Nurse-Managed Health Clinic for Homeless Populations: A 3-Year Success Story
University of Houston's innovative nurse-led clinic demonstrates exceptional feasibility and patient satisfaction serving Houston's homeless and working poor communities.
Healthcare Innovation
Community Impact
Transforming Healthcare Access Through Nurse-Led Innovation
514
Patients Served
Unique individuals received care over three years
1372
Visits Completed
Total appointments successfully delivered
59%
Return Rate
Patients returning for multiple visits
4.71
Satisfaction Score
Out of 5.0 - exceptional patient satisfaction
Addressing Critical Healthcare Gaps
The Challenge
Homelessness in the U.S. reached record levels with 771,480 people experiencing homelessness in 2024—a 32.9% increase since 2020. This vulnerable population faces mortality rates up to 10 times higher than housed individuals, yet has significantly lower access to primary care.
- 82.3% had no primary care provider
- 60.5% lacked health insurance
- 73.5% experienced some degree of homelessness
- 53.6% were unemployed
The Solution
The UH College of Nursing Health Clinic (UHCON-HC) established a nurse-managed primary care model in midtown Houston, strategically located next to services serving 5,000+ homeless and working poor individuals weekly.
- Led by board-certified Nurse Practitioners
- Free medications and lab tests on-site
- Integrated dental and optometry services
- Patient-centered, flexible care model
Patient Demographics & Social Determinants
Demographics
- 70.8% male patients
- 57.2% African American
- 37.8% White
- Average age: 49 years
- 68.8% single
Education & Employment
- 60.2% high school or less
- 53.6% unemployed
- 22.9% unable to work
- 42% reported disability
- 9% veterans
Top Health Issues
- 36.8% hypertension
- 27.6% emotional problems
- 18.1% substance use
- 15.2% high cholesterol
- 14.9% diabetes
Three-Year Growth Trajectory
1
Year 1 (2021-2022)
181 visits completed with 94 new patients. Clinic operated 1 day per week. Established trust and community relationships. 67.5% completion rate for scheduled appointments.
2
Year 2 (2022-2023)
465 visits completed with 163 new patients. Expanded to 2 days per week. Added dental van and optometry services. 67.3% completion rate showing sustained engagement.
3
Year 3 (2023-2024)
726 visits completed with 257 new patients. Continued expansion of integrated services. 71.7% completion rate demonstrating improved retention and patient commitment.
Exceptional Patient Satisfaction Results
76%
Very Satisfied
Global satisfaction with overall care received
77%
Interpersonal Care
Highest ratings for staff interest and emotional support
75%
NP Care Quality
Satisfaction with Nurse Practitioner services
74%
Team Coordination
Communication between healthcare professionals
"Clinic was very helpful. Don't change a thing. Very friendly and respectful environment.""I received a lot more than I anticipated in terms of help and assistance."— Patient feedback from satisfaction surveys
Comprehensive Services Delivered
Primary Care Services
Acute and chronic condition management including hypertension, diabetes, obesity. Preventive visits, well-woman exams, immunizations, and specialist referrals as needed.
On-Site Resources
Free medications dispensed at clinic. Point-of-care laboratory testing including blood work, urinalysis, COVID-19, flu testing, and TB screening for early detection.
Integrated Specialties
Monthly dental van services and optometry screenings through university partnerships. Mental health services launched in 2025 with psychiatric nurse practitioner addition.
Key Success Factors
Strategic Partnerships
Collaboration between University of Houston, faith-based organizations, and community agencies serving homeless populations creates comprehensive support network.
Patient-Centered Design
Services brought directly to where patients already receive support, building on established trust. Flexible scheduling and no-cost care remove critical barriers.
Nurse-Led Excellence
Board-certified Nurse Practitioners provide comprehensive primary care. Staff vetted for experience with underserved populations ensure culturally competent, compassionate care.
Challenges & Future Directions
Current Challenges
Regulatory Barriers: Texas requires physician supervision for NPs, limiting autonomy and increasing operational costs compared to 27 states with full practice authority.
- Building trust takes significant time with vulnerable populations
- Patient transience creates retention challenges
- Limited to 2 days/week affects continuity of care
- Competitive healthcare market impacts staff retention
- Grant-dependent funding model faces sustainability pressures
Future Opportunities
- Expand mental health services with psychiatric NP
- Increase clinic hours for better continuity
- Develop innovative funding models
- Advocate for NP practice authority reform
- Conduct prospective efficacy studies
- Examine long-term health outcomes
- Replicate model in similar communities
Research Implications & Conclusions
Feasibility Confirmed
Nurse-managed clinics can successfully recruit and retain homeless and working poor patients with 59.1% return rate and 69.6% appointment completion ratio over three years.
High Acceptability
Patient satisfaction scores of 4.66-4.71 out of 5.0 demonstrate exceptional acceptance of nurse-led care model, independent of demographics or social determinants.
Scalability Potential
Model demonstrates viability for addressing primary care gaps and physician shortages. Academic-community partnerships essential for sustainability and expansion.
Study SignificanceThis comprehensive three-year evaluation provides crucial evidence supporting nurse-managed health clinics as a viable solution for increasing primary care access among vulnerable populations. The UHCON-HC model demonstrates that strategic partnerships, patient-centered design, and nurse-led care can overcome traditional barriers to healthcare access.Results indicate homeless-tailored NMHCs can achieve high patient recruitment, retention, and satisfaction—independently of patient demographics or social determinants of health. The holistic, relationship-based approach helps overcome stigma and distrust, increasing treatment adherence and healthcare effectiveness.
Citation: McIntyre, T.M.; Varghese, S.B.; Taylor, W.P. A Comprehensive Evaluation of Feasibility and Acceptability of a Nurse-Managed Health Clinic for Homeless and Working Poor Populations: A 3-Year Study. Nurs. Rep. 2025, 15, 412.
Funding: Humana, F.W. Bert and Mae Dean Wheeler Foundation; Hawkins Family Foundation
Published: November 21, 2025
Open Access