Formative Assessment and Cluster Membership of Homeless Persons' Emergency Department Visits

Background Evidence is limited on whether homeless individuals who visit emergency departments (EDs) share similar clinical characteristics as individuals from private households who, upon examination, require emergency health services beyond preventative healthcare. While the literature is rich with studies on homeless persons in the ED, a comprehensive assessment of similarities and differences with other social groups is lacking. Consequently, there is a gap in knowledge as it pertains to the appropriate approaches that will further support the development of targeted healthcare and emergency health services for the homeless person. Aim The goal is to provide a framework for targeted interventions that hospitals can develop based on behavioral, health, and social characteristics and, in the process, better meet the healthcare needs of homeless patients. Methods Data were collected from the records of 85,350 patients in the National Hospital Ambulatory Medical Care Survey (NHAMCS) database who visited the ED between the years of 2013 and 2016; each patient was classified as having either a private residence, living in a nursing home, or homeless (n = 83,446, n = 1,459, and n = 925, respectively). Results Cluster analysis of the data confirmed that individuals with multiple comorbidities, as well as substance abuse or dependency, regardless of residence type, were more likely to have recurrent ED visits within 72 hours. Nominal regression analyses revealed that cluster membership generated from ED data could predict patient residence and suggest that substance abuse and depression can predict 72-hour ED visit recurrence. Conclusion Cluster analyses have the potential to reveal social health and group characteristics and can support targeted solutions respective to group individualities in the ED.