What do we know about wound care models outside of traditional hospital or office constructs for patients experiencing homelessness? One review took a closer look at several studies looking at innovative programs, including mobile options.¹ 

Design and Population 

This review article combined¹:  

• a targeted narrative review of 11 studies describing community-based wound care and harm-reduction programs worldwide; and  
• a mixed-methods program evaluation of a community-based wound care clinic for unhoused individuals in Honolulu, Hawai‘i (CHOW Project). Surveys were conducted among 116 clients (primarily unhoused individuals who inject drugs) and local healthcare providers from 2016–2017. 

The review included diverse community models: syringe-service and harm-reduction programs (Baltimore, Dhaka, Malmö, Miami, Tacoma), primary-care or nursing outreach (San Antonio, Melbourne), and recuperative or housing-linked programs (Seattle, Baltimore). 

Key Outcomes 

From the Literature Review¹: 

• Program success factors: 
  • Integration of wound care within broader social or harm-reduction programs 
  • Cost-effectiveness, with community models costing $5–$147 per client, versus nearly $5,000 per clinic-based patient 
  • Comprehensive services: drop-in access, syringe exchange, disease screening, mental health and housing assistance, and interdisciplinary teams 
• Representative models: 
  • Baltimore Needle Exchange Program (BNEP): Mobile wound clinic with assessment, debridement, and compression therapy 
  • Dhaka NSEP (Bangladesh): Combined syringe exchange, abscess management, and HIV prevention 
  • Cohealth (Melbourne): Drop-in podiatry for homeless clients, preventing escalation of minor wounds 
  • JustHealth Recuperative Care (Seattle): Motel respite care post-hospital discharge, reducing readmissions; cost $157/day vs $18,000–$48,000 in acute care 
• Lessons learned: Challenges included space limitations, poor follow-up due to lack of phones, and impracticality of certain inpatient-style treatments in street settings. Programs emphasized verbal outreach over printed materials and the need for mental-health integration. 

Honolulu CHOW Program Findings (2016–2017) 

• Demographics: 66% male; mean age 43 years; 66% unhoused; all injected drugs (opioids 66%, methamphetamine 33%) 
• Wound types: Abscess 26%, skin/soft-tissue infection 25%, venous ulcer 19% 
• Service usage: Clients averaged ≥2 visits; 96% requested help with wound cleaning 
• Barriers: Stigma, long ED wait times, lack of supplies, unstable housing 
• Provider survey (n = 4): Reported 6–15 wound cases/week; identified housing instability and supply access as key obstacles 
• Cost analysis: Seven-month operation cost ≈ $3,491 for 116 clients (~ $33 per patient, $15 per visit). Estimated ED cost per comparable visit: $1,613
• Sustainability issues: No insurance reimbursement for street-based care; limited ability to track wound closure or ED utilization reductions

Clinical Relevance 

The findings of this review suggest that community-based wound care could reduce emergency utilization, lower costs, and improve engagement among people experiencing homelessness or substance use disorder. Drop-in, mobile, or colocated services can foster trust and accessibility. Integration of housing, case management, and mental health support can also improve continuity of care.¹ 

The review authors share that programs using nursing-led, evidence-based, patient-centered care show measurable wound improvement and low recurrence. Education on wound hygiene and self-care enhanced adherence, they noted. However, maintaining supply chains, data systems, and reimbursement pathways remains a barrier to scalability.¹ 

Limitations and Next Steps 

The Hawai‘i survey reflects one site and limited follow-up; outcomes such as healing time or ED avoidance were not quantifiable. The review authors noted that further interventional or comparative studies are needed to define standardized protocols, sustainability models, and long-term cost metrics across urban and rural settings. 

In Summary  
Per this review in the Journal of Epidemiology and Global Health, community-based wound care models—especially when integrated with harm-reduction and housing support—offer low-cost, accessible, and trusted care for unhoused populations, though sustainability and follow-up continuity remain key challenges. 

Reference 

1. Goto T, Wang C, Kwiat C. et al. Community-Based Wound Care Programs for Unhoused Individuals. J Epidemiol Glob Health 13, 604–614 (2023). https://doi.org/10.1007/s44197-023-00157-6