Hospital Readmission and Emergency Department Revisits of Homeless Patients Treated at Homeless-Serving Hospitals in the
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Department of Public Health, Graduate School of Medicine, The University of TokyoTokyo, Japan; 2Health Services Research Development Center, University of TsukubaTsukuba, Ibaraki, Japan; 3Department of Emergency Medicine, Massachusetts General HospitalBoston, MA, USA; 4 Harvard Medical SchoolBoston, MA, USA; 5Department of Health Policy and Management, Harvard T.H. Chan School of Public HealthBoston, MA, USA; 6Department of Medicine, Brigham and Women’s HospitalBoston, MA, USA; 7Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine Los Angeles, CA, USA; 8Department of Health Policy and Management, UCLA Fielding School of Public HealthLos Angeles, CA, USA.
BACKGROUND: As the U.S. homeless population grows, so has the challenge of providing effective care to homeless individuals. Understanding hospitals that achieve better outcomes after hospital discharge for homeless patients has important implications for making our health system more sustainable and equitable. OBJECTIVE: To determine whether homeless patients experience higher rates of readmissions and emergency department (ED) visits after hospital discharge than nonhomeless patients, and whether the homeless patients exhibit lower rates of readmissions and ED visits after hospital discharge when they were admitted to hospitals experienced with the treatment of the homeless patients (“homeless-serving” hospitals—defined as hospitals in the top decile of the proportion of homeless patients). DESIGN: A population-based longitudinal study, using the data including all hospital admissions and ED visits in FL, MA, MD, and NY in 2014. PARTICIPANTS: Participants were 3,527,383 patients (median age [IQR]: 63 [49–77] years; 1,876,466 [53%] women; 134,755 [4%] homeless patients) discharged from 474 hospitals. MAIN MEASURES: Risk-adjusted rates of 30-day allcause readmissions and ED visits after hospital discharge. KEY RESULTS: After adjusting for potential confounders, homeless patients had higher rates of readmissions (adjusted rate, 27.3% vs. 17.5%; adjusted odds ratio [aOR], 1.93; 95% CI, 1.69–2.21; p < 0.001) and ED visits after hospital discharge (37.1% vs. 23.6%; aOR, 1.98; 95% CI, 1.74–2.25; p < 0.001) compared with non-homeless patients. Homeless patients treated at homeless-serving hospitals exhibited lower rates of readmissions (23.9% vs. 33.4%; p < 0.001) and ED visits (31.4% vs. 45.4%; p < 0.001) after hospital discharge than homeless patients treated at non-homeless-serving hospitals.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06029-0) contains supplementary material, which is available to authorized users. Received October 17, 2019 Accepted June 30, 2020
CONCLUSIONS: Homeless patients were more likely to be readmitted or return to ED within 30 days after hospital discharge, especially when they were treated at hospitals that treat a small proportion of homeless patients. These findings suggest that homeless patients may receive better discharge
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