Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK.
Pathway, 250 Euston Road, London, NW1 2PG, UK.
BMC Health Serv Res. 2019 Nov 21;19(1):857. doi: 10.1186/s12913-019-4620-1.
UK "Pathway" teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet "homelessness" is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless.
Retrospective analysis of patients referred to "Pathway" homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected.
A total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission.
Disengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.
英国的“Pathway”团队为无家可归者提供专业的医院护理协调。无家可归者在紧急医疗保健方面的使用率很高，但国民保健制度（NHS）数据中并未对“无家可归”进行常规编码。Pathway 团队的记录提供了一个机会，可以评估被认定为无家可归者的住院患者的入院和出院模式。
对英国七家医院的“Pathway”无家可归者团队转介的患者进行回顾性分析，以探讨住院、发病、二级医疗保健利用和住房状况的入院模式。每位患者均被单独认定为无家可归者。在六个月的时间内，收集了每位患者在入院前 120 天和入院后 120 天的人口统计学数据、入院原因、发病情况、死亡率和二级保健医院使用情况。
共转介了 1009 名患者，导致 1135 人次入院。大多数入院的原因是急性身体健康问题（94.9%）。合并的精神疾病和/或药物滥用较为常见（55.7%）。入院原因包括精神和行为障碍（药物过量、酒精戒断或抑郁，28.3%）、发病和死亡率的外部原因（袭击或创伤，18.7%）以及损伤、中毒和外部原因（头部损伤、跌倒和骨折，12.4%）。入院后，非计划性急诊就诊次数减少，非计划性入院次数略有增加。计划入院次数增加了一倍，总住院天数增加。出院时，超过 60%的住院患者的住房状况得到维持或改善。在入院后 12 个月内，有 50 名患者（5%）死亡，15 名死亡患者（30%）发生在入院期间。
无家可归者普遍与卫生服务脱节。许多死亡是由于可治疗的疾病（心脏病、肺炎、癌症）造成的。观察到计划入院人数的增加表明，Pathway 团队的干预措施促进了无家可归者的必要调查和治疗。公平、同等护理和价值应该成为纳入健康群体的干预措施，评估需要超越单纯寻求成本降低。
