Abstract: Evaluating the Access and Impact of Field Medicine Programs In Los Angeles County (Society for Social Work and Research 31st Annual Conference)

Schedule:

Saturday, January 23, 2027

Union Station 3 & 4 (Hilton San Francisco Union Square)

* noted as presenting author

Randall Kuhn, PhD, Professor, University of California, Los Angeles, CA

Jessie Chien, PhD, Researcher, University of California, Los Angeles

Irene Del Mastro, MA, PhD Student, University of California, Los Angeles

Sonali Saluja, MD, Medical Director of Care Management, Healthcare In Action

Amanda Gonzalez, PhD, Statistician, University of Southern California

Geoffrey Cui, MA, PhD Student, University of Southern California, Los Angeles, CA

Gisele Corletto, MSW, Project Specialist, University of Southern California, Los Angeles, CA

Sara Ozuna, MA, Research Project Specialist, University of Southern California, 90015, CA

Brian Zunner-Keating, MS, RN, Director, University of California, Los Angeles

Catherine Weaver, MD, Medical Director, University of California, Los Angeles

Coley King, DO, Director of Homeless Services, Venice Family Clinic

Charles Robinson, MBA, Chief Health Equity Officer, L.A. Care Health Plan

Benjamin Henwood, PhD, Professor, University of Southern California, Los Angeles, CA

Background

People experiencing homelessness (PEH) experience higher mortality and morbidity compared to the general population. Prior studies have linked homelessness to shortened life expectancy, higher rates of physical and mental illness, and disproportionate prevalence of substance use disorders. Despite higher demand for primary care, PEH still faces competing needs and access barriers. Building on existing street medicine approaches that deliver health care directly to places where PEH live, field medicine incorporates a wider range of intervention sites, including shelters, mobile clinics, and pop-up clinics. In California, Medicaid waiver programs allow health plans to deliver covered services through a field medicine provider. However, the effectiveness of field medicine programs in reaching the most vulnerable population remains largely unknown. Guided by the Gelberg-Anderson Behavioral Model for Vulnerable Populations, the current evaluation examines the following research questions through a mixed-methods approach: 1) How do field medicine patients differ from PEH who do not utilize field medicine? 2) How do PEH utilize and perceive field medicine services? And 3) whether field medicine utilization is associated with improvement in service access, health, and trust in the healthcare system.

Method

The current study leverages the existing respondents from the Periodic Assessment of Trajectories of Housing, Homelessness, and Health Study (PATHS), an ongoing longitudinal survey study of PEH in Los Angeles County. Our quantitative analytic sample consists of 833 cohort participants who are not enrolled in field medicine and 436 participants enrolled in field medicine. Monthly surveys and biannual follow-ups assess predisposing, enabling, and need factors laid out in the Gelberg-Anderson Model, along with field medicine exposure, healthcare utilization, provider engagement, health status, and access to basic, medical, social, and housing-related services. The qualitative portion includes semi-structured interviews with providers, field medicine patients, and unhoused non-patients. Qualitative and quantitative findings will be integrated to identify convergence, complementarity, and explanatory insights.

Preliminary Results

Preliminary findings suggest that field medicine programs have achieved geographic alignment with unsheltered PEH across Los Angeles County. Quantitative analysis indicates that, after controlling for covariates, PEH with higher trust in healthcare providers and lower health activation are more likely to access field medicine. In terms of health needs, patients with diagnoses of physical and mental health conditions have higher odds of utilizing field medicine. Being on a housing waitlist and past-month displacement also significantly predict cohort membership. Qualitative evidence suggests program-level and logistical barriers may constrain the accessibility of field medicine despite broad geographical coverage. Field Medicine patients also appear to have diverse and intensive health needs, for which chronic conditions and behavioral health issues may benefit from low-barrier, ongoing care delivery from field medicine.

Conclusion

The current study represents one of the first mixed-methods evaluations of field medicine programs within a major metropolitan area. By combining a large-sample longitudinal survey with an in-depth qualitative investigation, this evaluation is positioned to generate evidence on how field medicine providers can improve engagement, access, and population health among PEH. Findings can inform cross-institution coordination and policy decisions in Los Angeles County and other urban areas.