Use of health care utilization as a metric of intervention success may perpetuate racial disparities: An outcome evaluation of a homeless transitional care program.

Journal Article (Journal Article)


This study explored race-based differences in disease burden, health care utilization, and mortality for Black and White persons experiencing homelessness (PEH) who were referred to a transitional care program, and health care utilization and program outcomes for program participants.


This was a quantitative program evaluation.


Black and White PEH referred to a transitional care program (n = 450). We also analyzed data from the subgroup of program participants (N = 122). Of the 450 referrals, 122 participants enrolled in the program.


We included chronic disease burden, mental illness, substance use, health care utilization, and mortality rates for all PEH referred. For program participants, we added 6-month pre/post health care utilization and program outcomes. All results were dichotomized by race.


Black PEH who were referred to the program had higher rates of hypertension, diabetes, renal failure, and HIV and similar post-referral mortality rates compared to White PEH. Black and White PEH exhibited similar program outcomes; however, Black PEH revisited the emergency department (ED) less frequently than White PEH at 30 and 90 days after participating in the program.


Health care utilization may be a misleading indicator of medical complexity and morbidity among Black PEH. Interventions that rely on health care utilization as an outcome measure may unintentionally contribute to racial disparities.

Full Text

Duke Authors

Cited Authors

  • Nohria, R; Biederman, DJ; Sloane, R; Thibault, A

Published Date

  • November 2022

Published In

Volume / Issue

  • 39 / 6

Start / End Page

  • 1271 - 1279

PubMed ID

  • 35899908

Pubmed Central ID

  • PMC9796003

Electronic International Standard Serial Number (EISSN)

  • 1525-1446

International Standard Serial Number (ISSN)

  • 0737-1209

Digital Object Identifier (DOI)

  • 10.1111/phn.13121


  • eng