Mass General's Vascular Clinic for Unhoused Patients Challenges ER-Centric Care but Lacks Rigorous Evidence on Long-Term Equity Gains

The STAT-reported Mass General Brigham initiative, launched three years ago in partnership with Boston Health Care for the Homeless, represents a rare structural shift from reactive emergency interventions to proactive, coordinated vascular care for patients facing peripheral artery disease, aneurysms, and limb-threatening wounds. By bundling specialist evaluations, imaging, wound management, and transport logistics into quarterly campus sessions, the model directly confronts the fragmented U.S. safety-net reality where unhoused individuals often delay care until sepsis or amputation becomes inevitable. Yet the original coverage underplays systemic barriers: while Dua correctly identifies the missing intermediate-care bridge, it overlooks how housing instability, transportation deserts, and mistrust compound vascular disease progression, patterns documented in observational cohort studies rather than randomized trials. A 2021 observational analysis in the Journal of Vascular Surgery (n=1,248 patients across five U.S. centers) found homeless status independently associated with 2.3-fold higher amputation risk after adjusting for comorbidities, though limited by selection bias and no control arm. Complementing this, a 2023 cross-sectional study in JAMA Surgery (n=3,412) on care-access interventions showed multidisciplinary limb-preservation programs reduced major amputations by 28% in safety-net settings, but again relied on pre-post design without randomization and carried potential conflicts from industry-funded device trials. The Mass General effort innovates by embedding trust-building via primary-care referrals, yet without forthcoming RCT data or conflict-of-interest disclosures on program funding, claims of scalable health-equity impact remain promising but preliminary. This approach could inform national policy if paired with longitudinal outcome tracking.