Szymkowiak Dorota, Montgomery Ann Elizabeth, Johnson Erin E, Manning Todd, O'Toole Thomas P
*National Center for Homelessness Among Veterans, Philadelphia, PA †National Center for Homelessness Among Veterans, University of Alabama at Birmingham School of Public Health, Birmingham, AL ‡Providence VA Medical Center, Providence, RI §VHA Support Service Center, Johnson City, TN ∥National Center for Homelessness among Veterans, Providence VA Medical Center, Providence, RI.
Med Care. 2017 Oct;55(10):893-900. doi: 10.1097/MLR.0000000000000796.
Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood.
The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services.
We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans' diagnoses and acute care utilization.
Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity.
Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.
急性医疗服务的利用情况在无家可归者中经常出现。然而，对于哪些人会成为急性护理的持续超级利用者，我们了解得还比较少。
本研究的目的是确定那些更有可能成为急性护理服务持续超级利用者的人。
我们对退伍军人健康管理局企业数据仓库、无家可归者运营管理与评估系统的二手数据进行了潜在类别分析。研究样本包括16912名在2014年7月1日至2015年12月31日期间的任何一个季度中经历过无家可归且符合超级利用者标准的退伍军人。潜在类别分析包括退伍军人的诊断和急性护理利用情况。
医疗、心理健康和物质使用的发病率很高。超过一半的样本在超级利用急性护理服务的同时还利用了退伍军人健康管理局的无家可归者项目。有7个超级利用者亚组，它们在超级利用随时间持续的程度上有很大差异。大约三分之一的样本在≥3个季度中符合超级利用者标准；这一组年龄较大，男性、非西班牙裔白人、未婚的比例过高，9·11后服役率较低，农村居住率和与服役相关的残疾率较高。他们目前更有可能无家可归，患有更多的医疗、心理健康和物质使用疾病。
只有一部分无家可归的退伍军人是持续超级利用者，这表明需要更有针对性的干预措施。
