion of homeless adults, especially
  single men, have at least one felony conviction.
• All persons (37), Adults in families (12),
  Single adults (41),
• Single Men (48), Single women (17)
• Local governments need local data!
• (National statistics dont vote)

6
Homeward Community Information System (HCIS) -
Gender
7
Homeward Community Information System (HCIS) -
Race
8
Linking HMIS With Mainstream Healthcare Databases

• Homeward Community Information System (HMIS)
• HMIS identifies 7,649 Richmond-area individuals
  enrolled in homeless services
• 9,218 records less 1,439 missing or invalid SSNs
  less 130 duplicate entries (from 1/1/2003 through
  6/30/2006)
• Records the date of enrollment as documentation
  of an episode of homelessness
• Virginia Health Information (VHI) Database
• VHI identifies 231,275 Richmond-area individuals
  in inpatient hospital care (from 1/1/2001 through
  3/31/2006)
• Includes 21,115 people in inpatient psychiatric
  care

9
Non-HMIS Hospital Stays Patients Bed Days
10
HMIS Hospital Stays Patients Bed Days
11
Overlap found between HMIS and VHIDatabases
Local Hospital
PD 15 Homeless Services
2,540
231,275
7,649
20 of General Population In PD15
33 Of Homeless Population
12
Length of Hospital Stay (LOS)
Avg. Bed Days Used Over 5 year period Statewide
10.0 PD 15 Non-HMIS 11.7 HMIS 21.0
13
Non-HMIS Hospital Use by Major Diagnostic Category
14
HMIS Hospital Use by Major Diagnostic Category
15
HMIS Hospital Use Pre- and Post- HMIS Entry
16
Linking HMIS With Mainstream Healthcare Databases

• Homeward Community Information System (HMIS)
• HMIS identifies 7,649 people enrolled in homeless
  services
• Virginia Health Information (VHI) Database
• VHI identifies 231,275 people in inpatient
  hospital care
• Includes 21,115 people in inpatient psychiatric
  care
• Community Services Boards (CSB) Database (CCS)
• CCS identifies 33,507 people enrolled
  Richmond-Area Behavioral Healthcare
• Consumers of Mental Health and Substance Abuse
  services

17
Overlap found between HMIS, CSB and VHIDatabases
PD 15 CSB Services
Local Psych Hospital
7,300
21,115
33,507
660
1,479
1,123
PD 15 Homeless Services
CSB Consumers with Local Psych Hospital Non-HMIS
22.8 HMIS 44.6
7,649
18
HMIS by MDC Pre- and Post- HMIS Entry
19
PD15 Hospital Cost - 4 Quarters Surrounding HMIS
EntryMental Health and Co-occurring Illnesses
(n208)
20
PD15 Hospital Cost - 4 Quarters Surrounding HMIS
Entry Mental Health and Substance Abuse, or
Mental Health and Respiratory Illness,
or Mental Health and Trauma and Infections
21
PD15 Hospital Cost 4 Quarters Surrounding HMIS
EntryRevolving Door Psychiatric Admissions
22
DMH Funding for Housing First
  February 8, 2007     George Braunstein Executive
Director Chesterfield CSB PO Box
92 Chesterfield, VA 23832     Dear Mr.
Braunstein     We are pleased to announce that
the DMHMRSAS will support the Region IV Housing
First project, A Place to Start, with a 50,000
challenge grant that was matched through private
fundraising efforts and with an additional one
time grant of 400,000 to support that programs
start up costs. These funds are provided through
Virginias Federal Mental Health Block Grant
(MHBG).