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Hospital Readmissions Among Patients Experiencing Homelessness: An Electronic Health Record Data Study
Somalee Banerjee1, Maher Yassin2, Wendy T Dyer2
1Kaiser Permanente Oakland, Oakland, CA, USA.
Insights
Patients experiencing homelessness have higher hospital readmission rates. Senate Bill 1152 improved tracking, revealing increased emergency department use and readmissions for this vulnerable population, highlighting needs for better healthcare support.
Area of Science:
- Health Services Research
- Public Health
- Healthcare Policy
Background:
- Tracking hospital use for patients experiencing homelessness in integrated care systems has been challenging.
- California's Senate Bill 1152 (2019) mandated enhanced documentation for homeless patients post-hospital discharge.
- This legislation created an opportunity to study hospital utilization patterns in this population.
Purpose of the Study:
- To evaluate hospital use patterns among patients experiencing homelessness.
- To compare readmission rates between homeless patients and the general population.
- To assess the impact of housing status on hospital readmissions.
Main Methods:
- Utilized data from a large integrated health system in California.
- Identified patients experiencing homelessness through Senate Bill 1152 documentation changes.
- Compared hospital use and readmission rates with a matched general population group.
Main Results:
- Patients experiencing homelessness showed significantly higher rates of hospital readmission post-discharge in 2019-2020.
- Any address change within the prior year correlated with increased odds of emergency department readmission.
- Both integrated delivery system-enrolled and non-enrolled homeless patients exhibited higher readmission rates than housed individuals.
Conclusions:
- Senate Bill 1152 documentation facilitates better study of hospital use among those with housing instability.
- Understanding these hospital use patterns is crucial for identifying intervention points for social and healthcare support.
- Improved data collection aids in addressing the healthcare needs of vulnerable homeless populations.
Background:
Population-level tracking of hospital use patterns with integrated care organizations in patients experiencing homelessness has been difficult. A California law implemented in 2019 (Senate Bill 1152) aimed to ensure safety for this population after discharge from the hospital by requiring additional documentation for patients experiencing homelessness, which provides an opportunity to evaluate hospital use by this population.
Methods:
In a large integrated health system in California, patients experiencing homelessness were identified through documentation change requirements associated with this law and compared with a matched group from the general population.
Results:
Patients experiencing homelessness had increased rates of hospital readmission after discharge compared to the general population matched on demographics and medical comorbidity in 2019 and 2020. Any address change in the prior year for patients was associated with increased odds of emergency department readmission. Patients experiencing homelessness, both enrolled in an integrated delivery system and not, were successfully identified as having higher readmission rates compared with their housed counterparts.
Conclusion:
Documentation of housing status following Senate Bill 1152 has enabled improved study of hospital use among those with housing instability. Understanding patterns of hospital use in this vulnerable group will help practitioners identify timely points of intervention for further social and health care support.
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