Introduction: The Maine Medical Center Preble Street Learning Collaborative (PSLC) aims to couple medical education with addressing the unmet healthcare needs of those experiencing homelessness in Portland, Maine. The PSLC provides low-barrier medical, psychiatric, dental, and case management services to all-comers and is co-located near many of the city’s social services. The purpose of this study was to evaluate the impact of the PSLC in its first 19 months by describing demographic characteristics and patterns in hospital utilization of patients served by the PSLC.

Methods: We performed a retrospective chart review of 888 patients with one or more PSLC encounters between January 2017 and July 2018. We collected data from electronic health records and included one full year before and after each patient’s first PSLC encounter. We stratified patients based upon number of ED visits in the year prior to first PSLC encounter. Non-utilizers (N=392) made zero visits, low-utilizers (N=356) made 1-3 visits, high-utilizers (N=116) made 4-9 visits, and very-high-utilizers (N=made 10 or more visits.

Results: Pre- to post-PSLC engagement, we demonstrate significant increases in yearly mean number of ED visits (0 to 0.96, PPPP=.005) and very-high-utilizers (15.0 to 5.92, P<.001).

Conclusions: These results illustrate that engagement with the PSLC was associated with decreased ED visits by high- and very-high-utilizers and increased visits by previous non-utilizers. For high-utilizers experiencing homelessness, health systems may reduce rates of ED utilization by providing low-barrier access to complex care coordination in clinics specifically focused on serving this population.