Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Melbourne, Victoria, Australia.
Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia.
Emerg Med Australas. 2019 Aug;31(4):639-645. doi: 10.1111/1742-6723.13256. Epub 2019 Mar 28.
This study compared the prevalence of homelessness in consecutive patients presenting to a metropolitan hospital ED measured via a prospective housing screen with the prevalence of homelessness determined via retrospective audit of hospital data. Factors that altered the odds of patients being homeless and service outcomes that differed were examined for screened patients.
All patients presenting to the ED during a 7 day period in 2017 were invited to complete a housing screen. A retrospective audit of all ED presentations during the same period also occurred. Demographic (e.g. age, gender), clinical (e.g. reason for presentation, ED presentation history) and arrival mode (e.g. time, how arrived) predictors of homeless status were examined alongside care outcomes (e.g. ED length of stay, admission and 28 day re-presentation).
Of 1208 presenting patients, 504 were prospectively screened and 7.9% were homeless. This compared with 0.8% of ED presentations coded as homeless in the Victorian Emergency Minimum Dataset and 2.3% of the 704 non-screened patients identified as homeless using Victorian Emergency Minimum Dataset Usual Accommodation alongside primary diagnosis and registration address. Within the screened sample, homeless patients were more likely to be male, arrive by emergency ambulance/with police, have a psychosocial diagnosis, and be frequent presenters. Re-presentation within 28 days occurred for 43% of homeless and 15% of not-homeless patients.
Hospital ED administrative data substantially under-recognises the prevalence of homelessness in presenting patients. Standardised use of brief housing screens could improve identification of and provision of support to this often highly vulnerable population.
本研究通过前瞻性住房筛查，比较连续就诊于大都市医院急诊部的患者中无家可归者的患病率，并与通过回顾性审核医院数据确定的无家可归者患病率进行比较。对筛查患者进行了改变患者无家可归几率的因素和不同服务结果的检查。
在 2017 年的 7 天内，邀请所有就诊于急诊部的患者完成住房筛查。同期还对所有急诊部就诊进行了回顾性审核。对无家可归状态的人口统计学（如年龄、性别）、临床（如就诊原因、急诊就诊史）和到达方式（如时间、如何到达）预测因素以及护理结果（如急诊部停留时间、入院和 28 天再次就诊）进行了检查。
在 1208 名就诊患者中，有 504 名患者接受了前瞻性筛查，其中 7.9%的患者无家可归。相比之下，维多利亚州急诊最低数据集编码为无家可归的 ED 就诊率为 0.8%，而在未接受筛查的 704 名患者中，根据维多利亚州急诊最低数据集常规住宿情况以及主要诊断和登记地址，有 2.3%的患者被认定为无家可归。在筛查样本中，无家可归的患者更有可能是男性，乘坐紧急救护车/警察到达，有精神社会诊断，且经常就诊。在 28 天内再次就诊的患者中，无家可归者占 43%，而非无家可归者占 15%。
医院急诊部行政数据大大低估了就诊患者中无家可归者的患病率。标准化使用简短住房筛查可以改善对这一高度脆弱人群的识别和支持。
